Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs

Kirsten M.A. Trayner, Andrew McAuley, Norah E. Palmateer, David J. Goldberg, Samantha J. Shepherd, Rory N Gunson, Emily J Tweed, Saket Priyadarshi, Catriona Milosevic, Sharon J. Hutchinson

Research output: Contribution to journalArticle

9 Downloads (Pure)

Abstract

Background:Whilst injecting drugs in public places is considered a proxy for high risk behaviour among people who inject drugs (PWID), studies quantifying its relationship with multiple drug-related harms are lacking and none have examined this in the context of an ongoing HIV outbreak (located in Glasgow, Scotland). We aimed to: 1) estimate the prevalence of public injecting in Scotland and associated risk factors; and 2) estimate the association between public injecting and HIV, current HCV, overdose, and skin and soft tissue infections (SSTI).Methods:Cross-sectional, bio-behavioural survey (including dried blood spot testing to determine HIV and HCV infection) of 1469 current PWID (injected in last 6 months) recruited by independent interviewers from 139 harm reduction services across Scotland during 2017–18. Primary outcomes were: injecting in a public place (yes/no); HIV infection; current HCV infection; self-reported overdose in the last year (yes/no) and SSTI the last year (yes/no). Multi-variable logistic regression was used to determine factors associated with public injecting and to estimate the association between public injecting and drug-related harms (HIV, current HCV, overdose and SSTI).Results:Prevalence of public injecting was 16% overall in Scotland and 47% in Glasgow city centre. Factors associated with increased odds of public injecting were: recruitment in Glasgow city centre (aOR=5.45, 95% CI 3.48–8.54, p<0.001), homelessness (aOR=3.68, 95% CI 2.61–5.19, p<0.001), high alcohol consumption (aOR=2.42, 95% CI 1.69–3.44, p<0.001), high injection frequency (≥4 per day) (aOR=3.16, 95% CI 1.93–5.18, p<0.001) and cocaine injecting (aOR=1.46, 95% CI 1.00 to 2.13, p = 0.046). Odds were lower for those receiving opiate substitution therapy (OST) (aOR=0.37, 95% CI 0.24 to 0.56, p<0.001) and older age (per year increase) (aOR=0.97, 95% CI 0.95 to 0.99, p = 0.013). Public injecting was associated with an increased risk of HIV infection (aOR=2.11, 95% CI 1.13–3.92, p = 0.019), current HCV infection (aOR=1.49, 95% CI 1.01–2.19, p = 0.043), overdose (aOR=1.59, 95% CI 1.27–2.01, p<0.001) and SSTI (aOR=1.42, 95% CI 1.17–1.73, p<0.001).Conclusions:These findings highlight the need to address the additional harms observed among people who inject in public places and provide evidence to inform proposals in the UK and elsewhere to introduce facilities that offer safer drug consumption environments.
Original languageEnglish
Article number102663
Number of pages9
JournalInternational Journal of Drug Policy
Volume77
Early online date22 Jan 2020
DOIs
Publication statusE-pub ahead of print - 22 Jan 2020

Fingerprint

Soft Tissue Infections
HIV
Scotland
Pharmaceutical Preparations
HIV Infections
Skin
Opiate Alkaloids
Dried Blood Spot Testing
Harm Reduction
Homeless Persons
Proxy
Risk-Taking
Infection
Cocaine
Alcohol Drinking
Disease Outbreaks
Surveys and Questionnaires
Logistic Models
Interviews
Injections

Keywords

  • public injecting
  • drug-related harms
  • HIV
  • harm reduction
  • people who inject drugs

