Spore forming bacteria infections and people who inject drugs: Implications for harm reduction

Karen Dunleavy; Alison Munro; Kirsty Roy; Sharon  Hutchinson; Norah E. Palmateer; Tony Knox; David  Goldberg; Vivian Hope; John Campbell; Emma Hamilton; David Liddell; Gillian  Penrice; Avril Taylor

doi:10.1016/j.drugpo.2017.12.001

Spore forming bacteria infections and people who inject drugs: Implications for harm reduction

Karen Dunleavy (Lead / Corresponding author), Alison Munro, Kirsty Roy, Sharon Hutchinson, Norah E. Palmateer, Tony Knox, David Goldberg, Vivian Hope, John Campbell, Emma Hamilton, David Liddell, Gillian Penrice, Avril Taylor

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Abstract

Background: There is no research on public health interventions that alert people who inject drugs (PWID) to clusters/outbreaks of severe bacterial infections. In Scotland, during the botulism cluster/outbreak of Dec 2014-July 2015 harm reduction (HR) messages detailed on a postcard (Botulism Postcard) were distributed to PWID between Feb-April 2015. We examined the impact of the Botulism Postcard on cluster/outbreak awareness, healthcare seeking and HR behaviours among PWID; and their views on such clusters/outbreaks.

Methods: The Botulism Postcard questionnaire survey was undertaken with 288 PWID recruited in Greater Glasgow and Clyde between May-August 2015. Multivariate logistic regression was undertaken. Between Oct 2015-January 2016 22 in-depth interviews were conducted with PWID in Glasgow and Edinburgh, these underwent thematic analysis.

Results: 38% (108/284) had never seen the postcard, 14% (40/284) had only seen it, 34% (98/284) read but not discussed it and 13% (38/284) had discussed it with service staff. Cluster/outbreak awareness was higher among those who had read (adjusted odds ratio (aOR) = 5.374, CI 2.394-11.349, p<0.001) or discussed the postcard (aOR = 25.114, CI 3.188-190.550, p <0.001); and symptom awareness was higher among those who had read (aOR = 2.664, CI 1.322-4.890, p<0.001) or discussed the postcard (aOR=6.707, CI 2.744-16.252, p<0.001) than among those who had never seen it. The odds of introducing HR was higher among those who had discussed the postcard (AOR= 3.304 CI 1.425-7.660, p<0.01) than those who had only read it. PWID learnt about clusters/outbreaks from several sources and despite concerns they continued to inject during such events.

Conclusion: More widespread exposure to the Botulism Postcard during the outbreak/cluster was needed. The Botulism Postcard distributed to PWID may raise awareness of such events, the symptoms, and may encourage HR particularly when used as a tool by frontline staff to initiate discussion. Acknowledging that people continue to inject during clusters/outbreaks of such infections necessitates a pragmatic HR approach.

Original language	English
Pages (from-to)	45-54
Number of pages	10
Journal	International Journal of Drug Policy
Volume	53
Early online date	24 Dec 2017
DOIs	https://doi.org/10.1016/j.drugpo.2017.12.001
Publication status	Published - Mar 2018

Keywords

Botulism
Clusters/outbreaks
Harm reduction
People who inject drugs
Public health intervention
Spore forming bacteria

ASJC Scopus subject areas

Medicine (miscellaneous)
Health Policy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Accepted author manuscript, 1.23 MBLicence: CC BY-NC-ND

