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1.
J Infect Chemother ; 28(10): 1387-1392, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2007848

ABSTRACT

INTRODUCTION: Ralstonia insidiosa, a gram-negative waterborne bacteria able to survive and grow in any type of water source, can cause nosocomial infections, and are considered emerging pathogens of infectious diseases in hospital settings. In this study, we report an outbreak of R. insidiosa at our center related to contaminated heparinized syringes. MATERIAL AND METHODS: The present study was conducted in a tertiary care university hospital in Turkey. An outbreak analysis was performed between September 2021 and December 2021. Microbiological samples were obtained from environmental sources and from patient blood cultures. Species identification was performed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). To investigate the clonality of strains, all confirmed isolates were sent to the National Reference Laboratory and pulsed-field gel electrophoresis (PFGE) was used to perform molecular typing. RESULTS: Seventeen R. insidiosa isolates were identified from the blood cultures of 13 patients from various wards and intensive care units. Isolates from seven patient blood cultures and two heparinized blood gas syringes were characterized by PFGE. All isolates were found to belong to the same clone of R. insidiosa. CONCLUSION: R. insidiosa was identified as the cause of a nosocomial infection outbreak in our hospital, which was then rapidly controlled by the infection-control team. When rare waterborne microorganisms grow in blood or other body fluid cultures, clinicians and the infection-control team should be made aware of a possible outbreak.


Subject(s)
Cross Infection , Sepsis , Cross Infection/microbiology , Disease Outbreaks , Humans , Ralstonia , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Syringes
2.
Harm Reduct J ; 19(1): 78, 2022 Jul 15.
Article in English | MEDLINE | ID: covidwho-1938329

ABSTRACT

BACKGROUND: Syringe service programs (SSPs) provide essential harm reduction and prevention services for people who inject drugs in the USA, where SSP coverage is expanding. During the COVID-19 pandemic, US SSPs underwent unprecedented shifts in operational procedures (e.g., closures of physical sites, staff redeployment into pandemic response efforts). Given the critical role of US SSP workers in the pandemic, we sought to explore the occupational experiences and well-being of SSP staff to inform future emergency response efforts. METHODS: From July-October 2020, we conducted semi-structured interviews with staff members of four SSPs in diverse regions of Massachusetts. Trained interviewers administered qualitative interviews virtually. Interviews were coded in NVivo v12 and thematic analysis identified common occupational experiences and related impacts on staff well-being in the context of the COVID-19 pandemic. RESULTS: Among 18 participants, 12 (67%) had client-facing roles such as harm reduction specialists and six (33%) worked in program management or leadership. We found that staff were frequently anxious about SARS-CoV-2 transmission, which contributed to staff turnover. SSPs rapidly adapted and expanded their services to meet increasing client needs during the pandemic (e.g., food distribution, COVID-19 testing), leading to staff overexertion. Simultaneously, public health measures such as physical distancing led to staff concerns about reduced social connections with clients and coworkers. Through these challenges, SSPs worked to protect staff well-being by implementing flexible and tangible COVID-19-related policies (e.g., paid sick leave), mental health resources, and frequent communication regarding pandemic-related operational changes. CONCLUSION: SSPs in the USA adapted to the COVID-19 pandemic out of necessity, resulting in operational changes that threatened staff well-being. Despite the protective factors revealed in some narratives, our findings suggest that during prolonged, complex public health emergencies, SSPs may benefit from enhanced occupational supports to prevent burnout and promote wellness for this essential public health workforce.


