Dissertations / Theses on the topic 'Needle and syringe programs'
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Hagan, Hollis. "Syringe exchange and risk of hepatitis B and C in injection drug users /." Thesis, Connect to this title online; UW restricted, 1997. http://hdl.handle.net/1773/10958.
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Gibson, Brendan John Joseph, and brendan gibson@health gov au. "From Transfer to Transformation: Rethinking the Relationship between Research and Policy." The Australian National University. National Centre for Epidemiology and Population Health, 2004. http://thesis.anu.edu.au./public/adt-ANU20040528.165124.
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The most common and enduring explanation for the way research is used (or abused or not used) in policy is the two communities theory. According to this theory, the problematic relationship between research and policy is caused by the different cultures inhabited by policy makers and researchers. The most common and enduring types of strategies that are put forward to increase research use in policy involve bridging or linking these two communities. This study challenges this way of thinking about the relationship between research and policy. Four case studies of national public health policy in Australiabreast cancer screening, prostate cancer screening, needle and syringe programs in the community, and needle and syringe programs in prisonsare used to present the context, events, processes, research, and actors involved in policy making. Three theories are deployed to explore the relationship between research and policy in each of the cases individually and across the cases as a whole. These theories bring different determinants and dynamics of the relationship to light and each is at least partially successful in increasing our understanding of the relationship between research and policy. The Advocacy Coalition Framework (ACF) understands the relationship in terms of a power struggle between competing coalitions that use research as a political resource in the policy process. The Policy Making Organisation Framework (PMOF) understands the relationship in terms of institutional and political factors that determine the way data is selected or rejected from the policy process. The Governmentality Framework (GF) understands the relationship in terms of the Foucauldian construct of power/knowledge that is created through discourse, regimes of truth and regimes of practices found in public health policy and research. This study has found that in three of the four case studies, public health policy was strongly influenced by research, the exception being NSP in prisons. In all cases, however, it is not possible to construct a robust and coherent account of the policy process or the policy outcome without considering the multifaceted role of research. When these theories are explored at a more fundamental level they support the argument that when research influences policy it is transformed into knowledge-for-policy by being invested with meaning and power. This process of transformation occurs through social and political action that mobilises ideal structures (such as harm minimisation and the World Health Organisations principles for evaluating screening programs) and material structures (such as medical journals and government advisory bodies) to resolve meta-policy problems (such as how to define complex public health problems in a way that makes them amenable to empirical research and practical action). This study provides good evidence that the notion of research transfer between two communities is a flawed way of understanding the researchpolicy relationship. Rethinking the relationship between research and policy involves building an enhanced theoretical repertoire for understanding this complex social interaction. This step is essential to the success of future efforts to make public health policy that is effective, just and emancipatory. This study makes a contribution to this task.
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Hunter, Carole. "Evaluation of syringe markers distributed through community pharmacy needle exchanges." Thesis, University of Stirling, 2012. http://hdl.handle.net/1893/11096.
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The aim of this study is to evaluate the supply of markers for the identification of syringes distributed by pharmacy needle exchanges and to determine if this product and service delivery offers a feasible method of marking syringes to promote the reduction of accidental sharing of syringes and needles amongst injecting drug users (IDU) and thereby reduce the risk of transmission of blood borne viruses (BBVs) and other related infections. This study involves the assessment, implementation and evaluation of syringe markers as a pilot study within three community pharmacy sites in Glasgow. The secondary aims of the study were to identify whether the supply of syringe markers from community pharmacy needle exchanges was acceptable to IDU and if it enabled them to mark their syringes. The literature review demonstrates that providing a means of identification of personal injecting equipment has been proposed as a viable option that should be promoted to prevent the inadvertent accidental sharing of syringes within a group setting. Needle exchanges (NEX) are important component parts of the harm reduction responses designed to reduce the physical health harms caused to individuals through injecting drug use. The literature is reviewed on BBV transmission and the historical, legal and policy context associated with the development of NEXs. Community pharmacies act as a source of health advice and can help to facilitate access to treatment services for those attending the NEX. However the specific aim of this study is not to investigate the totality of the benefits of a NEX but to examine the supply of a potential means of reducing accidental and unintentional sharing of all injecting equipment and thereby contribute to minimising some of the health harms linked to injecting drug use. Three established community pharmacies were identified as suitable sites to pilot the supply of syringe markers. A number of criteria were used to select the sites. These included an assessment of the geographic locations, staffing arrangements, NEX attendances and transactional activity and the availability of private consultation facilities. The health board central database which holds records on a range of factors including, the characteristics of those who attend NEX and detailed information on all transactions, was used to identify the most suitable sites to pilot the new intervention. This indicated that the characteristics of those who attended the three chosen sites were broadly similar to the wider NEX attending population. The evaluation was conducted in two separate periods. The first 4 week period was the supply phase where markers were distributed over this period to all patients receiving NEX packs from the 3 pharmacies. The second data collection phase was undertaken in the following 4 week period. Data was collected by means of a structured questionnaire. In order to reduce the potential interviewer bias it was decided to incorporate the use of peer researchers in the administration of the questionnaire. The Scottish Drugs Forum (SDF) was approached and agreement was reached to use members of the Service User Involvement Group (SUIG) to assist with the design and administration of the questionnaire. A submission was made to the health board Research Ethics Committee (REC) and approval was given to enable the study and the research evaluation to proceed. Before the start of the study, joint briefing and training sessions were held for pharmacy staff from the 3 sites and the 6 participating SUIG members. A total of 177 questionnaires were completed during the second data collection phase of the evaluation. Information was collected on personal details and injecting behaviours (including deliberate and accidental sharing), any current means of syringe identification, use of the markers and on the usefulness of the instruction card. Most individuals (75%, n=132) had been supplied with the markers to trial during the first supply phase of the study with 63% of the 132 (n=83) of those individuals reporting use of the markers. The results of the evaluation and subsequent analysis of the findings indicated that the syringe marker supply could be successfully implemented using pharmacy NEXs. The product and the supply method were acceptable to both staff and service users. Initial bivariate analysis was conducted using a number of dependent and independent variables identified within the questionnaire. These findings highlighted a number of areas worthy of further exploration, including emerging differences between male and female respondents, and indicated specific target groups for future developments in syringe identification. The contribution of the peer researchers was found to be a significant factor in successfully completing the evaluation. However it is not possible to make any definitive statements on how effective the intervention is in terms of reducing the transmission of BBVs and other related infections. The findings of the evaluation indicated a number of potential areas of work that could be usefully explored to investigate the effectiveness of the markers in reducing the transmission of infections. The limitations of the evaluation became apparent during the course of the study and the implications of these limitations are discussed.
