Background: There is no research on public health interventions that alert people who inject drugs (PWID) to clusters/outbreaks of severe bacterial infections. In Scotland, during the botulism cluster/outbreak of Dec 2014-July 2015 harm reduction (HR) messages detailed on a postcard (Botulism Postcard) were distributed to PWID between Feb-April 2015. We examined the impact of the Botulism Postcard on cluster/outbreak awareness, healthcare seeking and HR behaviours among PWID; and their views on such clusters/outbreaks.Methods: The Botulism Postcard questionnaire survey was undertaken with 288 PWID recruited in Greater Glasgow and Clyde between May-August 2015. Multivariate logistic regression was undertaken. Between Oct 2015-January 2016 22 in-depth interviews were conducted with PWID in Glasgow and Edinburgh, these underwent thematic analysis. Results: 38% (108/284) had never seen the postcard, 14% (40/284) had only seen it, 34% (98/284) read but not discussed it and 13% (38/284) had discussed it with service staff. Cluster/outbreak awareness was higher among those who had read (adjusted odds ratio (aOR) = 5.374, CI 2.394-11.349, p<0.001) or discussed the postcard (aOR = 25.114, CI 3.188-190.550, p <0.001); and symptom awareness was higher among those who had read (aOR = 2.664, CI 1.322-4.890, p<0.001) or discussed the postcard (aOR=6.707, CI 2.744-16.252, p<0.001) than among those who had never seen it. The odds of introducing HR was higher among those who had discussed the postcard (AOR= 3.304 CI 1.425-7.660, p<0.01) than those who had only read it. PWID learnt about clusters/outbreaks from several sources and despite concerns they continued to inject during such events.Conclusion: More widespread exposure to the Botulism Postcard during the outbreak/cluster was needed. The Botulism Postcard distributed to PWID may raise awareness of such events, the symptoms, and may encourage HR particularly when used as a tool by frontline staff to initiate discussion. Acknowledging that people continue to inject during clusters/outbreaks of such infections necessitates a pragmatic HR approach.
- spore forming bacteria
- injecting drug users
Dunleavy, K., Munro, A., Roy, K., Hutchinson, S., Palmateer, N., Knox, T., Goldberg, D., Hope, V., Campbell, J., Hamilton, E., Liddell, D., Penrice, G., & Taylor, A. (2018). Spore forming bacteria infections and people who inject drugs: implications for harm reduction. International Journal of Drug Policy, 53, 45-54. https://doi.org/10.1016/j.drugpo.2017.12.001