Subject(s)
COVID-19 , COVID-19/prevention & control , COVID-19 Testing , Humans , Pandemics/prevention & control , SARS-CoV-2 , Syringes
3.
Soc Sci Med ; 305: 115069, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1915003

ABSTRACT

The diffusion of palliative care has been rapid, yet uncertainty remains regarding palliative care's "active ingredients." The National Consensus Project Guidelines for Quality Palliative Care identified eight domains of palliative care. Despite these identified domains, when pressed to describe the specific maneuvers used in clinical encounters, palliative care providers acknowledge that "it's complex." The field of systems has been used to explain complexity across many different types of systems. Specifically, engineering systems develop a representation of a system that helps manage complexity to help humans better understand the system. Our goal was to develop a system model of what palliative care providers do such that the elements of the model can be described concretely and sequentially, aggregated to describe the high-level domains currently described by palliative care, and connected to the complexity described by providers and the literature. Our study design combined methodological elements from both qualitative research and systems engineering modeling. The model drew on participant observation and debriefing semi-structured interviews with interdisciplinary palliative care team members by a systems engineer. The setting was an interdisciplinary palliative care service in a US rural academic medical center. In the developed system model, we identified 59 functions provided to patients, families, non-palliative care provider(s), and palliative care provider(s). The high-level functions related to measurement, decision-making, and treatment address up to 8 states of an individual, including an overall holistic state, physical state, psychological state, spiritual state, cultural state, personal environment state, and clinical environment state. In contrast to previously described expert consensus domain-based descriptions of palliative care, this model more directly connects palliative care provider functions to emergent behaviors that may explain system-level mechanisms of action for palliative care. Thus, a systems modeling approach provides insights into the challenges surrounding the recurring question of what is in the palliative care "syringe."


Subject(s)
Palliative Care , Syringes , Humans , Interdisciplinary Studies , Palliative Care/psychology , Qualitative Research , Rural Population
4.
Harm Reduct J ; 19(1): 47, 2022 05 19.
Article in English | MEDLINE | ID: covidwho-1910327

ABSTRACT

BACKGROUND: The coronavirus pandemic (COVID-19) exacerbated risks for adverse health consequences among people who inject drugs by reducing access to sterile injection equipment, HIV testing, and syringe services programs (SSPs). Several decades of research demonstrate the public health benefits of SSP implementation; however, existing evidence primarily reflects studies conducted in metropolitan areas and before the COVID-19 pandemic. OBJECTIVES: We aim to explore how the COVID-19 pandemic affected SSP operations in rural Kentucky counties. METHODS: In late 2020, we conducted eighteen in-depth, semi-structured interviews with persons (10 women, 8 men) involved in SSP implementation in rural Kentucky counties. The interview guide broadly explored the barriers and facilitators to SSP implementation in rural communities; participants were also asked to describe how COVID-19 affected SSP operations. RESULTS: Participants emphasized the need to continue providing SSP-related services throughout the pandemic. COVID-19 mitigation strategies (e.g., masking, social distancing, pre-packing sterile injection equipment) limited relationship building between staff and clients and, more broadly, the pandemic adversely affected overall program expansion, momentum building, and coalition building. However, participants offered multiple examples of innovative solutions to the myriad of obstacles the pandemic presented. CONCLUSION: The COVID-19 pandemic impacted SSP operations throughout rural Kentucky. Despite challenges, participants reported that providing SSP services remained paramount. Diverse adaptative strategies were employed to ensure continuation of essential SSP services, demonstrating the commitment and ingenuity of program staff. Given that SSPs are essential for preventing adverse injection drug use-associated health consequences, further resources should be invested in SSP operations to ensure service delivery is not negatively affected by co-occurring crises.


Subject(s)
COVID-19 , Substance Abuse, Intravenous , Female , Humans , Kentucky/epidemiology , Male , Needle-Exchange Programs , Pandemics/prevention & control , Rural Population , Substance Abuse, Intravenous/epidemiology , Syringes
5.
Drug Alcohol Depend ; 237: 109540, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1894967