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Straube, Ragnar, and Abouaoun Denny. "Ett skademinimerande arbete : Sprututbytesprogrammet i Sverige." Thesis, Malmö universitet, Malmö högskola, Institutionen för socialt arbete (SA), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-43181.
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Earlier research shows that persons who inject drugs are in heightened need of healthcare and medical assistance. But research has also shown that it can be difficult for them to receive care and assistance due to their circumstances. Sweden has a long history of restrictive drug policy and practice. This has affected how care for drug users has been managed and formed. In recent years, due to a change in the Swedish legislation, it has become easier to establish needle exchange programs. As a result, there has been an increase in the number of needle exchange programs during the last five years. The aim of this study was to examine the harm reducing work that is done within the swedish needle exchange program. For this, the study primarily focused on how the staff perceived harm reduction work, its possibilities and difficulties. The data was collected through four semistructured interviews with staff at needle exchanges in Sweden. The participants were either nurses or counselors, working at either newer or more established needle exchanges. The data was coded into the following themes; Reduction of harm- and transmission of infectious diseases, The outlook on drug abuse and The importance of treatment and relations. The results show that harm reduction is perceived to be a pragmatic alternative to the traditional care of drug users by the staff. The participants do stress that needle exchange programs by themselves aren't enough to reduce the harms of addiction. The results also highlight the importance of the relational- and emotional work, which is a real factor for effective harm reduction work. By developing trust and relations, the target groups' needs are both easier expressed and met at needle exchanges.
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Pettyjohn, Samuel, Manul Awasthi, Kelly Foster, and Joseph Baker. "Generational Differences in Support for Syringe Service Programs in Tennessee." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/24.
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People who inject drugs (PWIDs) are the most stigmatized and marginalized people in the general population (Ahern, Stuber, & Galea, 2007; Birtel, Wood, & Kempa, 2017). This group is not easily accessed by typical means of patient outreach and is one of the most underserved populations for primary care, mental health services, and care for chronic infectious diseases associated with injection drug use including HIV and HCV (Ahern et al., 2007; Dean et al., 2000; Livingston, Milne, Fang, & Amari, 2012; Zeremski et al., 2013). Syringe Service Programs (SSPs) can give public health and social support organizations and agencies access to an otherwise underserved population and give PWID potential access to a constellation of care to address multiple comorbidities associated with injection drug use (Barocas et al., 2014; Pollack, Khoshnood, Blankenship, & Altice, 2002; Zeremski et al., 2013). Additionally, the potential access to primary and secondary care that SSPs may connect PWID to, perceived social support is one of the strongest predictors of well-being and mental health among people with stigmatized conditions including HIV/AIDS, HCV, and PWID (Birtel et al., 2017). Wider adoption of SSPs and bridging of SSP clients to Medication Assisted Treatment providers is a potential tool in combating the current opioid epidemic in Tennessee. The Tennessee Poll by ETSU was conducted between March and April of 2017. The Tennessee Poll is an annual statewide public opinion poll conducted by the Applied Social Research Lab (ASRL). In the Tennessee Poll, questions were asked about attitudes and beliefs associated with SSPs and PWID in Tennessee. In a previous project, the research team, using generational demographic categories used in Pew surveys, looked at attitudes about both illicit and medical use of marijuana. In comparison of generations, Millennials were 15.62 times (95% CI 5.6, 43.56, p < .001) more likely to support recreational marijuana legalization versus the reference category (The Silent Generation or the generation before Baby boomers and sometimes called “The Greatest Generation”) and 3.7 times (95% CI 1.47, 9.3, p
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Strike, Carol Janice. "Organizational responses to illegitimacy, the case of needle exchange programs in Ontario." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/NQ58932.pdf.
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Cope, Afton D., and L. Lee Glenn. "Unsafe Injection Procedures and Staff Training." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/7485.
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The study by Rehan et al. [1] was evaluated for support of the conclusion was by the data. The deviations from recommended practices were infrequent and not shown to be clinically significant. Although a strong study, the conclusion that world-wide education programs are needed is not warranted.
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Bangah, Ramesh. "The State of Needle Exchange Programs in Sweden and Hepatitis C Virus Incidence." Thesis, Södertörns högskola, Miljövetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-40833.
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Hepatitis C virus (HCV) affects up to 45,000 people in Sweden today. Although it is a very treatable disease, the prevalence of HCV is extremely high within the population of people who inject drugs (PWID). This study examines the direct effect of needle exchange programs (NEPs) on HCV rates in Sweden. Previous research has shown that NEPs reduce the transmission of other blood-borne diseases among PWID. Using an interrupted time series (ITS) analysis, this study investigates if there are statistically significant differences between HCV rates in Swedish counties before and after the implementation of NEPs. The study also investigates via linear regression to see if there is a relationship between sterile injecting equipment (needles and syringes) dispensed and HCV rates in the counties where NEPs exist. While there has been a steady decrease in HCV rates across the country as a whole, the ITS analyses show no statistically significant differences in HCV rates due to the opening of NEPs. Because of the relatively recent introduction of NEPs in Sweden, more data points post-intervention may be needed before we can truly see the effect they have on regional HCV rates. There is also no relationship between the number of needles and syringes dispensed and county HCV rates. However, Sweden falls far short of the 300 syringes/needles per user per year recommendation of the World Health Organization at this time. Standardized data collection and further research can help answer these questions more clearly.
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Rålenius, Gustav. "Vägen till sprututbytet : Studie av brukarinflytande vid implementeringen av sprututbytet i Stockholm län." Thesis, Stockholms universitet, Statsvetenskapliga institutionen, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-115591.
