Theme: Epidemiology & Public Health Research Year: 2024
Background: The Harm Reduction Database Wales (HRD) records all Needle and Syringe Programme (NSP) activity at an individual-level to evidence and improve harm reduction service utility for people who inject drugs (PWID). The HRD captures real-time data on unique PWID, NSP interactions, and syringes/paraphernalia dispensed. Declines were observed across all measures during the COVID-19 pandemic and have continued to decline since. Three hypotheses were proposed to investigate these trends:
1. A real decline in PWID in Wales
2.Stable PWID population but fewer accessing NSPs
3.Stable PWID population accessing NSPs but data recording incomplete.
Method: Over 2023/24, a mixed method explanatory sequential study design was utilised comprising analysis of secondary HRD NSP activity data compared across years, health boards, and service types (specialist substance misuse services and pharmacy-based NSPs) to evidence trends. In-depth interviews were conducted with NSP providers and PWID following development of a structure sampling and interview framework. Quantitative analysis was conducted using R software and thematic analysis of qualitative data was completed manually.
Results: Compared to 2018/19, total recorded PWID injecting psychoactive drugs and in regular contact with NSP services declined by 54% (from 7,823 to 3,600 in 2023/24), and the number of syringes dispensed decreased by 48% over the same period. No corresponding increase in non-injecting paraphernalia has been observed. Qualitative data indicated a perceived real decrease in PWID, and in NSP access and activity but also inconsistency in recording NSP interactions.
Conclusions: The impact on PWID and NSP service access in 2020 has led to a substantial and sustained changes in NSP service utilisation up to present, representing clear public health challenges. Further research is required to better evidence the change in PWID population size and nature, NSP utility, and implications for reduced access to NSPs on health.
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