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.
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.