Theme: Social Science & Policy Research Year: 2022
People who use drugs (PWUD) are at increased risk of Human Immunodeficiency Syndrome (HIV), Hepatitis
C (HCV), and overdose. Given known risks of sharing drug use equipment, public health benefits of syringe
service programs (SSPs) that provide safer consumption supplies to prevent re-use and reduce spread of
HIV and HCV and overdose deaths are well-recognized. SSPs that include a mobile delivery option are
particularly effective at reducing barriers for rural PWUD. Research about safer consumption supply access
and SSPs in the U.S. South and Appalachia is limited but growing.
Using convenience, opportunistic, and purposive sampling, this mixed-methods study combines secondary
analysis of program data and past evaluation findings and primary analysis of ethnographic and ongoing
evaluation research data from three SSPs operating in Appalachian rural North Carolina (NC); Appalachian
rural and urban Tennessee (TN); and throughout rural and urban NC. All a range of mobile and/or fixed-site
services. Two offer HCV/HIV testing. These sources enable comparisons of distribution and overdose
reversal reports across rural/urban; mobile/fixed-site; NC/TN; and Appalachian/non-Appalachian settings.
SSPs that offered mobile distribution of supplies facilitated access to HCV/HIV prevention and reduction of
negative health consequences of drug use despite transportation barriers; health policy barriers; and
hostile policy climates. Rural SSPs provided more supplies at a time to fewer participants; urban SSPs
provided fewer supplies at a time to more participants and offered more HCV/HIV testing. All sites had
increased demand and reversal reports during the COVID-19 pandemic.
Across a range of settings in U.S. Southern and Appalachian contexts, a diversity of approaches to safer
drug consumption supply distribution and HCV/HIV testing increased access for PWUD. Mobile distribution
appears key to ensuring access to evidence-based disease and overdose prevention for rural PWUD.
Disclosure of Interest Statement: