Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, USA.
Department of Epidemiology, The Ohio State University College of Public Health, Columbus, USA.
Drug Alcohol Rev. 2022 May;41(4):863-872. doi: 10.1111/dar.13436. Epub 2022 Feb 3.
Ensuring adequate harm reduction infrastructure in rural areas is imperative, as drug-related epidemics expand into them. Here, we explore the capacity for sustainment of syringe service programs (SSP) in Appalachian Kentucky.
We interviewed all staff (n = 16) of all SSPs (n = 7) in two Kentucky health districts in 2018-2019 using semi-structured one-on-one qualitative interviews; local departments of health (DOH) operated the SSPs. Interview domains encompassed: (i) SSP establishment; (ii) day-to-day operations, participation and health impacts; (iii) perceived prospects for sustainment; and (iv) perceived influences on #i-#iii. We analysed verbatim transcripts using thematic analytic methods; Schell's 'capacity for sustainment' constructs were treated as sensitising concepts during the analysis.
Most community members, law enforcement and DOH staff opposed SSPs before they opened, because of stigma and concerns about enabling and needlestick injuries; DOH staff also opposed SSPs because they believed they lacked the capacity to operate them. Training, technical assistance, visible evidence of the programs' public health impact and contact with SSP participants transformed DOH staff into program champions. As champions, SSP staff developed programs that had strong capacity for sustainment, as defined by Schell (e.g. visible public health impact, stable funding, political support). Staff reported that the SSPs had high prospects for sustainment.
As in SSPs that opened in cities decades ago, staff in emerging SSPs in these rural areas appear to have become crucial champions for these controversial programs, and may serve as vital resources for expanding harm reduction programming more broadly in these underserved areas.
随着毒品相关疫情蔓延到农村地区，确保农村地区有足够的减少伤害基础设施至关重要。在这里，我们探讨了在阿巴拉契亚肯塔基州维持注射器服务项目 (SSP) 的能力。
我们在 2018-2019 年使用半结构化一对一的定性访谈，对肯塔基州两个卫生区的所有 7 个 SSP 中的所有工作人员（n=16）进行了访谈；当地卫生部门运营 SSP。访谈领域包括：(i) SSP 的建立；(ii) 日常运作、参与和健康影响；(iii) 对可持续性的预期；以及 (iv) 对 #i-#iii 的感知影响。我们使用主题分析方法对逐字记录进行了分析；在分析过程中，Schell 的“可持续性能力”结构被视为敏感概念。
在 SSP 开设之前，大多数社区成员、执法人员和卫生部门工作人员都反对 SSP，原因是存在污名和对启用以及针刺伤害的担忧；卫生部门工作人员也反对 SSP，因为他们认为自己没有能力运营它们。培训、技术援助、项目对公共卫生影响的明显证据以及与 SSP 参与者的接触，使卫生部门工作人员转变为项目的拥护者。作为拥护者，SSP 工作人员制定了具有强可持续性能力的计划，如 Schell 所定义的（例如明显的公共卫生影响、稳定的资金、政治支持）。工作人员报告说，SSP 有很高的可持续性前景。
与几十年前在城市开设的 SSP 一样，这些农村新兴 SSP 的工作人员似乎已经成为这些有争议项目的关键拥护者，并且可能成为在这些服务不足地区更广泛地扩大减少伤害计划的重要资源。
