Association between harm reduction intervention uptake and skin and soft tissue infections among people who inject drugs

Background: Bacterial skin and soft tissue infections (SSTIs) are a health issue for people who inject drugs (PWID). There is a lack of evidence on the associations between harm reduction (HR) uptake and SSTIs. This paper examines the associations between the uptake of injecting equipment (IE) and opiate substitution treatment (OST) on SSTIs among PWID, and the injecting behaviours associated with having had a SSTI. This is the first large-scale, national study to examine the association between IE uptake and SSTIs.

Methods: A cross-sectional, voluntary and anonymous survey was undertaken with PWID recruited from pharmacies/agencies providing IE across mainland Scotland during 2013-2014. Participants were asked: if they had a SSTI within the past year; about their uptake of HR within the past 6 months (including needle/syringes (N/S), paraphernalia and OST); and about their frequency of injecting, sharing of IE and re-use of own N/S. Data from 1876 PWID who had reported injecting within the past 6 months were analysed.

Findings: In multivariate logistic regression, those with high combined IE-OST uptake (adjusted odds ratio [AOR] 0.614, 95% CI 0.458-0.823, p = 0.001) and medium combined IE-OST uptake (AOR 0.725, 95% CI 0.546–0.962, p = 0.026) had lower odds of having had a SSTI compared to those with low combined IE-OST uptake.

Conclusions: IE and OST uptake may reduce the level of SSTIs among PWID, suggesting increasing combined uptake maybe beneficial. Nevertheless, a sizeable proportion of PWID with high HR uptake experienced SSTIs, suggesting the importance of other interventions.