Access to HIV, Viral Hepatitis, and Substance Use Disorder Treatment/Overdose Prevention Services: A Qualitative Analysis of Syringe Service Programs (SSPs) Serving Rural PWID

Abstract

Background

Syringe service programs (SSP) increasingly serve rural areas of the United States, yet little is known about access and perceived need for their services. Objectives: This paper presents the HIV and viral hepatitis prevention, testing, and treatment, and, substance use disorder treatment and overdose prevention services offered at three SSPs and which services their clients accessed. Across the three SSPs, 45 clients (people who inject drugs [PWID]), 11 staff, and five stakeholders were interviewed. Results: Most clients (n = 34) reported accessing SSP services weekly and primarily for sterile syringes and injection-related supplies. All clients reported testing for HIV at least once, though concern for acquiring or transmitting HIV was divided between some or no concern. Most clients (n = 43) reported testing for hepatitis C virus (HCV). Concern for acquiring or transmitting HCV was also mixed. Vaccination for hepatitis A and/or B teetered around half (HAV: n = 23) to a third (HBV: n = 15). Most clients (n = 43) knew where to access the overdose countering medication, Narcan. Feelings about substance use treatment options varied, yet most felt not enough were available. Of note, not all assessed services were offered by the sampled SSPs. Conclusions/Importance: The findings help us understand PWIDs’ rationale regarding services accessed and preference for particular services. The need for some services was not perceived by those at risk for the illness the services addressed. Discussing risk and providing tailored education is important when providing SSP services to rural residing PWIDs.

Keywords:

• Syringe service programs (SSPs)
• HIV
• viral hepatitis
• substance use disorder
• overdose prevention
• services provision

Acknowledgments

The authors thank to the client, staff, and stakeholder participants that informed these findings. We appreciate the time they took to discuss their experiences. We also appreciate the support from the participating SSPs, notably Dr. Michael Kilkenny and Michelle Perdue at the Cabell-Huntington Health Department, Loftin Wilson at the North Carolina Harm Reduction Coalition, and Matthew LaRocco, formerly at the Louisville Metro Syringe Exchange Program. We also thank our collaborators at RSS: Alisú Schoua-Glusberg, Casey Tesfaye, Danae Corado, Jessie Engel, Daniela Glusberg, Suzanne Allmart, and Jane Dillingham; UNLV: Paula Frew and Laura Randall; and, IMPAQ International: Bryan Gale, Valerie Betley, Elizabeth Gall, Karen Baldwin, and Vanessa Hoffman.

Declaration of interest

The authors declare that we have no competing financial, professional, or personal interests that might have influence the performance or presentation of the work described in this manuscript. We report no conflicting interests.

Additional information

Funding

This work was supported by the Centers for Disease Control and Prevention under contract to Research Support Services, Inc. (grant no. 200-2013-57341/0007).