Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA.
Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.
Subst Use Misuse. 2020;55(14):2268-2277. doi: 10.1080/10826084.2020.1800741. Epub 2020 Aug 4.
People who inject drugs (PWID) in rural areas of the United States have had limited access to syringe service programs (SSP). Rural SSP have recently surged, but accompanying research is lacking about PWID utilization, barriers, and preferences for SSP design and how those preferences vary by gender. Interviewer-administered surveys elicited information about utilization, barriers, and preferences for SSP design from 234 PWID recruited using respondent-driven sampling in Appalachian, Kentucky. Gender differences among reported barriers to utilizing SSP and preferences for program design were explored using Mantel-Haenszel chi-square tests. Overall, 49% of PWID had ever utilized an SSP. The most common reasons for not utilizing an SSP were lack of awareness (23%), fear of being seen or disclosing drug use (19%), and lack of need (19%). The most preferred SSP design was located within a health department (74%) and operating during afternoon hours (66%). Men were more likely than women to prefer SSP in health departments (80% vs. 65%, = 0.01), while more women than men preferred staffing by health department personnel (62% vs. 46%, = 0.02). Women were less likely to favor evening hours (55% vs. 70%, = 0.02). Fewer women wanted SSP nurses (78% vs. 90%, = 0.01), social workers (11% vs. 24%, = 0.01), or people who use drugs (20% vs 34%, = 0.02) to staff SSP. Despite recent scale-up, SSP in Appalachia remain under-utilized. PWID were open to a range of options for SSP design and staffing, though there were variations by gender. Implementation research that identifies best strategies for tailored SSP scale-up in rural settings should be considered.
美国农村地区的注射毒品者（PWID）获得注射器服务计划（SSP）的机会有限。最近，农村 SSP 激增，但缺乏关于 PWID 利用、障碍以及对 SSP 设计的偏好的相关研究，也缺乏这些偏好如何因性别而异的研究。采用应答驱动抽样法（RDS），在肯塔基州阿巴拉契亚地区招募了 234 名 PWID，通过访谈调查收集了他们关于 SSP 利用、障碍和 SSP 设计偏好的信息。使用 Mantel-Haenszel 卡方检验探讨了报告的利用 SSP 的障碍和对方案设计的偏好方面的性别差异。总体而言，49%的 PWID 曾使用过 SSP。不使用 SSP 的最常见原因是缺乏意识（23%）、害怕被看到或透露吸毒（19%）和没有需求（19%）。最受欢迎的 SSP 设计是位于卫生部门内（74%）并在下午时段运营（66%）。与女性相比，男性更倾向于选择卫生部门内的 SSP（80%对 65%，=0.01），而更多的女性倾向于由卫生部门人员提供服务（62%对 46%，=0.02）。女性不太喜欢晚上（55%对 70%，=0.02）。希望 SSP 有护士（78%对 90%，=0.01）、社工（11%对 24%，=0.01）或吸毒者（20%对 34%，=0.02）的人数较少。尽管最近规模扩大，但阿巴拉契亚地区的 SSP 仍未得到充分利用。PWID 对 SSP 设计和人员配备的各种选择持开放态度，尽管存在性别差异。应该考虑实施研究，以确定针对农村地区量身定制的 SSP 扩大规模的最佳策略。