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Studien undersöker förekomsten av brukarinflytande vid implementeringen av det första sprututbytet i Stockholms län. I studien ges en bakgrund till Sveriges narkotikapolitik och hur dess utvecklingen har sett ut från 70- talet fram till idag. I bakgrunden till studien presenteras ett governace-perspektiv på brukarinflytande och de deliberativa processer där brukarinflytande är en naturlig del av policyprocessen. Syftet med studien är undersöka förekomsten av brukarinflytande i implementeringsdelen av den besluts- policyprocess som ledde fram till sprututbytets öppnande i april 2013. Studiens teoretisk ramverk består av teorier som ifrågasätter givenheten i governance-synsättet på brukarinflytande genom hänvisning till svårigheter med aktörskap och risken med konstruerat brukarinflytande. Forskningsstrategin som studien utgår ifrån är intervjuer med utvalda respondenter som har varit delaktiga vid implementeringen av sprututbytet samt brukarorganisationer som representerar och företräder sprututbytets målgrupp. Resultatet av studien visar på en svag förekomst av brukarinflytande vid implementeringen av sprututbytet. Det brukarinflytande som kan anses har förekommit har varit på en individuell nivå och icke-formaliserat. I analysen presenteras tre möjlig förklaringar till den svaga förekomsten av brukarinflytande vid implementeringen av sprututbytet samt en analys om svårigheter med aktörskap vid implementeringen kopplat till studiens teoretiska ramverk.This study examines the occurrence of user influence during the implementation of the first Needle and Syringe exchange Programme (NSP) in Stockholm County. The survey in his study consists of interviews conducted with persons that have been involved during the process and debate around the NSP in Stockholm County. The interviews have been conducted with two different groups of actors: User organizations and public actors. The first group called user organizations consists of actors from three different user organizations representing and organizing the target group for the NSP. The second group called public actors consists of public actors which have been involved under and/or before the implementation of the NSP in Stockholm County. The study contains a description of the background of NSPs in Sweden. The study describes the development of the Swedish drug policy from 1970 until today. Further it covers the development of the NSPs in other parts of Sweden as well as the development of harm reduction as a general strategy for drug addiction management. Several definitions to the terms user and user influence are presented. Four are conventional definitions of the term user, together with a fifth one which is then used within in the context of the study. The study presents definitions of the term user influence by a model dividing user influence in three categories: individual level, operational level and system level. Another division of the term user influence presented is formalized and non-formalized user influence. These different classifications are used in the analysis of the results. The study also presents a background to the governance view on user influence as a natural and unproblematic part in the policy process. The theoretical framework in the study consists of two parts: The first part questions governance and the given of user influence within a policy process. The study highlights the problems with a governance view on actorhood and user influence. The second part of the theory chapter presents a model for the policy process. The policy process is described in five stages: Initiation, processing, decision making, implementation and evaluation. The results of the survey show little occurrence of user influence during the implementation of the NSP. By using the classification with the three different levels of user influence the result is that the occurrence of user influence found in the investigation has the characteristics of individual level user influence. The study also shows that the user influence found can be classified as non-formalised influence. The analysis first discusses the factors of why there has been little occurrence of user influence during the implementation of the NSP and proposes three different plausible explanations: Politically sensitive question, structural difficulties and users view was already known. The analysis also discuss the problem with a governance view on actorhood and user influence in relation to the study. The study concludes that there has been little occurrence of user influence during the implementation of the NSP in Stockholm County and that the occurrence of user influence found can be classified as individual level user influence, with one plausible exception.
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Ibrahim, Lauren Sue. "A Case Study of the Acceptance of the Tacoma-Pierce County Needle Exchange Program by Three Diverse Groups: Law Enforcement Personnel, Health Department Officials, and Program Clients (i.e., Intravenous Drug Users)." PDXScholar, 1993. https://pdxscholar.library.pdx.edu/open_access_etds/1383.
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Legitimate and underground needle exchange programs, specifically targeted for intravenous drug users (IVDUs) (i.e., currently the second largest risk group in the AIDS epidemic), have emerged in various locales in a desperate attempt to change their drug use practices and behaviors associated with the transmission of HIV-1/AIDS. This study focuses on one such program, the Tacoma-Pierce County Needle Exchange Program, in which the pioneering efforts of a private individual are provided, the manifestations of public entrepreneurism are examined, and in which various attributes of program acceptance are identified and explored. An introductory and exploratory case study approach is the research strategy used in this dissertation, since it is adaptive and flexible to accommodate the use of multiple data sources. Data have been collected through semi-structured interviews involving four law enforcement personnel and 21 program clients (i.e., IVDUs), which consisted of open-and close-ended questions regarding program acceptance. Existing data sources, such as court documents, published interviews with key officials, journals, and various news articles provide an assessment of the events and activities that relate to the evolution and success of the Tacoma-Pierce County Needle Exchange Program. The attributes identified and explored in this study include: settings, type of staff, method of service delivery (including spillover effects), nature of the geographic area, concern over the effects of AIDS, external environmental conduits (the informal communication network and the media), and characteristics of program clients. These attributes were found to be important to program acceptance of the Tacoma-Pierce County Needle Exchange Program; however, they should be further examined in other communities to see if they remain important. To this extent, the findings indicated that needle exchange programs have complex characteristics attached to them, and that they deserve to be further studied to understand those complexities. Other benefits of the Tacoma-Pierce County Needle Exchange Program found to be important include: (1) fewer citizen complaints about the carelessly discarded, used syringes often found in gutters, parks, greenbelts, alleys, and streets; and (2) fewer reports of infections caused by accidental needle stick injuries among law enforcement personnel (which can occur when a law enforcement officer frisks a suspect), maintenance employees, and grounds-keepers. Overall, phenomenal savings can accrue from such unintentional and additional benefits of needle exchange programs. In light of this debilitating disease, and of the high cost associated with medical care, such innovative interventions are perceived worthy in the course of this deadly epidemic.
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Stenström, Nils. "Sprutbyte vid Intravenöst Narkotikamissbruk : En longitudinell studie av deltagarna i sprutbytesprogrammet i Malmö." Doctoral thesis, Mittuniversitetet, Institutionen för socialt arbete, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-49.
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The aim of this thesis is to describe the users visiting the syringe exchange clinic in Malmö with respect to what characterises the group, how they utilize the services of the clinic and how their patterns of participation relate to risk behaviour, physical and mental health and social development. The heterogeneity of the group has been captured by the use of Stimsons dimensions “integration in majority society” and “involvement in sub-culture”, yielding four different groups of syringe exchangers: “stables”, “loners”, “two-worlders” and “junkies”. The study rests on two sources of data: a register from the clinic including all syringe exchangers that have visited the clinic between 1989 and 2003, altogether 3660 individuals, and an interview of visitors at the clinic during 1995, including 496 persons. The results show that syringe exchangers, compared to other persons with severe addiction in Malmö, to a larger extent use amphetamine as their drug-of-choice, are older and inject more irregularly. The population visiting the clinic is heterogeneous with respect to integration in society and involvement in sub-cultures. The group classified as junkies do, as expected, display the highest inclination to share syringes and needles with other and hence have the most advanced risk behaviours. As to utilization of the programme, the results show that the longer the syringe exchangers stay in the programme, the more frequent they visit it. Also with respect to utilization-patterns, we find substantial variations within the studied group. Five categories are discernible: drop-in visitors with only one or two visits, sporadic visitors who in spite of contacts over a number of years never really establish a regular contact, intermittent visitors who have had contact over several years but display a very irregular visiting pattern, regular visitors who relatively fast establish a consistent contact with visits between uniform time intervals and frequent visitors who tend to stay longer than others and visit the clinic more often. Another aspect of utilization is to what extent the distribution of needles and syringes cover the needs of the visitors. With a strict definition of need, only a minority manages to cover their needs, but if we accept a more extensive individual re-use, around 90 percent of the average need is covered. Data also reveals that a very high proportion of the users on at least one occasion have visited the programme without syringe exchange taking place or any complementary service delivered. Basically these visits seem to be of a more social nature, reinforcing the contacts between the staff and the visitors. Data do not give any clear support for the basic assumption that syringe exchange reduce the incidence of HIV or hepatitis. Recent sharing of utensils or low coverage of syringe need through the programme do not predict a higher infection risk. Instead we find that the social contacts with the staff (without syringe exchange) function as a predictor of lower incidence. This indicates that the mechanisms may be more complex than just related to the provision of clean needles and syringes. The result shows that integration increase over time while sub-cultural involvement decreases. However, the patterns for different groups are very diverse and we find no evidence that more frequent contacts as such are related to increased integration. There is however, some evidence that social visits are positively related to increased integration. No support could be found for the assumption that the programme increases the number of severe addicts.
