Mary C Figgatt1,2, Zach R Salazar3, Louise Vincent3, Diannee Carden-Glenn4, Kelly Link5, Lauren Kestner6, Tyler Yates7, Asher Schranz8, Elizabeth Joniak-Grant9, Nabarun Dasgupta10. 1. Injury Prevention Research Center, University of North Carolina At Chapel Hill, 725 Martin Luther King Jr. Blvd, CB #7505, Chapel Hill, NC, 27599, USA. mfiggatt@unc.edu. 2. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, 170 Rosenau Hall, CB #740, Chapel Hill, NC, 27599, USA. mfiggatt@unc.edu. 3. North Carolina Survivors Union, 1116 Grove Street, Greensboro, NC, 27403, USA. 4. ekiM for Change, 620 Lynndale Ct, Suite C, Greenville, NC, 27858, USA. 5. Community Hope Alliance, 2012 N Fayetteville St, Asheboro, NC, 27203, USA. 6. Center for Prevention Services, 1117 E Morehead St #200, Charlotte, NC, 28204, USA. 7. Guilford County Solution To the Opioid Problem, 1601 Walker Ave, Greensboro, NC, 27403, USA. 8. Division of Infectious Disease, Department of Medicine, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA. 9. Injury Prevention Research Center, University of North Carolina At Chapel Hill, 725 Martin Luther King Jr. Blvd, CB #7505, Chapel Hill, NC, 27599, USA. 10. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina At Chapel Hill, 170 Rosenau Hall, CB #740, Chapel Hill, NC, 27599, USA.
Abstract
INTRODUCTION: Bacterial and fungal infections, such as skin and soft tissue infections (SSTIs) and infective endocarditis (IE), are increasing among people who use drugs in the United States. Traditional healthcare settings can be inaccessible and unwelcoming to people who use drugs, leading to delays in getting necessary care. The objective of this study was to examine SSTI treatment experiences among people utilizing services from syringe services programs. This study was initiated by people with lived experience of drug use to improve quality of care. METHODS: We conducted a cross-sectional survey among participants of five syringe services programs in North Carolina from July through September 2020. Surveys collected information on each participant's history of SSTIs and IE, drug use and healthcare access characteristics, and SSTI treatment experiences. We examined participant characteristics using counts and percentages. We also examined associations between participant characteristics and SSTI history using binomial linear regression models. RESULTS: Overall, 46% of participants reported an SSTI in the previous 12 months and 10% reported having IE in the previous 12 months. Those with a doctor they trusted with drug use-related concerns had 27 fewer (95% confidence interval = - 51.8, - 2.1) SSTIs per every 100 participants compared to those without a trusted doctor. Most participants with a SSTI history reported delaying (98%) or not seeking treatment (72%) for their infections. Concerns surrounding judgment or mistreatment by medical staff and self-treating the infection were common reasons for delaying or not seeking care. 13% of participants used antibiotics obtained from sources other than a medical provider to treat their most recent SSTI. Many participants suggested increased access to free antibiotics and on-site clinical care based at syringe service programs to improve treatment for SSTIs. CONCLUSIONS: Many participants had delayed or not received care for SSTIs due to poor healthcare experiences. However, having a trusted doctor was associated with fewer people with SSTIs. Improved access to non-judgmental healthcare for people who use drugs with SSTIs is needed. Expansion of syringe services program-based SSTI prevention and treatment programs is likely a necessary approach to improve outcomes among those with SSTI and IE.
INTRODUCTION: Bacterial and fungal infections, such as skin and soft tissue infections (SSTIs) and infective endocarditis (IE), are increasing among people who use drugs in the United States. Traditional healthcare settings can be inaccessible and unwelcoming to people who use drugs, leading to delays in getting necessary care. The objective of this study was to examine SSTI treatment experiences among people utilizing services from syringe services programs. This study was initiated by people with lived experience of drug use to improve quality of care. METHODS: We conducted a cross-sectional survey among participants of five syringe services programs in North Carolina from July through September 2020. Surveys collected information on each participant's history of SSTIs and IE, drug use and healthcare access characteristics, and SSTI treatment experiences. We examined participant characteristics using counts and percentages. We also examined associations between participant characteristics and SSTI history using binomial linear regression models. RESULTS: Overall, 46% of participants reported an SSTI in the previous 12 months and 10% reported having IE in the previous 12 months. Those with a doctor they trusted with drug use-related concerns had 27 fewer (95% confidence interval = - 51.8, - 2.1) SSTIs per every 100 participants compared to those without a trusted doctor. Most participants with a SSTI history reported delaying (98%) or not seeking treatment (72%) for their infections. Concerns surrounding judgment or mistreatment by medical staff and self-treating the infection were common reasons for delaying or not seeking care. 13% of participants used antibiotics obtained from sources other than a medical provider to treat their most recent SSTI. Many participants suggested increased access to free antibiotics and on-site clinical care based at syringe service programs to improve treatment for SSTIs. CONCLUSIONS: Many participants had delayed or not received care for SSTIs due to poor healthcare experiences. However, having a trusted doctor was associated with fewer people with SSTIs. Improved access to non-judgmental healthcare for people who use drugs with SSTIs is needed. Expansion of syringe services program-based SSTI prevention and treatment programs is likely a necessary approach to improve outcomes among those with SSTI and IE.
Keywords:
Abscesses; Cellulitis; Drug use; Drug user led research; Endocarditis; Harm reduction; Healthcare access; Infectious disease; Skin and soft tissue infections; Syringe exchange programs; Syringe services programs; Wound care
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