School of Media, Culture and Society, University of the West of Scotland, Paisley, PA1 2BE, Scotland, United Kingdom.
School of Media, Culture and Society, University of the West of Scotland, Paisley, PA1 2BE, Scotland, United Kingdom.
Int J Drug Policy. 2018 Mar;53:45-54. doi: 10.1016/j.drugpo.2017.12.001. Epub 2017 Dec 24.
There is no research on public health interventions that alert people who inject drugs (PWID) to clusters/outbreaks of severe bacterial infections. In Scotland, during the botulism cluster/outbreak of Dec 2014-July 2015 harm reduction (HR) messages detailed on a postcard (Botulism Postcard) were distributed to PWID between Feb-April 2015. We examined the impact of the Botulism Postcard on cluster/outbreak awareness, healthcare seeking and HR behaviours among PWID; and their views on such clusters/outbreaks.
The Botulism Postcard questionnaire survey was undertaken with 288 PWID recruited in Greater Glasgow and Clyde between May-August 2015. Multivariate logistic regression was undertaken. Between Oct 2015-January 2016 22 in-depth interviews were conducted with PWID in Glasgow and Edinburgh, these underwent thematic analysis.
38% (108/284) had never seen the postcard, 14% (40/284) had only seen it, 34% (98/284) read but not discussed it and 13% (38/284) had discussed it with service staff. Cluster/outbreak awareness was higher among those who had read (adjusted odds ratio (aOR) = 5.374, CI 2.394-11.349, p < 0.001) or discussed the postcard (aOR = 25.114, CI 3.188-190.550, p < 0.001); and symptom awareness was higher among those who had read (aOR = 2.664, CI 1.322-4.890, p < 0.001) or discussed the postcard (aOR = 6.707, CI 2.744 16.252, p < 0.001) than among those who had never seen it. The odds of introducing HR was higher among those who had discussed the postcard (AOR = 3.304 CI 1.425 7.660, p < 0.01) than those who had only read it. PWID learnt about clusters/outbreaks from several sources and despite concerns they continued to inject during such events.
More widespread exposure to the Botulism Postcard during the outbreak/cluster was needed. The Botulism Postcard distributed to PWID may raise awareness of such events, the symptoms, and may encourage HR particularly when used as a tool by frontline staff to initiate discussion. Acknowledging that people continue to inject during clusters/outbreaks of such infections necessitates a pragmatic HR approach.
目前尚无针对提醒注射吸毒者（PWID）注意严重细菌感染群集/暴发的公共卫生干预措施的研究。在苏格兰，2014 年 12 月至 2015 年 7 月肉毒杆菌群集/暴发期间，减害（HR）信息详细列于一张明信片（肉毒杆菌明信片），并于 2015 年 2 月至 4 月间分发给 PWID。我们调查了肉毒杆菌明信片对 PWID 对群集/暴发的认识、寻求医疗保健和 HR 行为的影响；以及他们对这种群集/暴发的看法。
2015 年 5 月至 8 月，在大格拉斯哥和克莱德地区招募了 288 名 PWID，进行了肉毒杆菌明信片问卷调查。进行了多变量逻辑回归分析。2015 年 10 月至 2016 年 1 月，在格拉斯哥和爱丁堡对 22 名 PWID 进行了 22 次深入访谈，这些访谈进行了主题分析。
38%（108/284）的人从未见过明信片，14%（40/284）的人只见过，34%（98/284）的人阅读但未讨论，13%（38/284）的人曾与服务人员讨论过。阅读过（调整后的优势比（aOR）=5.374，CI 2.394-11.349，p<0.001）或讨论过明信片（aOR=25.114，CI 3.188-190.550，p<0.001）的人对群集/暴发的认识较高；阅读过（aOR=2.664，CI 1.322-4.890，p<0.001）或讨论过明信片（aOR=6.707，CI 2.744-16.252，p<0.001）的人对症状的认识较高。与从未见过明信片的人相比，讨论过明信片（AOR=3.304 CI 1.425-7.660，p<0.01）的人更有可能采用 HR。
在暴发/群集期间，需要更广泛地接触肉毒杆菌明信片。分发给 PWID 的肉毒杆菌明信片可能会提高对这类事件、症状的认识，并可能鼓励 HR，特别是当前线工作人员将其用作发起讨论的工具时。必须承认，在这种感染的群集/暴发期间，人们继续注射，这需要一种务实的 HR 方法。