ABSTRACT

BACKGROUND: Syringe services programs (SSPs) are an important venue for reaching people who inject drugs (PWID) to offer preventive services; however, not all SSPs offer vaccinations. We aimed to describe barriers and opportunities for SSPs to offer vaccinations. METHODS: During June-August 2021, we conducted a descriptive, cross-sectional survey of SSP providers in the United States. SSPs were recruited from national listservs using purposive sampling to ensure geographic diversity. The survey included questions about SSP characteristics, client demographics, existing vaccination resources, resource needs, and staff perspectives on client vaccination barriers. Statistical comparisons were made using Pearson's chi-square test. RESULTS: In total, 105 SSPs from 34 states responded to the survey; 46 SSPs (43.8%) offered on-site vaccinations. SSPs without on-site vaccinations were more likely operated by community-based organizations (81.4% vs 30.4%, p < 0.001) in urban areas (71.4% vs 40.0%, p = 0.002) than SSPs offering on-site vaccinations. The most common staffing need was for personnel licensed to administer vaccines (74/98, 75.5%). Over half of SSPs reported vaccine supply, administration supplies, storage equipment, and systems to follow-up clients for multidose series as important resource needs. The most common resource need was for reminder/recall systems for vaccines with multidose series (75/92, 81.5%). Vaccine safety concerns (92/95, 96.8%) and competing priorities (92/96, 95.8%) were the most common staff-reported client barriers to vaccinations. CONCLUSIONS: Addressing missed opportunities for offering vaccinations to PWID who use SSPs will require increased numbers of on-site personnel licensed to administer vaccines and additional training, vaccination supplies, and storage and handling equipment.


Subject(s)
Substance Abuse, Intravenous , Vaccines , Cross-Sectional Studies , Humans , Needle-Exchange Programs , Substance Abuse, Intravenous/epidemiology , Syringes , United States , Vaccination
6.
Aust N Z J Public Health ; 46(4): 524-526, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1886633

ABSTRACT

OBJECTIVE: Automatic syringe dispensing machines (ADM) have become an important adjunct to Australia's needle and syringe programs (NSP). However, concerns that they reduce face-to-face contact with health staff and other health interventions remain. We examined changes in the number of needle/syringes dispensed at an ADM and occasions of service at a co-located face-to-face NSP and targeted primary healthcare clinic during the first wave of COVID-19 restrictions. METHODS: We reviewed data from an inner-city harm reduction program during the study period of April 2020 to March 2021 compared to the previous year. Multivariable linear regression models were used to estimate the association between occasions of service and equipment distribution. RESULTS: ADM-dispensed equipment increased significantly by 41.1%, while face-to-face NSP occasions decreased by 16.2%. Occasions provided by the targeted primary healthcare clinic increased by 59.7% per month. CONCLUSION: We have shown that 24-hour ADM access did not adversely affect the number of people using targeted primary healthcare when provided within close proximity. Implication for public health: These findings reinforce the demand for 24-hour needle/syringe access and can be used to support the expanded access to ADMs, especially where people who inject drugs (PWID) have access to appropriate healthcare.


Subject(s)
COVID-19 , Substance Abuse, Intravenous , COVID-19/epidemiology , Humans , Needle-Exchange Programs , Primary Health Care , Substance Abuse, Intravenous/epidemiology , Syringes
7.
Drug Alcohol Depend ; 237: 109504, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1850941

ABSTRACT

INTRODUCTION: Among people with an opioid use disorder in the United States, only 10% receive buprenorphine treatment. The Ryan Haight Act is a federal law that has regulated buprenorphine delivery, requiring an in-person examination between a patient and provider before initiating treatment. At the beginning of the COVID-19 pandemic, federal agencies waived in-person examination requirements for buprenorphine treatment initiation. We examined whether Ryan Haight Act waiver improved implementation of telehealth buprenorphine within syringe service programs (SSPs) - organizations that serve people with historically low access to treatment. METHODS: We surveyed all known SSPs operating in the US in 2021 (N = 421) of which 77% responded (n = 325). We calculated the prevalence and accompanying 95% confidence intervals (CI) for implementation of telehealth buprenorphine inductions at SSPs in 2020. Multivariable logistic regression was used to assess differences in implementing telehealth buprenorphine inductions by organizational characteristics. RESULTS: In 2020, the prevalence of implementing buprenorphine inductions via telehealth was 24% (95% CI:19-30%). Non-governmental SSPs had a higher odds of telehealth buprenorphine inductions (adjusted odds ratio (aOR)= 2.92; 95% CI:1.22-7.00; p = 0.016), compared to governmental SSPs. Furthermore, the larger the organization's annual budget, the higher the odds of telehealth buprenorphine implementation (aOR=2.00 per quartile (95% CI:1.33-2.99; p = 0.001). SSPs located in states with higher opioid overdose mortality rates did not have significantly higher likelihood of telehealth buprenorphine implementation. CONCLUSION: A substantial number of SSPs implemented telehealth buprenorphine after waiver of the Ryan Haight Act. Permanent adoption of this waiver will be critical and providing financial resources to SSPs is vital to support implementation of new innovations.


