RESUMEN
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)â¯=â¯5.374, CI 2.394-11.349, pâ¯<â¯0.001) or discussed the postcard (aORâ¯=â¯25.114, CI 3.188-190.550, pâ¯<â¯0.001); and symptom awareness was higher among those who had read (aORâ¯=â¯2.664, CI 1.322-4.890, pâ¯<â¯0.001) or discussed the postcard (aORâ¯=â¯6.707, CI 2.744â¯16.252, pâ¯<â¯0.001) than among those who had never seen it. The odds of introducing HR was higher among those who had discussed the postcard (AORâ¯=â¯3.304 CI 1.425â¯7.660, pâ¯<â¯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.