Young people who inject drugs (PWID) often share the needles, thus exposing themselves to blood borne viruses including Human Immunodeficiency Virus (HIV), bacteremia/sepsis, Hepatitis B (HBV), and Hepatitis C (HCV) (Fernandes et al., 2017). The needle exchange program has been proposed by different authors for risk reduction among this population. However, there is still a gap on whether sufficient evidence for such a program exists in New South Wales (NSW).
The objective of this scoping review is to determine the quantity and the quality of peer-reviewed scholarly articles available on the topic.
The student assessed different online databases and conducted a search strategy on needle sharing, blood borne viruses, and needle exchange programs in NSW and other regions.
A total of 20 publications were used for the scoping review out of which 17 sources indicated that the needle exchange program significantly reduced the risk of PIWD contracting blood borne viruses. Two of the studies showed that there was no significant reduction in risk of transmitting diseases such as HIV, HPC and HPB. While one of the studies was neutral citing that PIWD were responsible with the way they use needles in such a way that they avoid risk exposure.
The implementation of needle exchange program is necessary to minimize risk of blood borne viruses. The PIWD who used the exchange programs instead of purchasing needle in the pharmacy are more responsible and it is easy to do follow up on them. There are challenges for such development, especially since there are few models to follow. Nonetheless, Stockholm, Sweden has been successful with its needle exchange program which can be emulated by others. Hence, there is a gap in implementation of needle and syringe exchange program that calls for more exploration by researchers.
The young people are most affected by injectable drugs which may pose risk to them due to sharing. Globally, more than 250 million people use addictive drugs out of which 40 to 60% relapse after rehabilitation (Resiak et al., 2021). The PWID, are more likely to get the blood borne viruses sue to such practice. Notably, in 2015, Seventy-one million people were infected with the HCV (Prouté et al., 2020). Therefore, harm mitigation strategies are needed so that the burden of diseases will be reduced and the youths will be safe. This scoping review will provide relevant evidence on if the publications available have sufficiently addressed the topic and determine whether there is a research gap.
This scoping review is relevant for practice, learning, and research since the topic of harm reduction among people with addiction is important. Healthcare organizations can benefit the PIWD and lower their chances of getting multiple infections. In addition, this scoping review is relevant to future researchers who desire to understand this topic, as it will provide recommendation to the existing research gap. The evidence from the study will also be used to enhance continuous learning to nursing students and professionals.
The objective of this scoping review is to provide a systematic review of the literature that is available on harm mitigation through needle exchange program. Moreover, the existing gaps will be assessed to provide guidance for future systematic reviews. The research question that guided this scoping review is: Can development of needle exchange program to reduce blood borne viruses amongst young people who inject drugs in NSW?
Protocol and Registration
Item 6: Eligibility criteria
Studies that were included for this scoping reviewed had young PIWD as the primary population and needle or syringe exchange program as a way of harm minimization against the blood borne viruses. Only studies written in English and published not earlier than 2010 were selected. The papers which focused reduction of other harms other than blood borne viruses were excluded. In addition, the publications that participants used drugs in any other form rather than through injection were excluded. Furthermore, those that were published before 2010 and those which were not peer reviewed were removed.
Different databases were used to search sources used in this scoping review including Medline, ProQuest, Google Scholar, Pubmed and CINAHL. To refine search within each of the database the use of limiters such as year of publication and type of publication was used. The PICO (problem/ population, intervention, comparison and outcome) was also utilized in refining the searches.
Boolean Search Strategy
- Injectable drugs AND needle sharing
- Needle exchange program OR syringe exchange program
- Harm reduction OR harm minimization
- Viral borne diseases OR HIV OR hepatitis B and C
- Young people OR Youth
- 1 AND 2 AND 3 AND 4 AND 5
Selection of sources of evidence
All the sources were first screened based on the title since limiters for date of publication had already been placed during the search. Depending with the title, the student selectively progressed to read the abstracts of the selected articles. The sources that were judged to be relevant to the scoping review were then assessed if available in full text before downloading.
In order to categorize and recognize patterns in the selected publications, the researcher solely charted the data to enable visualization of the characteristics of the data.
The collection of data was done on the author (s), research method, sample size, publication year, study aim, location and the main findings.
Critical appraisal of individual sources of evidence
Synthesis of results
To assess the scope of information that is available on needle exchange program for young people who are using injectable drugs data was categorized based on similarities in features. Particularly, the findings of the study were summarized to identify the similarities, points of contention and the existing gaps. A table is then used to visually present the evidence found from the scoping review.