Subject(s)
Buprenorphine , COVID-19 , Opioid-Related Disorders , Buprenorphine/therapeutic use , Humans , Opiate Substitution Treatment , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Pandemics , Syringes , United States/epidemiology
8.
Clin Cardiol ; 45(5): 583-589, 2022 May.
Article in English | MEDLINE | ID: covidwho-1802116

ABSTRACT

BACKGROUND: Adenosine has been recommended as a first-line treatment for stable supraventricular tachycardia (SVT). Standard guidelines recommend 6-mg of adenosine administered intravenously (IV) with an immediate 20-ml IV bolus of normal saline solution (NSS; double syringe technique [DST]). However, a newly proposed single-syringe technique (SST), in which adenosine is diluted with an up to 20 ml IV bolus of NSS, was found to be beneficial. HYPOTHESIS: We hypothesized that the SST was noninferior to the DST for terminating stable SVT. METHODS: A pilot multicenter, single-blind, randomized controlled study was conducted at nine hospitals in north and northeast Thailand. Thirty patients who were diagnosed with stable SVT were randomized into two groups of 15, with one receiving adenosine via the DST and the other via the SST. We examined SVT termination, the average successful dose, and the complication rate of each group. Analyses were based on the intention-to-treat principle. RESULT: The termination rate was 93.3% in the DST and 100% in the SST group (p = 1.000), and the success rate of the first 6-mg dose of adenosine was 73.3% and 80%, respectively (p = 1.000). The total administered dose was 8.6 ± 5.1 mg in the DST group and 7.6 ± 4.5 mg in the SST group (p = .608). No complications were found in either group. CONCLUSIONS: The SST was non-inferior to the DST for termination of SVT. However, a further definitive study with a larger sample size is required.


Subject(s)
Tachycardia, Paroxysmal , Tachycardia, Supraventricular , Adenosine , Anti-Arrhythmia Agents/therapeutic use , Humans , Single-Blind Method , Syringes , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/drug therapy
9.
Emerg Microbes Infect ; 11(1): 804-806, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1713525

ABSTRACT

In order to optimise the operational implementation of mass vaccination policies, it is critical to consider not only the supply of vaccines as well as each element of the vaccination process. This study, which was conducted in a vaccination center clearly shows how the choice of a syringe reference used during the COVID-19 vaccination campaign influences the number of vaccine doses available. The results appear to be closely related to the type of vaccine used (COMIRNATY® and SPIKEVAX®). In this context, the choice of the right reference of syringe has major economic and organisational consequences on a global scale.


Subject(s)
COVID-19 , COVID-19/prevention & control , COVID-19 Vaccines , Humans , Mass Vaccination , SARS-CoV-2 , Syringes , Vaccination
10.
Drug Alcohol Depend ; 232: 109323, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1670416

ABSTRACT

OBJECTIVES: This study describes harm reduction and health services provided by U.S syringe services programs (SSPs) in 2019 and changes in provision of those services in 2020. METHODS: SSPs were invited to participate in the Dave Purchase Memorial survey in August 2020. We collected programmatic data on services provided in 2019 and at the time of the survey in 2020. We conducted descriptive analyses using Chi-square and McNemar's tests. RESULTS: At the time of the survey, > 60% of SSPs reported increased monthly syringe and naloxone distribution and expansion of home-based and mail-based naloxone delivery in Fall 2020 compared to 2019. Approximately three-quarters of SSPs decreased or stopped providing on-site HIV and HCV testing. Nearly half of SSPs offering on-site medications for opioid use disorder (MOUD) in 2019 increased provision of MOUD in 2020. The proportion of SSPs offering on-site mental health care services and primary care services statistically significantly decreased from 2019 to Fall 2020, but telehealth offerings of these services increased. CONCLUSIONS: Many SSPs that offered health services in 2019 and remained operational in 2020 increased telehealth provision of mental health and primary care services, increased MOUD provision, and expanded harm reduction services, but most SSPs reduced or stopped on-site HIV and HCV testing. Sustaining SSP growth and innovation is paramount for preventing overdose deaths and HIV/HCV outbreaks after the deadliest year of the opioid epidemic in 2020.


