Significant decrease in injection risk behaviours among participants in a needle exchange programme

Figures & data

Figure 1. Flowchart of participants included by year and follow-up points.

Table 1. Baseline characteristics at inclusion for the included study population and injection risk behaviours (2013–2018, N = 2860).

	All	Shared needle/syringe	Shared paraphernalia
		past month	past month
	n (%)	n (%)	n (%)
Total	2860 (100%)	830 (29.0%)	975 (34.1%)
Gender
Men	2174 (76.0%)	536 (24.7%)	629 (28.9%)
Women	686 (24.0%)	294 (42.9%)	346 (50.4%)
Age at inclusion (years)
<25	358 (12.5%)	137 (38.3%)	138 (38.5%)
25–34	910 (31.8%)	306 (33.6%)	330 (36.3%)
>34	1592 (55.7%)	387 (24.3%)	507 (31.8%)
Country of birth
Sweden	2211 (77.3%)	701 (31.7%)	807 (36.5%)
Europe (excl. Sweden)	366 (12.8%)	71 (19.4%)	88 (24.0%)
Other countries	213 (7.4%)	39 (18.3%)	54 (25.4%)
Level of education
Partial or full elementary	1575 (55.1%)	489 (31.0%)	585 (37.1%)
Upper secondary/vocational	1059 (37.0%)	284 (26.8%)	331 (31.3%)
University	213 (7.4%)	52 (24.4%)	55 (25.8%)
Living situation the past 3 months
Homeless	592 (20.7%)	213 (36.0%)	255 (43.1%)
Not homeless	2262 (79.1%)	612 (73.7%)	716 (73.4%)
Employment the past 3 months
Unemployed	1476 (51.6%)	455 (30.8%)	569 (38.6%)
Part time	130 (4.5%)	35 (26.9%)	29 (22.3%)
Full time	265 (9.3%)	54 (20.4%)	60 (22.6%)
Student	81 (2.8%)	32 (39.5%)	27 (33.3%)
Sick/activity compensation	684 (23.9%)	189 (27.6%)	219 (32.0%)
Retirement	53 (1.9%)	7 (13.2%)	9 (17.0%)
Other	162 (5.7%)	54 (33.3%)	59 (36.4%)
Age at injecting drug debut (years)
≤16	653 (22.8%)	218 (33.4%)	255 (39.1%)
17–19	621 (21.7%)	182 (29.3%)	216 (34.8%)
20–24	731 (26.6%)	214 (29.3%)	229 (31.3%)
25–29	392 (13.7%)	99 (25.3%)	128 (32.7%)
≥30	424 (14.8%)	107 (25.2%)	136 (32.1%)
Drug at injecting drug debut
Amphetamines	1644 (57.5%)	517 (31.4%)	636 (38.7%)
Heroin	854 (29.9%)	207 (24.2%)	231 (27.0%)
Buprenorphine	81 (2.8%)	21 (25.9%)	25 (30.9%)
Other opioids	65 (2.3%)	16 (24.6%)	23 (35.4%)
Other	208 (7.3%)	66 (31.7%)	57 (27.4%)
Duration of injecting drug use (years)
0–2	424 (14.8%)	143 (33.7%)	148 (34.9%)
3–5	318 (11.1%)	102 (32.1%)	111 (34.9%)
6–9	353 (12.3%)	120 (34.0%)	123 (34.8%)
10–19	774 (27.1%)	236 (30.5%)	280 (36.2%)
≥20	952 (33.3%)	219 (23.0%)	302 (31.7%)
Drug at last injection
Heroin	1122 (39.2%)	298 (26.6%)	321 (28.6%)
Amphetamine	1267 (44.3%)	416 (32.8%)	526 (41.5%)
Methylphenidate	47 (1.6%)	10 (21.3%)	5 (10.6%)
Buprenorphine	180 (6.3%)	41 (22.8%)	43 (23.9%)
Other	158 (5.5%)	50 (31.6%)	55 (34.8%)
Shared needle/syringe (receptive) past month
No	2030 (71.0%)	0 (0.0%)	408 (20.1%)
Yes	830 (29.0%)	830 (100%)	567 (68.3%)
Shared paraphernalia (receptive) past month
No	1885 (65.9%)	263 (14.0%)	0 (0.0%)
Yes	975 (34.1%)	567 (58.2%)	975 (100%)
Apprehended past 12 months
No	2035 (71.2%)	543 (26.7%)	643 (31.6%)
Sectioned (psychiatric/dependency)	193 (6.7%)	91 (47.2%)	88 (45.6%)
Custody	215 (7.5%)	78 (36.3%)	88 (40.9%)
Prison	417 (14.6%)	118 (28.3%)	156 (37.4%)
Enrolled in social services
No	1254 (43.8%)	312 (24.9%)	386 (30.8%)
Yes	1606 (56.2%)	518 (32.3%)	589 (36.7%)
Enrolled in outpatient substance use disorder treatment
No	1894 (66.2%)	544 (28.7%)	672 (35.5%)
Yes	966 (33.8%)	286 (29.6%)	303 (31.4%)
Opioid substitution treatment (OST)
No	2600 (90.9%)	784 (30.2%)	936 (36.0%)
Yes	260 (9.1%)	46 (17.7%)	39 (15.0%)
HIV status at inclusion*
Negative	2674 (93.5%)	792 (29.6%)	928 (34.7%)
Positive	140 (4.9%)	27 (19.3%)	37 (26.4%)
HBV status at inclusion*
Negative	1156 (40.4%)	344 (29.8%)	406 (35.1%)
Positive	41 (1.4%)	11 (26.8%)	15 (36.6%)
Cleared	944 (33.0%)	232 (24.6%)	313 (33.2%)
Vaccinated	604 (21.1%)	216 (35.8%)	212 (35.1%)
HCV (viremic) status at inclusion*
Negative	1216 (42.5%)	320 (26.3%)	364 (29.9%)
Positive	1573 (55.0%)	496 (31.5%)	595 (37.8%)