Cite this

@article{c8a9225f0db345ce872efb5aa8a3ec29,

title = "Spore forming bacteria infections and people who inject drugs: Implications for harm reduction",

abstract = "Background: There is no research on public health interventions that alert people who inject drugs (PWID) to clusters/outbreaks of severe bacterial infections. In Scotland, during the botulism cluster/outbreak of Dec 2014-July 2015 harm reduction (HR) messages detailed on a postcard (Botulism Postcard) were distributed to PWID between Feb-April 2015. We examined the impact of the Botulism Postcard on cluster/outbreak awareness, healthcare seeking and HR behaviours among PWID; and their views on such clusters/outbreaks.Methods: The Botulism Postcard questionnaire survey was undertaken with 288 PWID recruited in Greater Glasgow and Clyde between May-August 2015. Multivariate logistic regression was undertaken. Between Oct 2015-January 2016 22 in-depth interviews were conducted with PWID in Glasgow and Edinburgh, these underwent thematic analysis.Results: 38% (108/284) had never seen the postcard, 14% (40/284) had only seen it, 34% (98/284) read but not discussed it and 13% (38/284) had discussed it with service staff. Cluster/outbreak awareness was higher among those who had read (adjusted odds ratio (aOR) = 5.374, CI 2.394-11.349, p<0.001) or discussed the postcard (aOR = 25.114, CI 3.188-190.550, p <0.001); and symptom awareness was higher among those who had read (aOR = 2.664, CI 1.322-4.890, p<0.001) or discussed the postcard (aOR=6.707, CI 2.744-16.252, p<0.001) than among those who had never seen it. The odds of introducing HR was higher among those who had discussed the postcard (AOR= 3.304 CI 1.425-7.660, p<0.01) than those who had only read it. PWID learnt about clusters/outbreaks from several sources and despite concerns they continued to inject during such events.Conclusion: More widespread exposure to the Botulism Postcard during the outbreak/cluster was needed. The Botulism Postcard distributed to PWID may raise awareness of such events, the symptoms, and may encourage HR particularly when used as a tool by frontline staff to initiate discussion. Acknowledging that people continue to inject during clusters/outbreaks of such infections necessitates a pragmatic HR approach.",

keywords = "Botulism, Clusters/outbreaks, Harm reduction, People who inject drugs, Public health intervention, Spore forming bacteria",

author = "Karen Dunleavy and Alison Munro and Kirsty Roy and Sharon Hutchinson and Palmateer, {Norah E.} and Tony Knox and David Goldberg and Vivian Hope and John Campbell and Emma Hamilton and David Liddell and Gillian Penrice and Avril Taylor",

note = "The NESI study was funded by the Scottish Government. The work for this paper was supported by Health Protection Scotland, the Scottish Government and the University of the West of Scotland.",

year = "2018",

month = mar,

doi = "10.1016/j.drugpo.2017.12.001",

language = "English",

volume = "53",

pages = "45--54",

journal = "International Journal of Drug Policy",

issn = "0955-3959",

publisher = "Elsevier",

}

TY - JOUR

T1 - Spore forming bacteria infections and people who inject drugs

T2 - Implications for harm reduction

AU - Dunleavy, Karen

AU - Munro, Alison

AU - Roy, Kirsty

AU - Hutchinson, Sharon

AU - Palmateer, Norah E.

AU - Knox, Tony

AU - Goldberg, David

AU - Hope, Vivian

AU - Campbell, John

AU - Hamilton, Emma

AU - Liddell, David

AU - Penrice, Gillian

AU - Taylor, Avril

N1 - The NESI study was funded by the Scottish Government. The work for this paper was supported by Health Protection Scotland, the Scottish Government and the University of the West of Scotland.