Subject(s)
COVID-19 , Substance Abuse, Intravenous , COVID-19/prevention & control , Harm Reduction , Health Services , Humans , Needle-Exchange Programs , SARS-CoV-2 , Substance Abuse, Intravenous/complications , Substance Abuse, Intravenous/epidemiology , Syringes
11.
J Assoc Nurses AIDS Care ; 33(3): 348-352, 2022.
Article in English | MEDLINE | ID: covidwho-1621701

ABSTRACT

ABSTRACT: People who inject drugs often have a higher prevalence of risk factors associated with coronavirus disease 2019 (COVID-19) infection and associated morbidity and mortality, compounded by challenges in health care access. This increased vulnerability underscores the critical need to prioritize people who inject drug in ongoing COVID-19 vaccination efforts. Co-location of syringe services, COVID-19 vaccination services, and other communicable disease testing has proved an effective model to provide necessary interventions without creating additional barriers. Here, we describe a partnership between the Baltimore City Health Department, Johns Hopkins Mobile Vaccine Unit, and the Center for Infectious Disease and Nursing Innovation at the Johns Hopkins School of Nursing to provide COVID-19 vaccination, HIV and sexually transmitted infection testing, wound care, and linkage to care services co-located with a long-running syringe services program. We describe the services offered by each partner and lessons learned from this community-based co-location of services initiative.


Subject(s)
COVID-19 , HIV Infections , Substance Abuse, Intravenous , COVID-19/prevention & control , COVID-19 Vaccines , HIV Infections/prevention & control , Humans , Substance Abuse, Intravenous/complications , Substance Abuse, Intravenous/epidemiology , Syringes , Vaccination
12.
Int J Drug Policy ; 101: 103570, 2022 03.
Article in English | MEDLINE | ID: covidwho-1587942

ABSTRACT

BACKGROUND: Healthcare delivery was disrupted during the COVID-19 pandemic, requiring minimized in-person contact between patients and clinicians. During the pandemic, people with opioid use disorder (OUD) were not only at elevated risk for COVID-19, but had markedly reduced access to treatment for OUD, Hepatitis C virus (HCV) and HIV due to recommended decreased in-person visits. METHODS: From March 15-June 15, 2020 at the syringe services program (SSP) in New Haven, Connecticut, USA, a differentiated care model evolved with reduced clinical demands on people who inject drugs (PWID) to ensure screening and treatment for HCV, HIV and OUD, with a focus on HCV treatment. This model involved a single, bundled screening, evaluation, testing (SET) and monitoring strategy for all three conditions, minimal in-person visits, followed by tele-health communication between patients, outreach workers and clinicians. In-person visits occurred only during induction onto methadone and phlebotomy at baseline and phlebotomy 12 weeks post-treatment for HCV to measure sustained virological response (SVR). Patients received supportive texts/calls from outreach workers and clinicians. RESULTS: Overall, 66 actively injecting PWID, all with OUD, underwent bundled laboratory screening; 35 had chronic HCV infection. Participants were 40 years (mean), mostly white (N = 18) men (N = 28) and 12 were unstably housed. Two were lost to-follow-up and 2 were incarcerated, leaving 31 who started pan-genotypic direct-acting antivirals (DAAs). The mean time from referral to initial phlebotomy and initiation of DAAs was 6.9 and 9.9 days, respectively. Fourteen additional patients were newly started on buprenorphine and 6 started on methadone; three and four, respectively, were on treatment at baseline. Overall, 29 (93.5%) PWID who initiated DAAs achieved SVR; among unstably housed persons the SVR was 83.3%. CONCLUSIONS: In response to COVID-19, an innovative differentiated care model for PWID at an SSP evolved that included successful co-treatment for HCV, HIV and OUD using a client-centered approach that reduces treatment demands on patients yet supports ongoing access to evidence-based treatments.