^* Laboratory verified.

Table 2. Adjusted odds ratios (aORs) for sharing needle/syringe and paraphernalia during the past month at inclusion, (2013–2018, N = 2860).

	Sharing needle/syringe past month			Sharing paraphernalia past month
	OR	95% CI	p Value	OR	95% CI	p Value
Gender
Men	1.00	ref		1.00	Ref
Women	1.95	1.61–2.37	<.001	2.41	1.99–2.91	<.001
Age at inclusion (years)
<25	1.03	0.77–1.38	.825	0.98	0.73–1.32	.889
25–34	1.00	ref		1.00	Ref
>34	0.65	0.53–0.80	<.001	0.84	0.69–1.03	.095
Level of education
Partial or full elementary	1.00	ref		1.00	ref
Upper secondary/vocational	0.88	0.73–1.06	.191	0.80	0.67–0.96	.017
University	0.86	0.61–1.22	.394	0.67	0.47–0.94	.021
Living situation past 3 months
Homeless	1.48	1.20–1.82	<.001	1.50	1.23–1.83	<.001
Not homeless	1.00	ref		1.00	ref
Age at injecting drug debut (years)
0–19	1.00	ref		1.00	ref
≥20	0.85	0.70–1.03	.104	0.86	0.72–1.04	.120
Duration of injecting drug use (years)
0–5	1.12	0.88–1.42	.364	1.01	0.80–1.27	.931
≥6	1.00	ref		1.00	ref
Drug at last injection
Heroin	1.00	ref		1.00	Ref
Amphetamine	1.33	1.09–1.61	.004	1.58	1.31–1.91	<.001
Methylphenidate	0.64	0.29–1.43	.280	0.30	0.11–0.78	.014
Buprenorphine	0.71	0.48–1.06	.094	0.74	0.51–1.07	.112
Other	1.33	0.91–1.93	.136	1.37	0.95–1.97	.094
Opioid substitution treatment (OST)
No	1.00	ref		1.00	ref
Yes	0.66	0.46–0.95	.025	0.35	0.23–0.51	<.001
HIV status at inclusion*
Negative	1.00	ref		1.00	ref
Positive	0.56	0.35–0.92	.021	0.62	0.40–0.96	.031
HBV status at inclusion*
Negative	1.00	ref		1.00	Ref
Positive	1.13	0.55–2.33	.732	1.31	0.67–2.57	.425
Cleared	0.86	0.69–1.09	.208	0.89	0.72–1.10	.284
Vaccinated	1.18	0.94–1.47	.146	0.90	0.73–1.12	.358
HCV status (viremic) at inclusion*
Negative	1.00	ref		1.00	ref
Positive	1.31	1.10–1.58	.003	1.41	1.18–1.68	<.001

^* Laboratory verified.

Figure 2. Changes in injection risk behaviours (sharing needle/syringe and paraphernalia) following inclusion in the NEP. Odds ratio (OR) at inclusion is set at 1 as reference value. N = 2860 at inclusion. p values represent changes in injection risk behaviours over the whole follow-up time.