An integrated supervised injecting program within a care facility for HIV-positive individuals: a qualitative evaluation

Abstract

While there has been growing interest in comprehensive models of treatment and care for individuals living with HIV/AIDS, little attention has been given to the potential role that supervised injecting programs could play in increasing access to prevention and care services for HIV-positive injection drug users (IDU). We conducted 22 semi-structured interviews with HIV-positive IDU regarding a supervised injection program integrated in an HIV focused care facility known as the Dr. Peter Centre (DPC). We also interviewed seven staff members who supervise injections within the facility. All interviews were audio recorded, transcribed verbatim, and a thematic analysis was conducted. Participant and staff reports indicated that the integrated supervised injection program influenced IDUs’ access to care by building more open and trusting relationships with staff, facilitating engagement in safer injection education and improving the management of injection-related infections. Participants and staff viewed the program as facilitating the delivery of care through mediating overdose risks, reducing the need to punitively manage drug use onsite and reducing the risks of encountering used syringes on the premises. For some participants, however, feelings of shame and fear of judgment in relation to their drug use limited initial uptake of the program. Our findings identify mechanisms through which integrated supervised injection programs may serve to better facilitate access and delivery of comprehensive care for HIV-positive IDU and highlight the benefits of addressing HIV-positive IDUs’ drug use in the context of comprehensive models of healthcare.

Keywords:

• supervised injecting
• access to care for injection drug users

Acknowledgements

The authors wish to thank the study participants for their time and participation. We also thank the research and administrative staff at the B.C. Centre for Excellence in HIV/AIDS for their research assistance, including Julio Montaner, Deborah Graham, and Tricia Collingham. Thanks are also due to the DPC participants, administration, and staff for their cooperation and patience.

Andrea Krüsi is supported by a SFU Graduate Fellowship.

Will Small is supported a Michael Smith Foundation for Health Research Senior Graduate Studentship and a Canadian Institutes of Health Research Doctoral Research Award.

Thomas Kerr is supported by a Michael Smith Foundation for Health Research Scholar Award and the Canadian Institutes of Health Research New Investigator Award.

Will Small, Andrea Krüsi and Thomas Kerr designed the data collection instruments and conducted the analyses of the data. Andrea Krüsi prepared the first draft of the manuscript. All authors contributed to the design of the study as well to the revision of the manuscript.

Notes

1. According to the HRR protocol counsellors and other non-nursing staff can supervise the injection preparation; however during the actual act of injecting and immediately afterwards the presence of a qualified nurse is required.