National Drug Research Institute, Curtin University, Perth, Western Australia, Australia.
Burnet Institute, Melbourne, Victoria, Australia.
Harm Reduct J. 2024 Feb 24;21(1):51. doi: 10.1186/s12954-024-00960-9.
Primary needle and syringe programs (NSPs) have been integral for the prevention of blood-borne virus (BBV) transmission among people who inject drugs. Despite this, many people who inject drugs face barriers accessing these services, particularly after-hours when most services are closed. To our knowledge, the St Kilda NSP, in Melbourne, Victoria, is the only primary NSP providing 24/7 dedicated stand-alone face-to-face services for people who inject drugs in Australia. We conducted an evaluation of the St Kilda NSP to assess its role and effectiveness in meeting client needs.
Mixed research methods were used to conduct the evaluation. We analysed four quantitative data sets including the Victorian Needle and Syringe Program Information System data; NSP 'snapshot' survey data; and St Kilda NSP records of after-hours contacts and naloxone training events. Qualitative interviews were conducted with 20 purposively selected NSP clients, which were focused on individual needs, expectations and experiences accessing the service. Interviews were audio recorded and transcribed, and data were analysed thematically. A convergent research design was used to merge the five data sets.
St Kilda NSP had 39,898 service contacts in 2018; 72% of contacts occurred outside business hours. Similarly, of 1,185,000 sterile needles and syringes dispatched, 71% were distributed outside business hours. Participants described valuing the after-hours service because drug use patterns did not always align with standard NSP opening hours and after-hours access afforded anonymity when collecting injecting equipment. Narratives highlighted several additional benefits of the 24/7 service, including: access to safer sex equipment; material support; naloxone training; referrals to specialist services; face-to-face emotional and social support from a non-judging worker; and for women involved in sex work in particular, being able to seek refuge when feeling unsafe on the streets.
Our study provides evidence of the social and health benefits (beyond that of preventing BBV transmission) that can be gained through the provision of 24/7 primary NSP services. Findings support the need for the establishment of after-hours primary NSPs in other areas of Australia where active street-based drug markets operate outside business hours and concentrated numbers of people who inject drugs live and spend time.
初级针具和注射器方案（NSP）对于预防经血液传播的病毒（BBV）在注射毒品的人群中传播至关重要。尽管如此，许多注射毒品的人在获得这些服务方面仍面临障碍，尤其是在大多数服务关闭的下班时间后。据我们所知，位于维多利亚州墨尔本的圣基尔达 NSP 是澳大利亚唯一一家提供 24/7 专用独立面对面服务的初级 NSP，专为注射毒品者提供服务。我们对圣基尔达 NSP 进行了评估，以评估其在满足客户需求方面的作用和效果。
采用混合研究方法对评估进行了评估。我们分析了包括维多利亚州针具和注射器方案信息系统数据在内的四个定量数据集；NSP“快照”调查数据；以及圣基尔达 NSP 下班后接触和纳洛酮培训活动的记录。对 20 名经过精心挑选的 NSP 客户进行了定性访谈，重点是个人需求、对服务的期望和经验。访谈进行了录音和转录，并进行了主题分析。采用收敛研究设计合并了五个数据集。
圣基尔达 NSP 在 2018 年有 39898 次服务接触；72%的接触发生在营业时间以外。同样，在分发的 1185000 个无菌针头和注射器中，71%是在营业时间以外分发的。参与者表示，他们非常重视下班后的服务，因为吸毒模式并不总是与标准 NSP 开放时间一致，并且下班后的服务提供了收集注射设备时的匿名性。叙述强调了 24/7 服务的其他一些好处，包括：获得更安全的性行为设备；物资支持；纳洛酮培训；转介到专科服务；非评判性工作人员提供面对面的情感和社会支持；特别是对于从事性工作的女性，当她们在街上感到不安全时，能够寻求庇护。
我们的研究提供了证据，证明通过提供 24/7 初级 NSP 服务可以获得社会和健康方面的好处（除了预防 BBV 传播之外）。研究结果支持在澳大利亚其他活跃的街头毒品市场在营业时间以外运作且大量注射毒品者居住和花费时间的地区建立下班后初级 NSP 的必要性。
