Authors: Eric Romo, Abby E. Rudolph, Thomas J. Stopka, Bo Wang, Bill M. Jesdale, Peter D. Friedmann
Background/Objectives: Obtaining sterile syringes via syringe services programs (SSPs) and pharmacies reduces injection-mediated risks associated with hepatitis C virus (HCV), but whether indirect use of SSPs via secondary exchange confers the same benefit remains unknown, particularly in rural settings. We compared HCV serostatus and injection-mediated risks by primary syringe source among a sample of rural people who inject drugs (PWID).
Methods: Data are from a cross-sectional study of adult PWID recruited from rural counties in New Hampshire, Vermont, and Massachusetts using respondent-driven sampling between 2018 and 2019. Study staff performed HCV antibody testing. An audio computer-assisted self-interview assessed sociodemographics and past 30-day injection-mediated risks. Based on self-report, participants’ primary syringe source was classified as direct SSP, pharmacy, indirect SSP (secondary exchange), or “other” sources (friend/acquaintance, street seller, partner/relative, found them). Mixed effects modified Poisson models assessed associations between syringe source and HCV seroprevalence and injection-mediated risks.
Results: Among 397 PWID, the most common primary syringe source was “other” sources (33%), followed by pharmacies (27%), SSPs (22%), and secondary exchange (18%). In multivariable models, participants primarily obtaining syringes from pharmacies had a lower HCV seroprevalence (adjusted prevalence ratio [APR]:0.85, 95% confidence interval [CI]:0.73-1.00) than participants using other sources. Compared with those primarily using other sources, PWID obtaining syringes directly from SSPs or pharmacies were less likely to report borrowing syringes (APR[SSP]:0.60, 95% CI:0.43-0.85 and APR[Pharmacies]:0.70, 95% CI:0.52-0.93), borrowing injection equipment (APR[SSP]:0.59, 95% CI:0.50-0.69 and APR[Pharmacies]:0.81, 95% CI:0.68-0.98), and backloading (APR[SSP]:0.65, 95% CI:0.48-0.88 and APR[Pharmacies]:0.78, 95% CI:0.67-0.91). Obtaining most syringes via secondary exchange was negatively, but imprecisely, associated with each injection risk behavior (e.g., APR borrowed syringes:0.89, 95% CI:0.62-1.28).
Conclusions: PWID in rural New England largely relied on unauthorized syringe sources. Primarily obtaining syringes from an SSP or pharmacy was associated with reductions in injection-mediated risks and decreased HCV seroprevalence, demonstrating the need for expanded local access.
Clinical and Population Health Research Program
University of Massachusetts Medical School
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