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Oliver, Kathleen Joan. "Behavioral and Community Impacts of the Portland Needle Exchange Program." PDXScholar, 1995. https://pdxscholar.library.pdx.edu/open_access_etds/1176.
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Research questions were: 1: Will Drug Injectors Use An Exchange In A StateWhere Syringes Are Legal? 2: Will Drug Injectors Using An Exchange Decrease Risky Behavior? 3: Will Frequent Clients Change Risk Behaviors More Than Infrequent Clients? 4: Will Drug Injectors Using An Exchange Change Risk Behaviors More Than A Comparison Group Not Using An Exchange? 5: Does An Exchange Have An Impact On The Number Of Discarded Syringes On The Streets? 6: Is There A Difference In The Rate Of Spread Of HIV Infection Among Users And Non-Users Of The Exchange. Drug injectors will use needle exchange programs, even in a state where syringes are legal. During the first four years, nearly 2,000 drug injectors made approximately 16,000 visits to the Exchange. Clients of the Exchange reduced risky behavior from intake to six months. Change lasted over time: at twelve months, change in behaviors continued to be significant. Frequent users of the Exchange were better on two variables than infrequent users: they borrowed syringes less, and were less likely to use a syringe and throw it away. Drug injectors using the Exchange were compared to those not using the Exchange, but using a bleach/outreach project. Clients of both projects reduced risky behaviors, with Exchange clients better on two variables: re-using syringes without cleaning, and throwing away used syringes. The two projects attracted different drug injectors, and should be viewed as complementary rather than competing AIDS prevention strategies. The impact of the Exchange on the community was evaluated by the change in the number of discarded syringes found on the streets. The number of syringes found per month decreased from 5.14 before the Exchange opened to 1.9 after it began -- a significant side benefit. The data presented here support the growing evidence that needle exchange programs produce behavioral risk reductions, and that the number of potentially infected syringes in public places can be reduced.
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Näslund, Linda. "Ökar livskvalitet hos personer som injicerar droger när tillgång till sprututbyte finns? : En longitudinell studie på Stockholms Sprututbyte." Thesis, Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-7790.
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Bakgrund: Personer som injicerar droger har i tidigare studier visat sig ha en lägre livskvalitet än andra populationer och många lider av psykisk ohälsa. Spridning av blodsmittor som hiv och hepatiter och andra blodburna infektioner kan vara en risk vid injicering. Tillgång till sterila sprutor och kanyler genom sprututbyte är en åtgärd för att minska spridning av infektionssjukdomar. Centralt för psykiatrisk omvårdnad, i likhet med harm reduction, är att värna mänskliga rättigheter, att erbjuda vård på lika villkor och stärka förmågan till egenvård. Syfte: Syftet med denna studie var att undersöka om livskvalitet hos personer som injicerar droger förbättras över tid efter inskrivning på Stockholms sprututbyte samt om det fanns någon skillnad mellan könen. Metod: Denna studie genomfördes som en prospektiv icke-experimentell longitudinell kvantitativ studie. Urvalet bestod av besökare på Stockholms sprututbyte som valde att delta. Studiedeltagarna svarade på livskvalitetsenkäten EQ-5D vid tre mättillfällen. EQ-5D mäter graden av tillfredsställelse i fem dimensioner (indexpoäng) samt innehåller en global skattning av nuvarande hälsotillstånd (EQ VAS). Förändring över tid analyserades med hjälp av ANOVA för upprepade mätningar. Resultat: Resultatet visade på en signifikant förbättring av livskvalitet över tid avseende EQ VAS för hela gruppen. Resultatet visade vidare att kvinnor skattade sitt nuvarande hälsotillstånd EQ VAS signifikant lägre än män. Slutsats: Deltagande i sprututbyte verkar ha betydelse och inverka positivt på hälsorelaterad livskvalitet hos personer som injicerar droger men mer behöver studeras för att få en bredare kunskap om vad det är som gör att det förhåller sig så.Background: People who inject drugs have shown in previous studies to have a lower quality of life than other populations and many suffer from mental illness. The spread of blood infections such as hiv and hepatitis and other blood borne infections can be a risk when injecting. Access to sterile syringes and needles through syringe exchange is a measure to reduce the spread of infectious diseases. Central to psychiatric care, like harm reduction, is to protect human rights, to offer care on equal terms and to strengthen the capacity for self-care. Aim: The purpose of this study was to investigate whether the quality of life of people who inject drugs improves over time after enrollment in Stockholm needle and syringe exchange program and if there were any gender differences. Method: This study was conducted as a prospective non-experimental longitudinal quantitative study. The selection consisted of visitors at the Stockholm exchange who chose to participate. The study participants answered the quality of life questionnaire EQ-5D on three occasions. EQ-5D measures the degree of satisfaction in five dimensions (index points) and contains a global estimate of the current state of health (EQ VAS). Change over time was analyzed using ANOVA for repeated measurements. Results: The results showed a significant improvement in quality of life over time with regard to EQ VAS for the entire group. The results further showed that women estimated their current state of health EQ VAS significantly lower than men. Conclusions: Participation in needle and syringe exchange programs appears to have significance and a positive impact on health-related quality of life but further studies needs to gain a broader knowledge of what it is that makes it so.
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Jones, Christopher McCall. "Estimating the Magnitude and Characteristics of Prescription Opioid Injection Misuse and the Role of Syringe Services Programs in Response to the Opioid Crisis in the United States." Thesis, The George Washington University, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13806240.