Subject(s)
COVID-19 , Drug Users , Hepatitis C, Chronic , Hepatitis C , Opioid-Related Disorders , Substance Abuse, Intravenous , Telemedicine , Antiviral Agents , Hepacivirus , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Hepatitis C, Chronic/drug therapy , Humans , Male , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/therapy , Pandemics , Pharmaceutical Preparations , SARS-CoV-2 , Substance Abuse, Intravenous/epidemiology , Syringes
13.
J Infus Nurs ; 45(1): 27-36, 2022.
Article in English | MEDLINE | ID: covidwho-1537598

ABSTRACT

The COVID-19 pandemic has led to a high-stress environment causing a significant impact on frontline workers, including pharmacists and nurses. In addition to the increased workload, scarcity of resources, and emotional challenges, the frontline health care workers are required to wear additional personal protective equipment that can further limit their range of movement and decrease efficiency. The potential for errors can increase in these types of high-stress situations. One way to reduce the risk of errors is to use manufacturer-prepared, ready-to-administer (RTA) prefilled syringes, when appropriate. The use of RTA prefilled syringes is supported by literature evidence, recommendations, and guidelines from various professional organizations and societies.


Subject(s)
COVID-19 , Syringes , Humans , Pandemics , Personal Protective Equipment , SARS-CoV-2
14.
Harm Reduct J ; 18(1): 116, 2021 11 19.
Article in English | MEDLINE | ID: covidwho-1526641

ABSTRACT

BACKGROUND: Syringe services programs (SSPs) remain highly effective, cost-saving interventions for the prevention of blood-borne infections among people who inject drugs. However, there have been restrictions regarding financial resources allocated to these programs, particularly in the US South. This study aimed to provide cost data regarding the implementation and first-year operations of an academic-based SSP utilizing fixed and mobile strategies, including the integration of onsite wound care. METHODS: We conducted a micro-costing study that retrospectively collected detailed resource utilization and unit cost data for both the fixed and mobile SSP strategies, including onsite wound care, from both healthcare and societal perspectives. A three-step approach was used to identify, measure, and value intervention costs, and cost components were categorized into implementation, variable program, and time-dependent costs. Sensitivity analysis was performed to examine the impact of SSP operational changes (i.e., needs-based distribution and opt-out HIV/HCV testing) on the cost-per-participant. Cost data we presented as overall cost and cost-per-participant adjusted to 2017 US dollars. RESULTS: A total of 452 and 129 participants enrolled in fixed and mobile SSP services, respectively. The total cost associated with implementation and first year operations for the fixed site was $407,217.22 or $729.72 per participant and $311,625.52 or $2415.70 per participant for the mobile unit. The largest cost component for both modalities was time-dependent costs (personnel and overhead), while intervention materials (syringes, injection equipment, naloxone) were less than 15% of the total program cost. DISCUSSION/CONCLUSION: Implementation and operation of new SSP models continue to be low cost compared to treatment for the multitude of harms PWID face without access to evidence-based prevention. Future cost-effectiveness and cost-benefit analyses integrating a comprehensive SSP model within an academic institution, including onsite wound care and other medical services, will provide a more comprehensive understanding of this model, and state-level policy action must be taken to lift the prohibition of state and local funds for the implementation, sustainability, and maintenance of these programs in Florida.


