Akiba Christopher F, Smith Jessica, Wenger Lynn D, Morris Terry, Patel Sheila V, Bluthenthal Ricky N, Tookes Hansel E, LaKosky Paul, Kral Alex H, Lambdin Barrot H
RTI International, Research Triangle Park, NC, United States.
Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
SSM Qual Res Health. 2024 Jun;5. doi: 10.1016/j.ssmqr.2024.100421. Epub 2024 Mar 20.
Syringe Services Programs (SSPs) provide evidence-based services like drug use equipment to prevent infectious disease, overdose prevention education, and naloxone distribution to people who use drugs (PWUD). However, inadequate funding threatens provision of these interventions. This study aimed to document how the current funding landscape impacted determinants of SSP implementation, particularly describing financial and staffing barriers, facilitators, and proposed strategies, using qualitative methods informed by three implementation research frameworks. We interviewed 20 leaders of SSPs in the United States using a semi-structured interview guide. Participants described how structural stigma against PWUD led to insufficient and restrictive funding, and burdensome reporting for SSPs. This resulted in harming program implementation outcomes like reach, fidelity, and sustainability. Inadequate funding also led to insufficient staffing and subsequent staff stress, burnout, and turnover. Taken together, these barriers threatened the implementation of evidence-based interventions that SSPs provided, ultimately harming their ability to effectively address health outcomes like infectious disease transmission and opioid overdose mortality within their communities. Interviewees described how upstream policy strategies like political advocacy might address structural stigma at the federal level. Participants also highlighted state-level efforts like harm reduction-centered funding, technical assistance and capacity-building, and clearinghouse programs that may facilitate better implementation and health outcomes. A more robust understanding of the relationship between financial barriers, facilitators, and strategies on implementation and health outcomes represents a novel and vital area of research within harm reduction literature.
注射器服务项目（SSPs）提供基于证据的服务，如提供预防传染病的吸毒用具、过量用药预防教育以及向吸毒者（PWUD）分发纳洛酮。然而，资金不足威胁到这些干预措施的提供。本研究旨在记录当前的资金状况如何影响SSP实施的决定因素，特别是使用三个实施研究框架提供的定性方法，描述资金和人员配备方面的障碍、促进因素以及建议的策略。我们使用半结构化访谈指南对美国20名SSP负责人进行了访谈。参与者描述了针对吸毒者的结构性污名如何导致资金不足和限制，以及给SSP带来繁重的报告负担。这导致了诸如覆盖面、保真度和可持续性等项目实施成果受到损害。资金不足还导致人员配备不足，进而导致工作人员压力、倦怠和离职。总之，这些障碍威胁到SSP所提供的基于证据的干预措施的实施，最终损害了它们在社区内有效应对诸如传染病传播和阿片类药物过量死亡率等健康问题的能力。受访者描述了诸如政治宣传等上游政策策略如何在联邦层面解决结构性污名问题。参与者还强调了州一级的努力，如以减少伤害为中心的资金投入、技术援助和能力建设，以及可能促进更好实施和健康成果的信息交换中心项目。对资金障碍、促进因素以及实施和健康成果方面的策略之间关系的更深入理解是减少伤害文献中一个新颖且重要的研究领域。