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The United States is experiencing an unprecedented crisis of prescription and illicit opioid misuse, addiction and overdose. Coincident with the increase in opioid misuse and addiction in the U.S. over the past decade are rising rates of prescription opioid injection and transmission of infectious diseases such as hepatitis C virus (HCV) and endocarditis.
Following the 2015 HIV outbreak in Scott County, Indiana associated with injection of the prescription opioid oxymorphone, and a decade-long increase in viral hepatitis infection rates, especially in areas of the U.S. with long-standing prescription opioid misuse and addiction, policymakers, public health practitioners, and other stakeholders have become increasingly concerned about prescription opioid injection misuse and related harms.
Syringe Services Programs (SSPs)—evidence-based programs that provide sterile injection equipment and comprehensive infectious disease, substance use, and overdose prevention and treatment services—have been identified as a potential key intervention in response to the opioid crisis and increasing opioid injection. However, there is limited recent research characterizing the population of people injecting prescription opioids and other drugs that can help guide how to best position SSPs to reach and impact this population. Further, the policy environment for SSPs is rapidly evolving, with multiple states enacting laws, regulations, and policies in recent years to enable the establishment of SSPs. Collectively, the research gaps around prescription opioid injection and the changing policy environment for SSPs has created a critical need to better define the characteristics of people who inject prescription opioids, to identify the services and resources needed by this population, and to understand how SSPs are navigating the evolving policy environment in order to maximize their role in response to the opioid crisis.
This dissertation research aims, through the use of mixed methods, to address these knowledge and policy gaps through: 1) systematically reviewing the literature to synthesize what is known about the population of individuals who inject prescription opioids in the U.S.; 2) estimating the magnitude of prescription opioid injection in the United States; 3) examining overall, sociodemographic, and substance use trends and correlates of prescription opioid injection among a nationally representative sample to identify populations at-risk for prescription opioid injection and related harms; and 4) using these quantitative findings to inform a qualitative exploration of SSPs’ responses to the rapidly changing policy environment in the midst of the evolving opioid epidemic and how they can be further leveraged to reduce the harms associated with opioid injection. This dissertation accomplishes these aims through three separate, but related studies. Taken together, the new knowledge produced from this dissertation can be used to inform the development, prioritization, and implementation of policies, programs, and practices that aim to reduce prescription opioid injection and its related harms and expand the role of SSPs in response to the U.S. opioid crisis.
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Wassberg, Bengt, and Johan Ramnebrink. "Sprutbyte – Not In My Back Yard : En diskursanalys om attityder kring införandet av Stockholms sprutbytesverksamhet." Thesis, Linnéuniversitetet, Institutionen för socialt arbete (SA), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-35338.
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About 35 years ago the WHO advocated that countries with injecting drug users should introduce the so-called needle exchange programs (NEP) to curb the spread of infection by blood-borne diseases. In Sweden the first NEP started 1985 in Lund, but the program was extremely controversial in a country with such a restrictive drug policy like Sweden. The study you are about to read shall process this controversy, when a NEP opened in Stockholm, by analyzing the articles published in the newspapers Dagens Nyheter and Svenska Dagbladet. By using discourse analysis as a processing tool we’ll try to see the difference between the two chosen newspapers. We will identify and analyze the different participant’s, such as doctors, politicians, user associations and media, arguments in the needle exchange issue. Our results show that the liberal DN articles were supportive of the NEP and that they considered it to be an infectious disease control issue. The liberal conservative newspaper SvD had a different view of the issue and considered NEP to be a question about drug policy. Even after the decision was made the city had problems to find suitable premises for the NEP to operate from.
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Salman, Rana. "L' impact des programmes de formation continue sur les compétences professionnelles des enseignants dans le contexte éducatif syrien : (cas de l'enseignement de base de la première à la sixième classe)." Thesis, Dijon, 2014. http://www.theses.fr/2014DIJOL005.
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Comme dans la quasi-totalité des pays, les autorités éducatives en Syrie ont des préoccupations quant à l’amélioration de la qualité de l’enseignement et quant aux réformes qu’elles cherchent à mettre en œuvre pour donner aux enseignants la possibilité d’acquérir les nouvelles connaissances et compétences avant et une fois qu’ils exercent leur métier, surtout dans le contexte du changement économique et social de grande ampleur que vit le monde aujourd’hui. La complexification du contexte éducatif a amené les autorités pédagogiques syriennes à accorder une attention particulière aux programmes de la formation initiale et continuée des enseignants. Pour juger de l’efficacité des programmes de formation continue qui existent actuellement en Syrie, la présente thèse s’est fixée comme objectif d’analyser les impacts de ces programmes sur l’amélioration des compétences professionnelles des enseignants. Il ressort des analyses que les programmes de formation continue suivis en Syrie sont positivement corrélés à l’ensemble des compétences professionnelles des enseignants de l’échantillon. Les programmes de formation continue génèrent, d’après les estimations des membres de l’échantillon, une grande différence dans le niveau général de leur travail professionnel. Les analyses ont abouti également à la conclusion que d’autres facteurs jouent dans l’amélioration des compétences des enseignants. L’indicateur de la formation continue est donc statistiquement plus significatif si cette dernière s’adhère aux autres facteursAs in nearly all countries, educational authorities in Syria have concerns about improving the quality of education and about there forms they seek to implement to give teachers the opportunity to acquire new knowledge and skills before and once they start teaching, especially in the context of economic and social change of the magnitude the world lives today. The complexity of the educational context has led the Syrian educational authorities to pay particular attention to programs for initial and continuous training of teachers.To assess the effectiveness of continuous training programs that currently exist in Syria, this thesis has set as its objective to analyze the impact of these programs on the improvement of professional skills of teachers. The statistical analysis shows that continuous training programs followed in Syria are positively correlated with all the professional skills of teachers in the sample. The continuous training programs generate, according to the estimates of the sample, a big difference in the overall level of their professional work. The analysis concludes that other factors play also a role in improving the skills of teachers. The indicator of continuous training programs is statistically significant if it adheres to other factors
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Nordin, Cornelia, and Ida Ragnarsson. "Uppfattning om egenvård och behov av vård hos personer som injicerar droger : En intervjustudie." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-319093.