Cite this

@article{a88f175e0ca9462d9d5e916f4f6749bf,
title = "Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs",
abstract = "Background:Whilst injecting drugs in public places is considered a proxy for high risk behaviour among people who inject drugs (PWID), studies quantifying its relationship with multiple drug-related harms are lacking and none have examined this in the context of an ongoing HIV outbreak (located in Glasgow, Scotland). We aimed to: 1) estimate the prevalence of public injecting in Scotland and associated risk factors; and 2) estimate the association between public injecting and HIV, current HCV, overdose, and skin and soft tissue infections (SSTI).Methods:Cross-sectional, bio-behavioural survey (including dried blood spot testing to determine HIV and HCV infection) of 1469 current PWID (injected in last 6 months) recruited by independent interviewers from 139 harm reduction services across Scotland during 2017–18. Primary outcomes were: injecting in a public place (yes/no); HIV infection; current HCV infection; self-reported overdose in the last year (yes/no) and SSTI the last year (yes/no). Multi-variable logistic regression was used to determine factors associated with public injecting and to estimate the association between public injecting and drug-related harms (HIV, current HCV, overdose and SSTI).Results:Prevalence of public injecting was 16{\%} overall in Scotland and 47{\%} in Glasgow city centre. Factors associated with increased odds of public injecting were: recruitment in Glasgow city centre (aOR=5.45, 95{\%} CI 3.48–8.54, p<0.001), homelessness (aOR=3.68, 95{\%} CI 2.61–5.19, p<0.001), high alcohol consumption (aOR=2.42, 95{\%} CI 1.69–3.44, p<0.001), high injection frequency (≥4 per day) (aOR=3.16, 95{\%} CI 1.93–5.18, p<0.001) and cocaine injecting (aOR=1.46, 95{\%} CI 1.00 to 2.13, p = 0.046). Odds were lower for those receiving opiate substitution therapy (OST) (aOR=0.37, 95{\%} CI 0.24 to 0.56, p<0.001) and older age (per year increase) (aOR=0.97, 95{\%} CI 0.95 to 0.99, p = 0.013). Public injecting was associated with an increased risk of HIV infection (aOR=2.11, 95{\%} CI 1.13–3.92, p = 0.019), current HCV infection (aOR=1.49, 95{\%} CI 1.01–2.19, p = 0.043), overdose (aOR=1.59, 95{\%} CI 1.27–2.01, p<0.001) and SSTI (aOR=1.42, 95{\%} CI 1.17–1.73, p<0.001).Conclusions:These findings highlight the need to address the additional harms observed among people who inject in public places and provide evidence to inform proposals in the UK and elsewhere to introduce facilities that offer safer drug consumption environments.",
keywords = "public injecting, drug-related harms, HIV, harm reduction, people who inject drugs",
author = "Trayner, {Kirsten M.A.} and Andrew McAuley and Palmateer, {Norah E.} and Goldberg, {David J.} and Shepherd, {Samantha J.} and Gunson, {Rory N} and Tweed, {Emily J} and Saket Priyadarshi and Catriona Milosevic and Hutchinson, {Sharon J.}",
note = "Acceptance in SAN OA article",
year = "2020",
month = "1",
day = "22",
doi = "10.1016/j.drugpo.2020.102663",
language = "English",
volume = "77",
journal = "International Journal of Drug Policy",
issn = "0955-3959",
publisher = "Elsevier B.V.",

}

Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs. / Trayner, Kirsten M.A.; McAuley, Andrew; Palmateer, Norah E.; Goldberg, David J.; Shepherd, Samantha J.; Gunson, Rory N ; Tweed, Emily J; Priyadarshi, Saket; Milosevic, Catriona; Hutchinson, Sharon J.

In: International Journal of Drug Policy, Vol. 77, 102663, 03.2020.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs

AU - Trayner, Kirsten M.A.

AU - McAuley, Andrew

AU - Palmateer, Norah E.

AU - Goldberg, David J.

AU - Shepherd, Samantha J.

AU - Gunson, Rory N

AU - Tweed, Emily J

AU - Priyadarshi, Saket

AU - Milosevic, Catriona

AU - Hutchinson, Sharon J.

