Post on 03-Jan-2016
description
Harm Reduction Success as Needle Exchange Program
Distributes Safer Crack Smoking Resources
Lynne Leonard Emily Meadows, Linda Pelude
Joyce Seto, Nick Birkett, Emily Medd
HIV Prevention Research Team University of Ottawa
Ottawa, Canada
Harms Associated with Smoking Crack
Harms Associated with Smoking Crack
Safer Crack-Smoking InitiativeApril 2005
Safer Crack-Smoking Kit
Methods
•Personal structured interviews with 634 street-recruited active IDUs.
•550 reported smoking crack in previous 6 months. • Interviewed at four time points
6 months PRE 112 crack-smokers 1 month POST 114 crack-smokers 6 months POST 157 crack-smokers
12 months POST 167 crack-smokers•Provided saliva samples for HIV and HCV testing.•Compensated $10 CA.•Extraction NEP program data.
Results: Program Uptake
Immediate, high and sustained• Direct users
80 % 1 month POST
80 % 6 months POST
87 % 12 months POST
• Direct and indirect users
81 % 1 month POST
86 % 6 months POST
94 % 12 months POST p=.003
Results: Impact on Sharing Crack-Smoking Equipment
• Significant decline in sharing crack-smoking equipment
85 % 6 months PRE85 % 1 month POST80 % 6 months POST80 % 12 months POST
p<0.01
• Among “sharers”, significant decline in sharing every time
37 % 6 months PRE31 % 1 month POST12 % 6 months POST13 % 12 months POST
p=0.001
Results: Transitioning
Significant increase in smoking crack• Smoked crack in six months prior to interview
77 % 6 months PRE86 % 1 month POST89 % 6 months POST97% 12 months POST p ≤
0.001
• Frequency of smoking crack since availability of crack-smoking equipment
26 % “more” 6 months POST 29 % “more” 12 months POST
Results: Transitioning
Significant decrease in injecting drugs• Injected drugs in month prior to interview
96 % 6 months PRE84 % 1 month POST78 % 6 months POST78 % 12 months POST p ≤
0.001
• Frequency of injecting since availability of crack-smoking equipment
41 % “less” 6 months POST 40 % “less” 12 months POST
Scaling Up Harm Reduction
6 Months
PRE
1 Month
POST
6 Months
POST
Cumulative12 Months
IDU
ONLY 2,566 723 1,829 4,566
IDU and Smoke Crack
N/A 742 2,040 4,838
Smoke Crack ONLY
N/A 543 1,899 4,469
Conclusions
Significant and sustained community and individual level harm reduction impacts:
• Increased availability and accessibility of resources to reduce the harms associated with smoking crack.
• Decrease in the frequency of engagement in the multi-person use of crack-smoking implements.
• Transitioning to smoking crack – significant predictor of injection cessation.
• Contact with previously un-engaged population at risk of the harms associated with drug use.
• Evaluation findings suggest the urgent utility of replicating this initiative at all NEPs.
Acknowledgements
Research Team• Interviewers I-Track Project• Women and men in Ottawa who inject
drugsFunders
• Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada
• City of Ottawa Public Health• Institut National de Santé Publique,
Québec• Ontario HIV Treatment Network (OHTN)
ADDITIONAL SLIDES
Socio-demographic Profile
AgeAverage 37 years; range 16 – 63
GenderMale 77%
EthnicityCanadian 79% Aboriginal 11%
Highest education levelLess than high school 50%Some post secondary 23%
HousingUnstable housing 48%
Socio-demographic Profile
History HIV testing 87%
Positive HIV Lab result 11%
History HCV testing 85%
Positive HCV Lab result 55%
Socio-demographic Profile
Drugs injected most often in past 6 monthscocaine 35%crack 22%morphine 31%heroin 4%
Age first smoked crackmean 25 years range 7 – 54 years
Duration smoking crackmean 10 yearsrange 1 month – 49 years
Resource Costs
Cost
Glass stem 30 cents
Mouthpiece 4 cents
Screens 8 cents
Complete kit 2 dollars
Results: Distribution
One Month
Six Months
TwelveMonths
Crack kits 1,419 183 42
Glass stems 7,212 17,696 28,768
Screens 9,185 32,557 52,001
Mouthpieces 3,123 8,123 9,306
Results: Distribution
One Month
Six Months
Twelve Months
#s
Dist.
Crack Kits 90% 81% 30% 1,644
Glass Stems 52% 97% 97% 53,678
Screens 51% 88% 88% 93,745
Mouthpieces 34% 56% 52% 20,552