Factors Associated with Sterile Syringe Acquisition among People Who Inject Drugs in West Virginia

Abstract

Background

Syringe services programs (SSPs) are evidence-based interventions that provide essential overdose and infectious disease prevention resources to people who inject drugs (PWID). Little research has examined factors associated with sterile syringe acquisition at SSPs among rural PWID populations.

Objectives

We aim to identify factors associated with PWID in a rural county in West Virginia having recently acquired sterile syringes at an SSP.

Methods

PWID (n = 420) completed a survey that included measures related to sociodemographics, structural vulnerabilities, and substance use. We used multivariable Poisson regression with robust variance estimation to examine independent associations with sterile syringe acquisition at an SSP.

Results

Sixty-five percent of our sample reported having recently acquired sterile syringes at an SSP. Factors associated with recent sterile syringes acquisition at an SSP included: being older (aPR [adjusted prevalence ratio]: 1.011, 95% CI: 1.003–1.019), single (aPR: 0.862, 95% CI: 0.755–0.984), experiencing food insecurity (aPR: 1.233, 95% CI: 1.062–1.431), recently injecting fentanyl (aPR: 1.178, 95% CI: 1.010–1.375) and prescription opioid pain relievers (aPR: 0.681, 95% CI: 0.551–0.842), and recent naloxone acquisition (aPR: 1.360; 95% CI: 1.178–1.569). Receptive syringe sharing was inversely associated with acquiring sterile syringes at an SSP (aPR: 0.852; 95% CI: 0.741–0.979).

Conclusion

PWID accessing sterile syringes at an SSP was associated with several sociodemographic, structural, and substance use factors. Ensuring rural SSP operations are tailored to local PWID population-level needs is paramount to the prevention of infectious disease outbreaks and overdose fatalities.

Keywords:

• Injection drug use
• rural health
• syringe service program
• people who use drugs
• harm reduction

Acknowledgments

We are grateful to the collaboration of the Cabell Huntington Health Department, without whom, this project would not have been possible. We are especially grateful to Thommy Hill, Tyler Deering, Kathleen Napier, Jeff Keatley, Michelle Perdue, Chad Helig, and Charles “CK” Babcock for all their support throughout the study implementation. We are also grateful for the hard work of the West Virginia COUNTS! research team: Megan Keith, Anne Maynard, Aspen McCorkle, Terrance Purnell, Ronaldo Ramirez, Kayla Rodriguez, Lauren Shappell, Kristin Schneider, Brad Silberzahn, Dominic Thomas, Kevin Williams, and Hayat Yusuf. We gratefully acknowledge the West Virginia Department of Health and Human Resources. We also wish to acknowledge Josh Sharfstein, Michelle Spencer, Dori Henry, and Akola Francis for their support throughout each phase of the study. Most importantly, we are grateful to our study participants.

Author contributions

STA, RHW, and AO oversaw the study implementation and data collection. RHW, AM, PW, and STA conducted the analyses. STA, AM, AO, and RHW drafted the paper, and all other authors provided critical feedback, revisions, and interpretations of findings.

Competing interests

The authors have no competing interests to declare.

Data availability

The data are not publicly available due to privacy concerns for study participants.

Additional information

Funding

This research was supported by a grant from the Bloomberg American Health Initiative at the Johns Hopkins Bloomberg School of Public Health to Dr. Sean T. Allen. This research has been facilitated by the infrastructure and resources provided by the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189), and DC Center for AIDS Research (AI117970), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. STA is also supported by the National Institutes of Health (K01DA046234). The funders had no role in study design, data collection, or in analysis and interpretation of the results, and this paper does not necessarily reflect views or opinions of the funders.