N1 - Acceptance in SAN OA article

PY - 2020/1/22

Y1 - 2020/1/22

N2 - Background:Whilst injecting drugs in public places is considered a proxy for high risk behaviour among people who inject drugs (PWID), studies quantifying its relationship with multiple drug-related harms are lacking and none have examined this in the context of an ongoing HIV outbreak (located in Glasgow, Scotland). We aimed to: 1) estimate the prevalence of public injecting in Scotland and associated risk factors; and 2) estimate the association between public injecting and HIV, current HCV, overdose, and skin and soft tissue infections (SSTI).Methods:Cross-sectional, bio-behavioural survey (including dried blood spot testing to determine HIV and HCV infection) of 1469 current PWID (injected in last 6 months) recruited by independent interviewers from 139 harm reduction services across Scotland during 2017–18. Primary outcomes were: injecting in a public place (yes/no); HIV infection; current HCV infection; self-reported overdose in the last year (yes/no) and SSTI the last year (yes/no). Multi-variable logistic regression was used to determine factors associated with public injecting and to estimate the association between public injecting and drug-related harms (HIV, current HCV, overdose and SSTI).Results:Prevalence of public injecting was 16% overall in Scotland and 47% in Glasgow city centre. Factors associated with increased odds of public injecting were: recruitment in Glasgow city centre (aOR=5.45, 95% CI 3.48–8.54, p<0.001), homelessness (aOR=3.68, 95% CI 2.61–5.19, p<0.001), high alcohol consumption (aOR=2.42, 95% CI 1.69–3.44, p<0.001), high injection frequency (≥4 per day) (aOR=3.16, 95% CI 1.93–5.18, p<0.001) and cocaine injecting (aOR=1.46, 95% CI 1.00 to 2.13, p = 0.046). Odds were lower for those receiving opiate substitution therapy (OST) (aOR=0.37, 95% CI 0.24 to 0.56, p<0.001) and older age (per year increase) (aOR=0.97, 95% CI 0.95 to 0.99, p = 0.013). Public injecting was associated with an increased risk of HIV infection (aOR=2.11, 95% CI 1.13–3.92, p = 0.019), current HCV infection (aOR=1.49, 95% CI 1.01–2.19, p = 0.043), overdose (aOR=1.59, 95% CI 1.27–2.01, p<0.001) and SSTI (aOR=1.42, 95% CI 1.17–1.73, p<0.001).Conclusions:These findings highlight the need to address the additional harms observed among people who inject in public places and provide evidence to inform proposals in the UK and elsewhere to introduce facilities that offer safer drug consumption environments.

AB - Background:Whilst injecting drugs in public places is considered a proxy for high risk behaviour among people who inject drugs (PWID), studies quantifying its relationship with multiple drug-related harms are lacking and none have examined this in the context of an ongoing HIV outbreak (located in Glasgow, Scotland). We aimed to: 1) estimate the prevalence of public injecting in Scotland and associated risk factors; and 2) estimate the association between public injecting and HIV, current HCV, overdose, and skin and soft tissue infections (SSTI).Methods:Cross-sectional, bio-behavioural survey (including dried blood spot testing to determine HIV and HCV infection) of 1469 current PWID (injected in last 6 months) recruited by independent interviewers from 139 harm reduction services across Scotland during 2017–18. Primary outcomes were: injecting in a public place (yes/no); HIV infection; current HCV infection; self-reported overdose in the last year (yes/no) and SSTI the last year (yes/no). Multi-variable logistic regression was used to determine factors associated with public injecting and to estimate the association between public injecting and drug-related harms (HIV, current HCV, overdose and SSTI).Results:Prevalence of public injecting was 16% overall in Scotland and 47% in Glasgow city centre. Factors associated with increased odds of public injecting were: recruitment in Glasgow city centre (aOR=5.45, 95% CI 3.48–8.54, p<0.001), homelessness (aOR=3.68, 95% CI 2.61–5.19, p<0.001), high alcohol consumption (aOR=2.42, 95% CI 1.69–3.44, p<0.001), high injection frequency (≥4 per day) (aOR=3.16, 95% CI 1.93–5.18, p<0.001) and cocaine injecting (aOR=1.46, 95% CI 1.00 to 2.13, p = 0.046). Odds were lower for those receiving opiate substitution therapy (OST) (aOR=0.37, 95% CI 0.24 to 0.56, p<0.001) and older age (per year increase) (aOR=0.97, 95% CI 0.95 to 0.99, p = 0.013). Public injecting was associated with an increased risk of HIV infection (aOR=2.11, 95% CI 1.13–3.92, p = 0.019), current HCV infection (aOR=1.49, 95% CI 1.01–2.19, p = 0.043), overdose (aOR=1.59, 95% CI 1.27–2.01, p<0.001) and SSTI (aOR=1.42, 95% CI 1.17–1.73, p<0.001).Conclusions:These findings highlight the need to address the additional harms observed among people who inject in public places and provide evidence to inform proposals in the UK and elsewhere to introduce facilities that offer safer drug consumption environments.

KW - public injecting

KW - drug-related harms

KW - HIV

KW - harm reduction

KW - people who inject drugs

U2 - 10.1016/j.drugpo.2020.102663

DO - 10.1016/j.drugpo.2020.102663

M3 - Article

VL - 77

JO - International Journal of Drug Policy

JF - International Journal of Drug Policy

SN - 0955-3959

M1 - 102663

ER -