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      Predictors of skin and soft tissue infections among sample of rural residents who inject drugs

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          Abstract

          Introduction

          Skin and soft tissue infections (SSTIs) are among the leading causes of morbidity and mortality for people who inject drugs (PWID). Studies demonstrate that certain injection practices correlate with SSTI incidence among PWID. The opioid epidemic in the USA has particularly affected rural communities, where access to prevention and treatment presents unique challenges. This study aims to estimate unsafe injection practices among rural-dwelling PWID; assess treatments utilized for injection related SSTIs; and gather data to help reduce the overall risk of injection-related SSTIs.

          Methods

          Thirteen questions specific to SSTIs and injection practices were added to a larger study assessing unmet health care needs among PWID and were administered at six syringe exchange programs in rural Wisconsin between May and July 2019. SSTI history prevalence was estimated based on infections reported within one-year prior of response and was compared to self-reported demographics and injection practices.

          Results

          Eighty responses were collected and analyzed. Respondents were white (77.5%), males (60%), between the ages 30 and 39 (42.5%), and have a high school diploma or GED (38.75%). The majority of respondents (77.5%) reported no history of SSTI within the year prior to survey response. Females were over three times more likely to report SSTI history (OR = 3.07, p = 0.038) compared to males. Water sources for drug dilution ( p = 0.093) and frequency of injecting on first attempt ( p = 0.037), but not proper skin cleaning method ( p = 0.378), were significantly associated with a history of SSTI. Injecting into skin ( p = 0.038) or muscle ( p = 0.001) was significantly associated with a history of SSTI. Injection into veins was not significantly associated with SSTI ( p = 0.333).

          Conclusion

          Higher-risk injection practices were common among participants reporting a history of SSTIs in this rural sample. Studies exploring socio-demographic factors influencing risky injection practices and general barriers to safer injection practices to prevent SSTIs are warranted. Dissemination of education materials targeting SSTI prevention and intervention among PWID not in treatment is warranted.

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          Most cited references29

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          Respondent-Driven Sampling: A New Approach to the Study of Hidden Populations

          Douglas D Heckathorn (1997)
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            Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration.

            Sandro Galea, David Vlahov (2002)
            This article reviews the evidence on the adverse health consequences of low socioeconomic status, homelessness, and incarceration among drug users. Social and economic factors shape risk behavior and the health of drug users. They affect health indirectly by shaping individual drug-use behavior; they affect health directly by affecting the availability of resources, access to social welfare systems, marginalization, and compliance with medication. Minority groups experience a disproportionately high level of the social factors that adversely affect health, factors that contribute to disparities in health among drug users. Public health interventions aimed at improving the health of drug users must address the social factors that accompany and exacerbate the health consequences of illicit drug use.
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              Syringe Service Programs for Persons Who Inject Drugs in Urban, Suburban, and Rural Areas - United States, 2013.

              Don Des Jarlais, Ann Nugent, Alisa Solberg … (2015)
              Reducing human immunodeficiency virus (HIV) infection rates in persons who inject drugs (PWID) has been one of the major successes in HIV prevention in the United States. Estimated HIV incidence among PWID declined by approximately 80% during 1990-2006 (1). More recent data indicate that further reductions in HIV incidence are occurring in multiple areas (2). Research results for the effectiveness of risk reduction programs in preventing hepatitis C virus (HCV) infection among PWID (3) have not been as consistent as they have been for HIV; however, a marked decline in the incidence of HCV infection occurred during 1992-2005 in selected U.S. locations when targeted risk reduction efforts for the prevention of HIV were implemented (4). Because syringe service programs (SSPs)* have been one effective component of these risk reduction efforts for PWID (5), and because at least half of PWID are estimated to live outside major urban areas (6), a study was undertaken to characterize the current status of SSPs in the United States and determine whether urban, suburban, and rural SSPs differed. Data from a recent survey of SSPs(†) were analyzed to describe program characteristics (e.g., size, clients, and services), which were then compared by urban, suburban, and rural location. Substantially fewer SSPs were located in rural and suburban than in urban areas, and harm reduction services(§) were less available to PWID outside urban settings. Because increases in substance abuse treatment admissions for drug injection have been observed concurrently with increases in reported cases of acute HCV infection in rural and suburban areas (7), state and local jurisdictions could consider extending effective prevention programs, including SSPs, to populations of PWID in rural and suburban areas.
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                Author and article information

                Contributors
                Amelia Baltes:
                ORCID: http://orcid.org/0000-0002-0416-9810
                amelia.baltes@fammed.wisc.edu
                Journal
                Journal ID (nlm-ta): Harm Reduct J
                Journal ID (iso-abbrev): Harm Reduct J
                Title: Harm Reduction Journal
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1477-7517
                Publication date (Electronic): 2 December 2020
                Publication date PMC-release: 2 December 2020
                Publication date Collection: 2020
                Volume: 17
                Electronic Location Identifier: 96
                Affiliations
                [1 ]GRID grid.28803.31, ISNI 0000 0001 0701 8607, Department of Family Medicine and Community Health, School of Medicine and Public Health, , University of Wisconsin, ; Madison, WI USA
                [2 ]GRID grid.28803.31, ISNI 0000 0001 0701 8607, Department of Medicine, School of Medicine and Public Health, , University of Wisconsin, ; Madison, WI USA
                [3 ]GRID grid.28803.31, ISNI 0000 0001 0701 8607, Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, , University of Wisconsin, ; Madison, WI USA
                [4 ]GRID grid.280246.a, ISNI 0000 0004 0470 9885, Wisconsin Department of Health Services Hepatitis C Program, ; Madison, USA
                [5 ]GRID grid.265219.b, ISNI 0000 0001 2217 8588, School of Public Health and Tropical Disease, , Tulane University, ; New Orleans, USA
                Author information
                http://orcid.org/0000-0002-0416-9810
                Article
                Publisher ID: 447
                DOI: 10.1186/s12954-020-00447-3
                PMC ID: 7709308
                PubMed ID: 33267848
                SO-VID: acf42f40-421e-4c39-a0c8-9100b1540552
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 31 August 2020
                Date accepted : 20 November 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000026, National Institute on Drug Abuse;
                Award ID: UG3DA044826
                Award Recipient :
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                ScienceOpen disciplines: Health & Social care
                Keywords: skin and soft tissue infections,people who inject drugs,heroin,opioid,methamphetamine,injection drug use,public health
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: skin and soft tissue infections, people who inject drugs, heroin, opioid, methamphetamine, injection drug use, public health

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