Selection of sources of evidence
Characteristics of sources of evidence
The table 1 below shows some of the characteristics of the selected sources in terms of sample, date of publication, place of publication, sample size and outcome.
Table 1: Showing source characteristics.
|Characteristics||Category of each characteristic||Number of publication (n=20)|
|Date of publication|
|Place of publication|
|The United States||4|
|Randomized Control Trial||1|
|Meta- analysis or systematic Review||2|
|Overview of Systematic Reviews||1|
|Respondent-Driven Sampling (RDS)||1|
|Qualitative case study||1|
|Needle exchange program minimized risk||17|
|Needle exchange program did not minimize risk||2|
|Needle exchange program was neutral||1|
Critical appraisal within sources of evidence
Results of individual sources of evidence
Table 2 below shows the results and outcomes of each source including information on country, type of study, sample size and outcome summary.
|Citation||Country of publication||Study type||Summary of outcomes|
|(Brener et al. 2018)||Australia||Cross-Sectional Survey||Drug users act responsibly in harm prevention implying needle exchange program not useful.|
|(Bryant et al., 2010)||Australia||Cross-Sectional Survey||People who got needle from pharmacy more at risk of sharing and getting blood borne virus as compared to those in needle exchange program. Particulary the “adjusted odds ratio 5.9, 95% confidence interval 2.02-17.14” (Bryant et al., 2010)|
|(Cunninghum et al., 2017)||Australia||Longitudinal study design||Risk of blood-borne virus minimized through needle exchange programs|
|(Davis et al. 2018)||United States||Qualitative case study||needle exchange programs (NEP) beneficial in risk reduction although no existing model for sustainable implementation|
|(Dmitrieva et al., 2021)||Ukrain||Descriptive||Neutral, need for political change before implementation of needle exchange program|
|(Fernandes et al., 2017)||Portugal.||Overview of Systematic Reviews||Needle and syringe programs effective in reducing HIV transmission among PWID|
|(Fisher et al., 2016)||Australia||Cross-sectional face-to-face survey||Aboriginal PIWD more at risk of infection transmission due to lack of access to needle exchange programs|
|(Jacka et al., 2017)||Australia||Longitudinal design||needle-syringe programs (NSP) reduce blood borne viruses for people who inject performance and image-enhancing drugs (PIEDs) by 9%|
|(Kåberg et al., 2017)||Sweden||Cross-sectional||High incidences of HCV among PIWD despite being on a needle exchange program|
|(Kåberg et al., 2020)||Sweden||Prospective Open Cohort Study||Evidence at Stockholm NEP resulted in significant decrease in injection risk|
|(Karlsson et al., 2021)||Sweden||prospective cohort study||The NEP enabled, more follow up which minimized risk of infections.|
|(Lancaster et al., 2020)||United States||Quantitative||Evidence for positive outcome with needle exchange program|
|(Niklas et al., 2021)||Sweden||systematic Review||Implementation of NEP resulted in scale-up harm reduction|
|(O’Keefe et al., 2019)||United States||Descriptive Report||Needle and syringe programmes offer sterile injection equipment|
|(Prouté et al., 2020)||Thailand||Respondent-Driven Sampling (RDS)||Only 5% of PWID population enrolled in harm reduction program due to misinformation|
|(Rowe et al., 2017)||Australia||Cross-Sectional Survey||PIWD from culturally and linguistically diverse (CALD) at higher risk of needle sharing due to lack of NEP|
|Resiak, Mpofu, and Rothwell, 2021)||Australia||Scoping review||needle and syringe programs (NSPs) results in reduced harm but its sustainability depend with its implementation procedure and perception from the community.|
|(Teshale et al., 2019)||United States||Descriptive design using records||Comprehensive syringe service program (SSP) cost varies thus preventing effective planning to reduce harm|
|(Treloar, McCredie, and Lloyd, 2016).||Australia||Cohort study||Needle syringe programs minimizes blood-borne virus (BBV|
|(Zhou et al., 2019)||China||Systematic Review and Meta-Analysis||sterile needles and syringes ensure safe injection, thus reducing harm|
Synthesis of results
Through this scoping review the quality and the quantity of the 20 sources that were selected using predetermined inclusive and exclusive criteria have been determined. Notably, from the findings, it is apparent that the amount of data that is available on needle exchange program for the PIWD is minimal. It was even difficult to find publications that are exclusive for Australia, hence more studies from other countries were also included. Specifically, Australia was leading in the number of publications, most likely because it was included in the search terms. Sweden also had up to four sources and was followed by United States. Other countries which had sources include Thailand, China and Portugal.
