Kathryn E Lancaster1, Hannah L F Cooper2, Christopher R Browning3, Carlos D Malvestutto4, John F P Bridges5, April M Young6,7. 1. Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA. 2. Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA. 3. Department of Sociology, The Ohio State University, Columbus, Ohio, USA. 4. Division of Infectious Diseases, The Ohio State University Medical Center, Columbus, Ohio, USA. 5. Departments of Biomedical Informatics and Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, USA. 6. Department of Epidemiology, University of Kentucky, Lexington, Kentucky, USA. 7. Center on Drug and Alcohol Research, University of Kentucky, Lexington, Kentucky, USA.
Abstract
Background People who inject drugs (PWID) in rural areas of the United States have had limited access to syringe service programs (SSP). Rural SSP have recently surged, but accompanying research is lacking about PWID utilization, barriers, and preferences for SSP design and how those preferences vary by gender. Methods: Interviewer-administered surveys elicited information about utilization, barriers, and preferences for SSP design from 234 PWID recruited using respondent-driven sampling in Appalachian, Kentucky. Gender differences among reported barriers to utilizing SSP and preferences for program design were explored using Mantel-Haenszel chi-square tests. Results: Overall, 49% of PWID had ever utilized an SSP. The most common reasons for not utilizing an SSP were lack of awareness (23%), fear of being seen or disclosing drug use (19%), and lack of need (19%). The most preferred SSP design was located within a health department (74%) and operating during afternoon hours (66%). Men were more likely than women to prefer SSP in health departments (80% vs. 65%, p = 0.01), while more women than men preferred staffing by health department personnel (62% vs. 46%, p = 0.02). Women were less likely to favor evening hours (55% vs. 70%, p = 0.02). Fewer women wanted SSP nurses (78% vs. 90%, p = 0.01), social workers (11% vs. 24%, p = 0.01), or people who use drugs (20% vs 34%, p = 0.02) to staff SSP. Conclusions: Despite recent scale-up, SSP in Appalachia remain under-utilized. PWID were open to a range of options for SSP design and staffing, though there were variations by gender. Implementation research that identifies best strategies for tailored SSP scale-up in rural settings should be considered.
Background People who inject drugs (PWID) in rural areas of the United States have had limited access to syringe service programs (SSP). Rural SSP have recently surged, but accompanying research is lacking about PWID utilization, barriers, and preferences for SSP design and how those preferences vary by gender. Methods: Interviewer-administered surveys elicited information about utilization, barriers, and preferences for SSP design from 234 PWID recruited using respondent-driven sampling in Appalachian, Kentucky. Gender differences among reported barriers to utilizing SSP and preferences for program design were explored using Mantel-Haenszel chi-square tests. Results: Overall, 49% of PWID had ever utilized an SSP. The most common reasons for not utilizing an SSP were lack of awareness (23%), fear of being seen or disclosing drug use (19%), and lack of need (19%). The most preferred SSP design was located within a health department (74%) and operating during afternoon hours (66%). Men were more likely than women to prefer SSP in health departments (80% vs. 65%, p = 0.01), while more women than men preferred staffing by health department personnel (62% vs. 46%, p = 0.02). Women were less likely to favor evening hours (55% vs. 70%, p = 0.02). Fewer women wanted SSP nurses (78% vs. 90%, p = 0.01), social workers (11% vs. 24%, p = 0.01), or people who use drugs (20% vs 34%, p = 0.02) to staff SSP. Conclusions: Despite recent scale-up, SSP in Appalachia remain under-utilized. PWID were open to a range of options for SSP design and staffing, though there were variations by gender. Implementation research that identifies best strategies for tailored SSP scale-up in rural settings should be considered.
Entities:
Keywords:
Appalachia; Needle exchange programs; gender; harm reduction; people who inject drugs; rural
Authors: Don C Des Jarlais; Ann Nugent; Alisa Solberg; Jonathan Feelemyer; Jonathan Mermin; Deborah Holtzman Journal: MMWR Morb Mortal Wkly Rep Date: 2015-12-11 Impact factor: 17.586
Authors: Karla D Wagner; Stephen E Lankenau; Lawrence A Palinkas; Jean L Richardson; Chih-Ping Chou; Jennifer B Unger Journal: Psychol Health Med Date: 2010-10 Impact factor: 2.423
Authors: Angela T Hetrick; April M Young; Miriam R Elman; Sarann Bielavitz; Rhonda L Alexander; Morgan Brown; Elizabeth Needham Waddell; P Todd Korthuis; Kathryn E Lancaster Journal: Trials Date: 2021-12-20 Impact factor: 2.279