Subject(s)
HIV Infections , Substance Abuse, Intravenous , Academic Medical Centers , HIV Infections/prevention & control , Humans , Needle-Exchange Programs , Retrospective Studies , Syringes
15.
Am J Prev Med ; 61(5 Suppl 1): S118-S129, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1499600

ABSTRACT

Diagnoses of HIV among people who inject drugs have increased in the U.S. during 2014-2018 for the first time in 2 decades, and multiple HIV outbreaks have been detected among people who inject drugs since 2015. These epidemiologic trends pose a significant concern for achieving goals of the federal initiative for Ending the HIV Epidemic in the U.S. Syringe services programs are cost effective, safe, and highly effective in reducing HIV transmission and are an essential component of a comprehensive, integrated approach to addressing these concerns. Yet, geographic coverage of these programs remains limited in the U.S., and many jurisdictions continue to have laws and policies that limit or disallow syringe services programs. An in-depth literature review was conducted on the role of syringe services programs in the Ending the HIV Epidemic initiative. Empirical and model-based evidence consistently shows that syringe services programs have the highest impact in HIV prevention when combined with access to medications for substance use disorder and antiretroviral therapy. Their effectiveness is further maximized when they provide services without restrictions and include proven and innovative strategies to expand access to harm-reduction and clinical services (e.g., peer outreach, telehealth). Increasing geographic and service coverage of syringe services programs requires strong and sustainable policy, funding, and community support and will need to address new challenges related to the COVID-19 pandemic. Syringe services programs have a key role in all 4 Ending the HIV Epidemic initiative strategies-Prevent, Diagnose, Treat, and Respond-and thus are instrumental to its success in preventing disease and saving lives.


Subject(s)
COVID-19 , HIV Infections , Substance Abuse, Intravenous , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV Infections/prevention & control , Harm Reduction , Humans , Pandemics , SARS-CoV-2 , Substance Abuse, Intravenous/complications , Substance Abuse, Intravenous/epidemiology , Syringes
17.
BMJ Support Palliat Care ; 11(3): 303-304, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1379624
18.
Int J Pharm ; 608: 121053, 2021 Oct 25.
Article in English | MEDLINE | ID: covidwho-1373073

ABSTRACT

As global vaccine production capacity is limited, every optimization strategy must be explored to rapidly increase the number of people vaccinated. The objective of this study is to determine which medical devices allow the extraction of the maximum number of doses from different vaccine vials (Pfizer-BioNTech, AstraZeneca, Moderna and Johnson & Johnson vaccines) by analyzing all the factors involved in the preparation of the injected doses. By measuring the dead-volume of 32 syringe-needle combinations, we show that fixed-needle syringe with a dead-volume of less than 5 µL can extract up to 7 doses from Pfizer vials, 13 doses from AstraZeneca vials, 12 doses from Moderna vials and 6 doses from Johnson & Johnson vials. We found that the syringe accuracy is important, and can compromise the chances of extracting additional doses when withdrawing too large a volume. For Pfizer vaccine, particular attention must be paid to the choice of dilution syringe, which may compromise the extraction of the 7th dose. The withdrawal of extra doses from vaccine vials was not operator-dependent. In this unprecedented health context, the medical device considerations presented here could help to optimize every COVID-19 vaccine vial.


Subject(s)
COVID-19 , Syringes , COVID-19 Vaccines , Humans , Needles , SARS-CoV-2
19.
AIDS Behav ; 26(1): 57-68, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1263159

ABSTRACT

Syringe services programs (SSPs) are essential to preventing injection drug use-related infections and overdose death among people who use drugs (PWUD). The novel coronavirus (COVID-19) pandemic initially impeded SSPs' operations. To effectively support these programs, information is needed regarding SSPs' experiences adapting their services and the challenges posed by COVID-19. We conducted qualitative interviews with leadership and staff from a sample of 31 U.S. SSPs. Respondents discussed urgent concerns including reduced reach of services, suspended HIV/hepatitis C testing, high COVID-19 risk among PWUD, and negative impacts of isolation on overdose and mental health. They also noted opportunities to improve future services for PWUD, including shifting to evidence-based distribution practices and maintaining regulatory changes that increased access to opioid use disorder medications post-pandemic. Findings can inform efforts to support SSPs in restoring and expanding services, and provide insight into SSPs' role in engaging PWUD during the COVID-19 response and future emergencies.