PY - 2018/3

Y1 - 2018/3

N2 - Background: There is no research on public health interventions that alert people who inject drugs (PWID) to clusters/outbreaks of severe bacterial infections. In Scotland, during the botulism cluster/outbreak of Dec 2014-July 2015 harm reduction (HR) messages detailed on a postcard (Botulism Postcard) were distributed to PWID between Feb-April 2015. We examined the impact of the Botulism Postcard on cluster/outbreak awareness, healthcare seeking and HR behaviours among PWID; and their views on such clusters/outbreaks.Methods: The Botulism Postcard questionnaire survey was undertaken with 288 PWID recruited in Greater Glasgow and Clyde between May-August 2015. Multivariate logistic regression was undertaken. Between Oct 2015-January 2016 22 in-depth interviews were conducted with PWID in Glasgow and Edinburgh, these underwent thematic analysis.Results: 38% (108/284) had never seen the postcard, 14% (40/284) had only seen it, 34% (98/284) read but not discussed it and 13% (38/284) had discussed it with service staff. Cluster/outbreak awareness was higher among those who had read (adjusted odds ratio (aOR) = 5.374, CI 2.394-11.349, p<0.001) or discussed the postcard (aOR = 25.114, CI 3.188-190.550, p <0.001); and symptom awareness was higher among those who had read (aOR = 2.664, CI 1.322-4.890, p<0.001) or discussed the postcard (aOR=6.707, CI 2.744-16.252, p<0.001) than among those who had never seen it. The odds of introducing HR was higher among those who had discussed the postcard (AOR= 3.304 CI 1.425-7.660, p<0.01) than those who had only read it. PWID learnt about clusters/outbreaks from several sources and despite concerns they continued to inject during such events.Conclusion: More widespread exposure to the Botulism Postcard during the outbreak/cluster was needed. The Botulism Postcard distributed to PWID may raise awareness of such events, the symptoms, and may encourage HR particularly when used as a tool by frontline staff to initiate discussion. Acknowledging that people continue to inject during clusters/outbreaks of such infections necessitates a pragmatic HR approach.

AB - Background: There is no research on public health interventions that alert people who inject drugs (PWID) to clusters/outbreaks of severe bacterial infections. In Scotland, during the botulism cluster/outbreak of Dec 2014-July 2015 harm reduction (HR) messages detailed on a postcard (Botulism Postcard) were distributed to PWID between Feb-April 2015. We examined the impact of the Botulism Postcard on cluster/outbreak awareness, healthcare seeking and HR behaviours among PWID; and their views on such clusters/outbreaks.Methods: The Botulism Postcard questionnaire survey was undertaken with 288 PWID recruited in Greater Glasgow and Clyde between May-August 2015. Multivariate logistic regression was undertaken. Between Oct 2015-January 2016 22 in-depth interviews were conducted with PWID in Glasgow and Edinburgh, these underwent thematic analysis.Results: 38% (108/284) had never seen the postcard, 14% (40/284) had only seen it, 34% (98/284) read but not discussed it and 13% (38/284) had discussed it with service staff. Cluster/outbreak awareness was higher among those who had read (adjusted odds ratio (aOR) = 5.374, CI 2.394-11.349, p<0.001) or discussed the postcard (aOR = 25.114, CI 3.188-190.550, p <0.001); and symptom awareness was higher among those who had read (aOR = 2.664, CI 1.322-4.890, p<0.001) or discussed the postcard (aOR=6.707, CI 2.744-16.252, p<0.001) than among those who had never seen it. The odds of introducing HR was higher among those who had discussed the postcard (AOR= 3.304 CI 1.425-7.660, p<0.01) than those who had only read it. PWID learnt about clusters/outbreaks from several sources and despite concerns they continued to inject during such events.Conclusion: More widespread exposure to the Botulism Postcard during the outbreak/cluster was needed. The Botulism Postcard distributed to PWID may raise awareness of such events, the symptoms, and may encourage HR particularly when used as a tool by frontline staff to initiate discussion. Acknowledging that people continue to inject during clusters/outbreaks of such infections necessitates a pragmatic HR approach.

KW - Botulism

KW - Clusters/outbreaks

KW - Harm reduction

KW - People who inject drugs

KW - Public health intervention

KW - Spore forming bacteria

UR - http://www.scopus.com/inward/record.url?scp=85039739129&partnerID=8YFLogxK

U2 - 10.1016/j.drugpo.2017.12.001

DO - 10.1016/j.drugpo.2017.12.001

M3 - Article

C2 - 29281807

SN - 0955-3959

VL - 53

SP - 45

EP - 54

JO - International Journal of Drug Policy

JF - International Journal of Drug Policy

ER -

Spore forming bacteria infections and people who inject drugs: Implications for harm reduction

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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