Three Decades Of Harm Reduction Programs In A Country With Liberal Drug Policies: Factors Associated With Its Uptake Among People Who Inject Drugs In Amsterdam

Author: van Santen D.K, Matser A, Boyd A, Prins M

Theme: Epidemiology & Public Health Research Year: 2018

The Netherlands was one of the first countries to implement low-threshold harm-reduction
programs (HRP) worldwide, probably contributing to declining HIV and hepatitis C virus
incidence among people who inject drugs (PWID). We aimed to assess socio-demographic,
drug-related and clinical factors associated with HRP-uptake in a setting with liberal drug
policies and unrestricted access to HRP.
Participants were included from the Amsterdam Cohort Studies among PWID (1985-2015).
Data on injecting drug use (IDU), use of needle and syringe exchange programs (NSP) and
opioid substitution therapy (OST) dosage were used to create a 5-category uptake variable:
no HRP-uptake, incomplete HRP-uptake (<100% NSP and/or OST <60 mg), and complete HRP-uptake (100% NSP and OST ≥60mg) in current PWID; limited dependency (OST <60mg) and no dependency (no OST) in non-current PWID. Multinomial logistic regression with robust standard errors was used to assess associations of outcomes versus ‘no HRP-uptake’. Results: We included 985 PWID with a median 18 study visits. Homeless PWID had significantly lower odds for complete HRP-uptake (ORcomplete=0.5, 95%CI=0.4-0.8), limited dependency (ORlimited=0.3, 95%CI=0.2-0.5) and no dependency (ORno-dependency=0.4, 95%CI=0.3-0.7) versus no HRP-uptake. Having a current PWID steady partner, versus no (PWID) partner, was negatively associated with limited and no dependency (ORlimited=0.2, 95%CI=0.1-0.4; ORnodependency=0.1, 95%CI=0.05-0.2), while positively associated with incomplete HRP-uptake (ORincomplete=2.1, 95%CI=1.1-4.0). HIV-positive status was associated with incomplete and complete HRP-uptake (ORincomplete=1.9, 95%CI=1.3-2.9; ORcomplete=3.8, 95%CI=2.4-5.9). Older age and longer duration since IDU initiation were positively associated with complete HRPuptake, limited and no dependency. Alcohol use was negatively associated with incomplete and complete HRP-uptake and with limited dependency. Conclusion: Homelessness and having a current PWID partner were the most consistent and strongest factors negatively associated with HRP uptake. Our findings could be used to target and tailor interventions for increasing HRP-uptake among PWID. Disclosure of Interest Statement No conflicts

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