The NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West project, in collaboration with the Addictions Health Integration Team, examining whether a new ‘low dead space’ syringe would be acceptable to people who inject drugs as an alternative to traditional syringes, has found that users support use of the new syringe. Low dead space syringes could reduce the chance of spreading infections among people who inject drugs if syringes are re-used. This project was a collaboration with the NIHR Health Protection Research Unit in Evaluation of Interventions.
Needle and syringe programmes supply sterile equipment to people who inject drugs to reduce the transmission of blood-borne viruses and other infections caused by sharing injecting equipment. However, sometimes needles and syringes still get re-used or shared. This increases the chance of spreading infections such as HIV and hepatitis C. The likelihood of spreading these infections is influenced by the type of equipment used to inject drugs.
Research suggests that this new type low dead space syringe with a detachable needle could reduce the chance of spreading infections if syringes are re-used or shared. A low dead space syringe limits the dead space that exists between the syringe hub and needle. Changing to this type of syringe and supplying them through needle and syringe programmes can therefore help protect people who inject drugs from harm of infection.
The aim of this study was to understand the acceptability among people who inject drugs of this new syringe with detachable needles and whether people would actually use them.
Researchers reviewed what is already known about these syringes and their acceptability. They also undertook interviews with 23 people who inject drugs, and 13 volunteers and professionals who work with them, to explore their views on low dead space syringes, to be able to decide whether an intervention is required to promote their use.
Despite anticipated initial frustration about having to change familiar equipment, most people were expected to be willing to try the new syringes and to continue using them if they worked as well as the original equipment. They found support among people who inject drugs who valued the benefits of less wasted drug and the lower risk of transferring infections.
Their finding that low dead space syringes are likely to be acceptable to people who inject drugs has potential implications for needle and syringe programmes.
Based on the findings of the review and interviews they developed recommendations for the introduction of detachable low dead space syringes. The principles of this intervention include: training needle and syringe programme staff, education for people who inject drugs, persuasion to try detachable low dead space syringes by offering a few to try with usual equipment and eventual restriction of the usual equipment. Alongside the introduction of low dead space syringes, encouraging appropriate syringe rinsing methods targeting those known to re-use or share equipment may also be necessary.
They will present our findings at two public health conferences in March: the South West Public Health Conference on 16 March and the Applied Epidemiology Scientific Conference on 22-23 March. These conferences are a great opportunity to engage with those making decisions about guidance and funding for needle and syringe programmes.
Furthermore, they expect the findings to be of interest to the National Institute of Clinical Excellence and Care (NICE) who produce guidance for needle and syringe programmes.
They are developing materials to support the implementation of detachable low dead space syringes including a flyer to be used by needle and syringe programmes to help inform people who inject drugs about the new equipment. They are also developing a step-by-step guide for needle and syringe programmes to implement the new syringes and are considering a cost-effectiveness analysis to help service providers make decisions about investing in the new equipment.
The steering group for this project had Patient and Public Involvement (PPI) in the form of service user input from Bristol Drugs Project (BDP). People who inject drugs are typically challenging to engage with in research due to their addictions and sometimes difficult circumstances. The success of this involvement hinged on the support of our BDP collaborators who identified service users and facilitated their attendance at meetings. PPI engagement was valuable in this project as it offered useful insights into our findings and plans for implementation.
From the service user perspective, taking part in the oversight of this project was an enjoyable and empowering experience. The research team learnt how important it is to enable service user engagement through practical support and by making an effort to explain the acronyms used during the meetings.