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Bakgrund Personer som injicerar droger uppsöker vården mindre frekvent än övriga befolkningen men löper ökad risk för ohälsa utifrån olika riskbeteenden såsom att dela injektionsmaterial och bruka olagliga substanser. Ohälsa som uppkommer kopplat till injicering av droger orsakar lidande hos individen samt stora kostnader för sjukvården. Förmåga att ta hand om egenvård påverkar möjligheten att bibehålla hälsa och inkluderas i samhället. Syfte Att utforska hur egenvård uppfattas av personer som injicerar droger samt vilket behov av vård dessa personer ger uttryck för. Metod Kvalitativ intervjustudie med explorativ ansats. Semistrukturerade intervjuer genomfördes med 12 personer som besökte sprututbytesmottagningen vid Karolinska universitetssjukhuset i Stockholm. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat Analysen resulterade i tre kategorier: Önskan om att bibehålla hälsa trots substansbrukssyndrom, Behov av specifik kompetens och personcentrerad vård och Behov av specifik vård och säkra miljöer. I kategorin Önskan om att bibehålla hälsa trots substansbrukssyndrom beskrivs att egenvård uppfattas som att använda droger säkert och att i övrigt upprätthålla en god fysik och psykisk hälsa. I kategorin Behov av specifik kompetens och personcentrerad vård framkom att specifik omvårdnadskompetens och kunskap om substansbrukssyndrom inom hälso- och sjukvården efterfrågas. I kategorin behov av Specifik vård och säkra miljöer beskrivs att personer som injicerar droger efterfrågar tillgång till vård anpassad efter de specifika behov och hälsorisker som droganvändning medför. Slutsats Egenvård uppfattas som att bibehålla hälsa genom att injicera droger på ett säkert sätt, minska riskbeteende samt att undvika att exkluderas från samhället genom att ta hand om utseende, hygien och sträva mot en meningsfull vardag. Respondenterna uttrycker behov av personcentrerad vård, värdigt bemötande samt kompetens avseende droganvändande hos vårdpersonal. En personlig och kontinuerlig kontakt ses som essentiellt för att förbättra upplevelsen av vård hos denna målgrupp.Background People who inject drugs are less able to access healthcare than the general population, but are at increased risk of illness related to risk behaviors such as sharing injection equipment and use of illegal substances. Illness caused by injection drug use is related to individual suffering as well as increased health care costs. The ability to perform self-care affects the ability to maintain health and being included in society. Aim The aim was to explore how self-care is percieved by people who inject drugs, as well as the needs of healthcare expressed by these individuals. Method Qualitative interview study with explorative design. Semi structured interviews were conducted with 12 people visiting a needle exchange clinic at the Karolinska University Hospital in Stockholm, Sweden. The interviews were analyzed using content analysis. Results The analysis resulted in three categories: A wish to maintain good health despite substance use disorder, Need for specific competence and patient-centered care and Need for specific care and safe environments. The category A wish to maintain good health despite substance use disorder showed that self-care was perceived as using drugs in a safe way and to maintain a good physical and mental health overall. The category Need for specific competence and patient-centered care describes a wish for specific nursing skills and increased knowledge of substances use disorders within the health care system. The category Need for specific care and safe environments demonstrate that people who inject drugs are requesting access to healthcare adjusted to their specific needs and health risks. Conclusions The respondents perceive self-care as maintaining health by injecting drugs safely, reduce risk behavior and avoid being excluded from society by caring for appearance, hygiene and striving for a meaningful life. The respondents in this study express the need for person-centered care, dignified treatment and drug use expertise within the health care system. An individual and continuous contact at the needle exchange clinic is essential to improve the experience of health care for these individuals.
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Black, Michael David. "Central city youth and HIV/AIDS an emerging community construct: Finding the best fit ofprovention and intervention service." CSUSB ScholarWorks, 1998. https://scholarworks.lib.csusb.edu/etd-project/1814.
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Tsai, Huei-Yin, and 蔡慧茵. "Willingness to and the experiences of Participating in Needle Syringe Programs among Community Pharmacies." Thesis, 2008. http://ndltd.ncl.edu.tw/handle/86338609096195223983.
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碩士國立臺灣大學
衛生政策與管理研究所
96
HIV infection among injection drug users (IDUs) due to sharing needles and syringes poses great challenge for the current HIV prevention tasks, and unlimited provision of sterile needles and syringes to IDUs therefore constitutes the most cost-effective measure of public health. “Needle and Syringe Program”, one of the core programs of the domestic Harm Reduction Program, has been initiated nationwide since 2006. Community pharmacies are chosen to be the main locations to execute the program. To increase the program coverage and provide more accessible services, it is necessary to understand the responses and willingness of pharmacists in proving and selling clean needles and syringes. Of greater significance, barriers encountered by community pharmacists who have ever participated or are participating in the program should be explored to provide feedbacks to current program implementation. Based on the Theory of Planned Behavior, this study aims to examine the perceptions, cognitions, and behavioral characteristics of current program participants, previous participants, and non-participants. Special experiences from previous and current participation were particularly emphasized to respond to current policy. In March 2008, self-administered questionnaires were distributed, mainly through mailing, to employees/employers of community pharmacies located in four counties of northern part of Taiwan. A total of 178 valid questionnaires were collected, which made a final response rate of 20.8%. The main findings are as follows: (1) 43.3% of the surveyed pharmacies were “very willing or willing” to provide and sell sterile needles and syringes to IDUs, (2) The major attitudinal factors affecting participation are “the program can contribute to the reduction of infections such as HIV and hepatitis, “the reactions of neighborhoods”, and “moral and ethic consideration in the provision of needles and syringes to IDUs”. (3) The more positive of the “attitudes” and the less influenced by the “subjective norms” and “perceived behavioral control” the more likely a pharmacist was willing to join the program, and (4) For non participants, safety was their primary concern, and for previous participants, which was “demanding and heavy work load.” The major difficulties encountered in the execution of the program were referral to other areas of services, ineffective delivery of health education, collection of used needles and syringes. They suggested more efforts be made to enhance campaign and drug education. The following aspects of suggestions are proposed based on the above findings: (1) To increase the coverage of the program through more intensive recruitment and training which emphasize public health implications of the program, and by so doing to raise the social responsibility and passion of community pharmacies and. (2) The government should provide supports and consultations, and build partnerships with community pharmacies to understand their needs and improve their quality of services. (3) Incentives should be provided to reduce the socio-structural barriers faced by community pharmacies, such as their concerns of safety.
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Lin, Chung-Bing, and 林傳斌. "Implementation of Needle-Syringe Program by Pharmacists in Community Pharmacies: a Primary Research on Taipei City." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/26277643125512829420.
