Abstract
Background: In 2016, the City of Tshwane Metropolitan Municipality (CoTMM) requested the Department of Family Medicine (DFM) at the University of Pretoria (UP) to establish the Community Oriented Substance Use Programme (COSUP) in response to the increase in drug use in the city. People who inject drugs (PWID) are at increased risk for several detrimental health outcomes from risky drug use, related practices, and contextual risk factors.
Aim and objectives: The study aimed to evaluate the impact of needle and syringe programme services in COSUP-a community-based harm-reduction programme for people who inject drugs in Tshwane, South Africa. The objectives were to describe needle and syringe sharing behaviours and associated traits among PWID who utilise needle and syringe services at COSUP; to evaluate knowledge, attitudes, perceptions and actions of PWID on the use of needle and syringe service components at COSUP; and to identify the factors that promote and hinder access to clean injecting equipment of PWID using needle and syringe services at COSUP in Tshwane.
Methodology: The study applied a quantitative, cross-sectional study design. The study population was people who inject drugs and access needle and syringe services at COSUP in Tshwane. The sample size was calculated using EPINFO app version 7.2, and was calculated with a 95% confidence level and a 5% margin of error. A contingency of 25% was added to the estimated sample size (223), bringing the total estimated sample size to 280 (25/100 x 223 = 57 + 223 = 280). The researcher made use of interviewer-assisted tablet-based questionnaires. The collected quantitative data were analysed using the Statistical Package for Social Sciences (SPSS) version 29. Pearson’s Correlation test was conducted to test for the relationship between the constructs. Correlation analysis was measured by the correlation coefficient (rho).
Results: The results of the study indicate that most of the respondents were male 266 (95,0%), 148 (52,9%) were aged between 18 and 34 years, 190 (67,9%) had a lower that Grade 12 level of education, and 178 (63,6%) were unemployed. The analysis revealed that respondents age displayed a statistically significant (p-value = 0.03) relationship with clean injection equipment. 170 (60,7%) did not share their needle and
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syringe equipment, while in their last injection, 90 (81,8%) used the injecting equipment after someone used it; 109 (64,1%) did not use the injecting equipment and gave it to someone else. Also, the number of times the respondents inject drugs displayed a statistically significant relationship (p-value < 0.001) with clean injection equipment. The mean number of injections of 4.13 (SD 0.944), confirms the overall positive responses to the questions measuring the knowledge of NSP. There is a statistically and significantly (p-value < 0.01) strong positive correlation between knowledge of NSP and respondents’ attitude of NSP (r = 0.662). Respondents were in agreement with the questions measuring attitude towards NSP. A large proportion of the respondents 139 (49,9%) agreed that NSP is helping them to stay alive, while 138 (49,3%) agreed that NSP helps them to care more about themself and their health. The results revealed that there was a moderately positive correlation between knowledge of NSP and respondents’ actions (r = 0.086). A large number 102 (48,6%) respondents agreed that they are careful about how to get rid of their used needles, 131 (46,8%) agreed that they inject more safely, 86 (41,0%) agreed that they share less, and they have used other services offered, and 75 (35,7%) agreed that the number of times they inject substances has decreased. Lastly, the summed mean value of 3.96 with the (SD1.018) imply the overall positive response to the questions measuring the NSP and the actions of clients who inject drugs.
Conclusion: This study demonstrated that providing people who inject drugs with sterile injecting equipment is estimated to be effective in providing service users with education on safer injecting practices and enable clients to take part in other harm-reduction interventions. People who inject drugs and access services at COSUP show a low prevalence of sharing injecting equipment in Tshwane district. PWID report that NSPs in Tshwane support safer injecting practices and reduce risk of infections among PWID. Sustaining and expanding NSP services could further reduce injecting-related harms.
Keywords: harm reduction, needles and syringes, people who inject drugs, community-based