RESUMEN: Los programas de servicios de jeringas (reconocido como SSP en inglés) son esenciales para prevenir las infecciones relacionadas con el consumo de drogas inyectables y la muerte por sobredosis entre las personas que consumen drogas (reconocidos como PWUD en ingles). La nueva pandemia del coronavirus (COVID-19) inicialmente impidió las operaciones de los SSP. Para apoyar eficazmente estos programas, se necesita información sobre las experiencias de los SSP que adaptan sus servicios y los desafíos que plantea COVID-19. Realizamos entrevistas cualitativas con el liderazgo y el personal de una muestra de 31 SSPs de EE.UU. Los encuestados discutieron las preocupaciones urgentes, incluyendo la reducción del alcance de los servicios, la suspensión de las pruebas de VIH/hepatitis C, el alto riesgo de COVID-19 entre la PWUD, y los impactos negativos del aislamiento en las sobredosis y la salud mental. También identificaron las oportunidades de mejorar los servicios futuros para las PWUD, incluyendo el cambio a prácticas de distribución basadas en evidencias y el mantenimiento de cambios regulatorios que aumentaran el acceso a medicamentos para el trastorno por consumo de opiáceos después de la pandemia. La información que se encontró en este estudio se puede utilizar junto los esfuerzos para apoyar a los SSP en la restauración y expansión de los servicios, y proporcionar información sobre el papel de los SSP en la participación de PWUD durante la respuesta covid-19 futuras emergencias.


Subject(s)
COVID-19 , HIV Infections , Substance Abuse, Intravenous , HIV Infections/epidemiology , HIV Infections/prevention & control , Harm Reduction , Humans , Needle-Exchange Programs , Pandemics , SARS-CoV-2 , Substance Abuse, Intravenous/epidemiology , Syringes
20.
BMC Public Health ; 21(1): 630, 2021 03 31.
Article in English | MEDLINE | ID: covidwho-1166900

ABSTRACT

BACKGROUND: A key strategy for mitigating the current opioid epidemic is expanded access to medications for treating opioid use disorder (MOUD). However, interventions developed to expand MOUD access have limited ability to engage opioid users at higher levels of overdose risk, such as those who inject opioids. This paper describes the study protocol for testing STAMINA (Syringe Service Telemedicine Access for Medication-assisted Intervention through NAvigation), an intervention that engages high-risk opioid users at community-based syringe service programs (SSP) and quickly links them to MOUD using a telemedicine platform. METHODS: This randomized control trial will be conducted at three SSP sites in Chicago. All participants will complete an initial assessment with a provider from a Federally Qualified Health Center who can prescribe or refer MOUD services as appropriate. The control arm will receive standard referral to treatment and the intervention arm will receive immediate telemedicine linkage to the provider and (depending on the type of MOUD prescribed) provided transportation to pick up their induction prescription (for buprenorphine or naltrexone) or attend their intake appointment (for methadone). We aim to recruit a total of 273 participants over two years to provide enough power to detect a difference in our primary outcome of MOUD treatment linkage. Secondary outcomes include treatment engagement, treatment retention, and non-MOUD opioid use. Data will be collected using structured interviews and saliva drug tests delivered at baseline, three months, and six months. Fixed and mixed effects generalized linear regression analyses and survival analysis will be conducted to compare the probabilities of a successful treatment linkage between the two arms, days retained in treatment, and post-baseline opioid and other drug use. DISCUSSION: If successful, STAMINA's telemedicine approach will significantly reduce the amount of time between SSP clients' initial indication of interest in the medication and treatment initiation. Facilitating this process will likely lead to stronger additional treatment- and recovery-oriented outcomes. This study is also timely given the need for more rigorous testing of telemedicine interventions in light of temporary regulatory changes that have occurred during the COVID-19 pandemic. TRIAL REGISTRATION: ClinicalTrials.gov (Clinical Trials ID: NCT04575324 and Protocol Number: 1138-0420). Registered 29 September 2020. The study protocol is also registered on the Open Science Framework (DOI 10.17605/OSF.IO/4853 M).


Subject(s)
COVID-19 , Needle-Exchange Programs , Opioid-Related Disorders , Telemedicine , Chicago , Humans , Opioid-Related Disorders/drug therapy , Pandemics , Quality of Life , Randomized Controlled Trials as Topic , Syringes
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