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碩士國立陽明大學
衛生福利研究所
105
This study aims to investigate the implementation of needle-syringe program by pharmacists in community pharmacies since 2006. This study adopts a qualitative research method of interviewing 15 pharmacists working in 5 different districts in Taipei who have participated in the program for more than 5 years. The main findings are as follows: (1) the major motivation of these pharmacists to participate in the program is social responsibility, which is similar to the findings of other literature; (2) while most of the participants acknowledge the effectiveness of the harm reduction program, they do not consider it morally right and call it the “necessary evil;” (3) if participants show positive attitude toward drug addicts，they will play more positive roles in N.S.P, and they feel less role conflict. (4) many participants keep their participation in the harm reduction program from general customers for the fear of affecting their business, but some claim it is for the protection of the privacy of drug addicts; (6) in spite of acknowledging of the merits of the harm reduction program, participants also mention that the program can not eliminate drug addiction.
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Gibson, Brendan John Joseph. "From Transfer to Transformation: Rethinking the Relationship between Research and Policy." Phd thesis, 2003. http://hdl.handle.net/1885/47083.
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The most common and enduring explanation for the way research is used (or abused or not used) in policy is the ‘two communities’ theory. According to this theory, the problematic relationship between research and policy is caused by the different ‘cultures’ inhabited by policy makers and researchers. The most common and enduring types of strategies that are put forward to increase research use in policy involve bridging or linking these ‘two communities’. This study challenges this way of thinking about the relationship between research and policy. Four case studies of national public health policy in Australia are used to present the context, events, processes, research, and actors involved in policy making. Three theories are deployed to explore the relationship between research and policy in each of the cases individually and across the cases as a whole. The Advocacy Coalition Framework (ACF) understands the relationship in terms of a power struggle between competing coalitions that use research as a political resource in the policy process. The Policy Making Organisation Framework (PMOF) understands the relationship in terms of institutional and political factors that determine the way data is selected or rejected from the policy process. The Governmentality Framework (GF) understands the relationship in terms of the Foucauldian construct of power/knowledge that is created through discourse, ‘regimes of truth’ and ‘regimes of practices’ found in public health policy and research. ...
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Chen, Chuan-Gen, and 陳傳根. "“Syringe Needle Album” Artistic Statement of Chuan-Gen Chen." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/06327938103344703521.
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碩士國立高雄師範大學
美術學系
103
All things could get sick. How to choose a comfortable way to face with it? Everyone has their own method. I choose to work out regularly and control my diet for a long period of time. So I can gain more power to keep fulfilling my dream. There is no cure for diabetes so far. So the sufferer can only rely on medication to make their life keep going. With this experience, I try to release my anxiety through doing my art works and then it set me free. I focus on the coexistence of ‘myself’ and ‘disease’ in my thesis. The trace of this coexistence is just like the historical verify which comes from looking through albums. I play with my daily stuff like syringe needle as my artistic expression, and it also the mode of finding out the relationship between those daily stuff and me. “Love yourself, before loving the others.” This kind of love means consideration. We all have the instinct to concern with the others no matter how dangerous it is. And the instinct is also the best timing to help people. But if I were in an insecure status, how can I possibly save the others? This is not an excuse or a selfish mind. It’s because of I am already and always on the border between living and death. I take myself as an outstanding example and try hard to share this experience of disease through my art works, lectures, bloggers and books. Because I know the predecessors can deeply influence the development of posterities. And that is the reason makes my mind become stronger and makes my sorrow diminished. When an art work to be created, it’s not only about sharing of artist’s thought and emotion, but also giving an insight to the viewers. The viewers can deeply feel the existence of disease through my works. And it does exist just around us! When you care more about the disease, you get more pain, but also get more excitement. I realize that I can embrace the existence of disease, because we are two roles of one life unity. It’s hard to distinguish the border of reality and visionary in a dream sometimes. And I deeply hope that all the painful memories can stay in the dreams, and the beautiful memories can live in a reality. There is the only way for me to conquer all the difficulties in the future, and that is to face with myself profoundly.
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Stanislavová, Anita. "Počátky harm reduction v České republice v kontextu zahraniční protidrogové politiky." Master's thesis, 2017. http://www.nusl.cz/ntk/nusl-358466.
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This diploma thesis describes the origins of harm reduction (HR) in the Czech drug policy. It focuses on the role of HR in national strategies and the development of syringe and needle program and substitution treatment. The aim of the thesis is to describe and explain how the HR approach was developed in the Czech environment. Using the framework of policy diffusion, the author explains the mechanisms by which harm reduction was transferred from abroad. Thesis describes the history of drug policy and the development of the harm reduction approach in the world. This information forms the context in which the author advocates HR development in the Czech Republic's drug policy after 1989. By analysing expert texts and expert interviews she explains how the first national strategies were formed in which HR has been included since 1993. Similarly, it deals with the beginnings of syringe exchange, which has been in operation since 1986, and substitution treatment that was first used in 1992 and has been officially operational since 1997. The mechanisms of diffusion of HR from abroad to the Czech Republic are defined. In all three areas, the mechanism of learning is defined. Substitution treatment and national strategies are also defined by the mechanism of emulation. To a lesser extent, a mechanism of...
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Luke, Stephen. "Needle exchange networks : the emergence of 'peer-professionals' : a thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in Sociology at the University of Canterbury /." 2007. http://hdl.handle.net/10092/1038.
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Rey, Michel Richard. "On-farm evaluation of a needle-free injection device to vaccinate beef calves under Western Canadian conditions." 2013. http://hdl.handle.net/1993/14423.
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This study was conducted to compare animal performance, presence of skin reactions and immune response following vaccination of beef calves via needle-free (NF) and needle-syringe (NS) vaccination techniques. Spring-born (Study A) and fall-born (Study B) calves were vaccinated against bovine viral diarrhea virus (BVDV) and Clostridium chauvoei (C. chauvoei) via NF and NS vaccination techniques. The parameters measured in this study included body weight (BW), skin reactions and serum antibodies. Animal performance and antibody levels against BVDV and C. chauvoei did not differ between vaccination techniques. However, NF vaccinated calves had a greater frequency of skin reactions when compared to NS vaccinated calves, except for day 42 of Study B. It can be concluded that a needle-free injection device (NFID) can be used effectively to stimulate an immune response without impacting animal performance, but may cause a greater frequency of skin reactions.
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Huang, GEORGE. "Modeling the Impact of Needle Exchange Programs Accounting for both HIV and HCV Infections and HIV/CV Co-Infections." Thesis, 2014. http://hdl.handle.net/1974/12155.
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Purpose: The aim of this study is to model the impact of needle exchange interventions on human immunodeficiency virus (HIV) and hepatitis C virus (HCV).
