Teaching Proper Injection Practices Reduces the Complications of Injection Drug Use

Injection drug use carries a number of risks, including soft tissue infection and transmission of hepatitis C virus (HCV) and HIV. This study evaluated a French program that provided education on HIV and HCV transmission along with training on proper injection practices that included direct observation of participants injecting the substance they generally used. Participants (N = 144) and controls (N = 127, education only) were interviewed at baseline, 6, and 12 months. The primary endpoint was unsafe HIV/HCV transmission practices in the previous 4 weeks at each interview and the secondary endpoint was injection site complications in the previous 4 weeks.

• At baseline, participants in the intervention group were more likely to report unsafe HIV/HCV transmission practices. At 6 months, this declined in the intervention group (from 44% to 25%), but not significantly in the control group (27% to 23%). While the rate at 12 months in the intervention group was similar to the rate at 6 months (26%), this was not significant when compared with baseline.
• Participants in the intervention group had a significant decline in injection site complications (66% to 39% at 12 months), while controls did not (56% versus 62%).
• On multivariable analysis, the intervention was associated with a significant decline in HIV/HCV transmission practices at 6, but not 12, months. Injection site complications were lower at 12 months.

Comments:

Providing education on HIV/HCV transmission is a commonly accepted and uncontroversial intervention. The novel component of this study is teaching proper injection practices, with an observed demonstration. This may not be politically feasible given the widespread belief that interventions like this encourage injection drug use. A less intensive intervention—such as providing education without direct observation—would probably be more politically palatable and may also be effective.

Darius A. Rastegar, MD

Reference:

Roux P, Le Gall JM, Debrus M, et al. Innovative community-based educational face-to-face intervention to reduce HIV, hepatitis C virus and other blood-borne infectious risks in difficult-to-reach people who inject drugs: results from the ANRS-AERLI intervention study. Addiction. 2015 [Epub ahead of print]. doi: 10.1111/add.13089.