From the charting it is clear that the use of needle exchange program reduced the risk of transmission of the blood borne viruses among the PIWD. This is evident from the fact that 17 out of the 20 sources included in the review revealed that there was safe usage with such a system. Only two of the publications disputed these findings while one remained neutral. One of the themes that emerged as a gap in the study is lack of models to follow. It appears that NEP has only recently been considered by healthcare organizations. As such it is vital for future researcher to further explore this gap focusing on the resources such as financial and human that is necessary for successful implementation of the program.
Summary of evidence
This scoping review used inclusion and exclusion criteria to identify a total of 20 sources that were relevant to the topic. All the selected studies had to have been published not earlier than 2010. They were all peer reviewed to enhance quality. Sorting of the sources was conducted focusing on elements such as year of publication, county, design and sample size. Through such categorization it was possible to notice the existing trends.
The scoping review established that there was paucity of studies that have explored needled exchange programs for PIWD. Thus, there is need for more study, especially on sustainable implementation. Sweden emerged as the only country with an exceptional NEP that can be used for benchmark. The rationale for minimal risk is due to more freedom in accessing of a sterilized needle, increased accountability and follow up. People in such programs were less likely to share their syringes and needles which resulted in low risk of acquiring blood borne infections.
There are many limitations of this scoping review which make generalization of findings to be applied only selectively. To start with, all the limitations of the studies included directly affects the credibility of the current review. In addition, there are only 20 sources which were used from diverse countries and with different designs. Thus, the result cannot be genialized to all settings. The is also a chance of research bias given that the review is not quantitative.
The scoping review has mapped the available literature on the topic of providing needled exchange programs for PIWD. Notably, there are paucities of studies that have explored effectiveness of needle exchange programs in Australia. As such, this study has identified significant gaps in the implementation of the programs. The implication of the findings for future implementation is that it will help in understanding the resources needed and the procedures for success of a needle and exchange program. The scoping review also has implications for future researchers as it provides recommendation.
Self-Assessment and Reflection
Multidisciplinary collaboration and teamwork are now familiar concepts in the workplace, more so within the public health. As such, it is relevant for students to adopt social and leadership skills that can be useful when working in an organization with professionals from different disciplines (Dinh et al., 2019). With this knowledge in mind, I endeavoured to take the health planning project with the seriousness that it deserves. Specifically, I was a member in a group of four students tasked with cooperatively completing a project. There were two primary roles that I played within the group including public health research coordinator, as well as public health and health promotion. In this reflection paper I provide a brief self-assessment on my role and key skills in the group.
To start with, under my role as the coordinator I had to depict strong leadership and communication skills. Worthy of note, I made contributed in managing the team’s activities including meeting time and venue. Moreover, managing time and ensuring that each of the group’s milestone was achieved within the schedule was my role. Additionally, I was the primary contact person for the group which proved relevant when external stakeholders needed to pass a message to the team. Last but not least, I led in conducting research on the public health promotion activity and sharing my discoveries with others.
With regards to public health promotion involving external coordinators, a holistic communication plan needs to be adopted. First, the media of communication for each group is needed given that each has different strengths and limitations; hence, different suitability (Ward, 2020). For example, the social media can be an appropriate cannel for the public. Next, talks with project team members should use both face-to-face conversation and using cell phones for coordination. To pass information to major partners official emails can be used. An official tone is most appropriate to emphasize the need of the health promotion.
In my team, I was tasked with ensuring that I organize for group discussions and other meetings. The implication is that I would consult with each member to establish the time that was most appropriate and convenient for all members. One of the lessons that I learned just as explained by Gluyas (2015), is that effective communication is important in a team structure. For example, the first meeting that we were supposed to hold failed due to the poor approach that I used to impose on others the time. Only two members turned up because others were engaged in other things. Commendably, I managed to handle the crisis well by first admitting to my failures and apologizing then changing my way of scheduling group events. On that day, I learned that to be an effective leader it is important to involve others in critical decision making.
Conclusively, my experience working in a team provided great insights on how the work environment operates. My leadership skills such as effective communication, group coordination, time management and research proved relevant in accomplishing the tasks of the team. My communication plan involves selection of the appropriate media through which message is passed to different individuals using appropriate language. I also had significant contributions to the team where I was tasked with health promotion and coordination. It is my endeavor that I will continue to hone my skills so that I become a great leader.
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