Methods: In order to model the impact of needle exchange interventions, behavioural effects (sexual and drug use) were translated into estimates of the number of HIV and HCV cases averted by the programs through a mathematical model. Behavioural effects data on 63 clients had been collected previously by two Health Units in Ontario. The secondary data were analyzed to estimate the number of HIV and HCV cases averted while accounting for co-infection. A Bernoulli process model was used to estimate the number of averted cases for the condom distribution and counselling aspects of the needle exchange intervention. A modification of the Bernoulli process model was used for needle exchange interventions to account for drug use behaviours. Furthermore, this model estimated the number of cases averted while also accounting for the clients’ partner’s co-infection status. Once the number of HIV and HCV cases averted was determined, a cost analysis was conducted to estimate the net medical savings of the interventions. Costs were converted to 2011 Canadian dollars.
Results: Of the 63 clients, 21.40 HIV and 5.18 HCV cases were directly averted by the needle exchange intervention when HIV/HCV co-infection status of the partner was not taken into account. When the clients’ partners’ co-infection status was taken into account, lesser numbers were directly averted by the needle exchange intervention. The discounted medical savings averted were $6,950,028 and $6,741,331 when co-infection was and was not accounted for, respectively, for the 63 individuals.
Conclusion: The study demonstrated a different modeling method to account for HIV and HCV cases averted in the context of needle exchange. This study provides a foundation for future large scale cost-effectiveness studies.Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2014-04-29 13:45:07.698
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BACÚŠANOVÁ, Veronika. "Pohled pracovníků kontaktních center na praktikování a význam Harm Reduction." Master's thesis, 2010. http://www.nusl.cz/ntk/nusl-51813.
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The thesis deals with the issue of care of drug addicts in the in the Czech Republic, particularly the Harm Reduction. The theoretical part of the thesis describes the above-mentioned working procedures with clients, the legislative framework of the services and the current situation on the drug scene in the Czech Republic. The practical part uses a qualitative form of research. The information was collected by means of structured interviews with open questions. The respondents were eleven workers of contact centres in the Central Bohemian region which has five such facilities. I cooperated with four of them for the purposes of the thesis. The objective of the thesis was to demonstrate that the Harm Reduction services are important and beneficial from the viewpoint of workers of contact centres and to find out whether the contact workers have any suggestions about how to improve the Harm Reduction services in the Czech Republic.
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Bégin, Marc-Antoine. "L’association entre les divers types de services de santé et l’initiation du traitement de l’hépatite C chez les utilisateurs de drogues par injection." Thèse, 2013. http://hdl.handle.net/1866/9949.
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Introduction: Malgré des taux d’efficacité comparable du traitement antiviral de l’hépatite C (VHC) entre utilisateurs de drogues par injection (UDIs) et non-UDIs, il y a encore d’importantes barrières à l’accessibilité au traitement pour cette population vulnérable. La méfiance des UDIs à l’égard des autorités médicales, ainsi que leur mode de vie souvent désorganisé ont un impact sur l’initiation du traitement. L’objectif de cette étude est d’examiner les liens entre l’initiation du traitement du VHC et l’utilisation des services de santé chez les UDIs actifs.
Methode: 758 UDIs actifs et séropositifs aux anticorps anti-VHC ont été interrogés durant la période de novembre 2004 à mars 2011, dans la région de Montréal. Des questionnaires administrés par des intervieweurs ont fourni des informations sur les caractéristiques socio-économiques, ainsi que sur les variables relatives à l’usage de drogues et à l’utilisation des services de santé. Des échantillons sanguins ont été prélevés et testés pour les anticorps anti-VHC. Une régression logistique multivariée a permis de générer des associations entre les facteurs relatifs aux services de santé et l’initiation du traitement contre le VHC.
Resultats: Parmi les 758 sujets, 55 (7,3%) avaient initié un traitement du VHC avant leur inclusion dans l’étude. Selon les analyses multivariées, les variables significativement associées à l’initiation du traitement sont les suivantes: avoir vu un médecin de famille dans les derniers 6 mois (Ratio de Cote ajusté (RCa): 1,96; Intervalle de Confiance à 95% (IC): 1,04-3,69); plus de 2 ans sous traitement de la dépendance à vie, sans usage actuel de méthadone (RCa: 2,25; IC: 1,12-4,51); plus de 2 ans sous traitement de la dépendance à vie, avec usage actuel de méthadone (RCa: 3,78; IC: 1,85-7,71); et avoir déjà séjourné en prison (RCa: 0,44; IC: 0,22-0,87).
Conclusion: L’exposition à des services d’aide à la dépendance et aux services médicaux est associée à l’initiation du traitement du VHC. Ces résultats suggèrent que ces services jouent leur rôle de point d’entrée au traitement. Alternativement, les UDIs ayant initié un traitement du VHC, auraient possiblement adopté une attitude proactive quant à l'amélioration de leur santé globale. D’autre part, l’incarcération ressort comme un obstacle à la gestion de l’infection au VHC.Introduction: In spite of comparable hepatitis C virus (HCV) treatment efficacy between injection drug users (IDUs) and non-IDUs, there are still important barriers impeding antiviral treatment access in this vulnerable population. Mistrust between IDUs and health care providers, along with IDU disorganised lifestyle, affect HCV treatment uptake. The objective of this study is to examine the association between HCV treatment initiation and the use of healthcare services among active IDUs. Methodology: 758 active IDUs, seropositive for anti-HCV antibody, were surveyed from November 2004 to March 2011 in Montreal. Interviewer-administered questionnaires elicited information on socio-demographic factors, drug use related behaviors and health care service utilization. Blood samples were collected and tested for HCV antibodies. Multivariate logistic regression analysis was conducted to identify the health service correlates of HCV treatment initiation. Results: Among the 758 subjects, 55 (7.3%) had initiated an HCV treatment prior to enrolment. In multivariate analysis, variables independently associated with treatment initiation included: having seen a general practitioner in the last 6 months (adjusted Odds Ratio (aOR): 1,96; 95% Confidence Interval (CI): 1,04-3,69); more than 2 years of lifetime addiction treatment exposure without current methadone use (aOR: 2,25; CI: 1,12-4,51); more than 2 years of lifetime addiction treatment exposure with current methadone use (aOR: 3,78; CI: 1,85-7,71); and having spent time in prison (aOR: 0,44; CI: 0,22-0,87). Conclusion: Exposure to addiction and medical services is associated with HCV treatment initiation. These results suggest that such services efficiently play their role as entry points for HCV treatment. Alternatively, IDU who have initiated HCV treatment, regardless of the viral response outcome, may have adopted a proactive stance towards improving their overall health. Incarceration on the other hand seems to be an obstacle to HCV treatment uptake.