The impact of the COVID-19 pandemic on harm reduction services in Catalonia: the experience of people who use drugs and harm reduction professionals.

BACKGROUND: Harm reduction services and professionals have had to reorganise and adapt to COVID-19 prevention measures while still ensuring health and social services for people who use drugs (PUD). OBJECTIVE: To assess the impact of the COVID-19 pandemic on PUD and on the professionals who provide harm reduction services. METHODS: A qualitative, exploratory, multicentre design was used. Two focus groups were held with harm reduction professionals, and 40 individual semi-structured interviews were undertaken with PUD in various harm reduction services in Catalonia. Interviews and focus group discussions were transcribed and analysed using thematic content analysis. RESULTS: Harm reduction services adapted to the pandemic situation by employing methods such as reducing opening hours and closing drop in areas, along with health protection measures such as access control, which in turn led to stress among both professionals and service users. Despite the changes implemented, PUD continued to have access to sterile drug use equipment and methadone treatment. In addition, those who were not in treatment were able to access it rapidly. Regarding their emotional state, the PUD reported that it was worse during the pandemic than before the lockdown, with women affected to a greater extent than men. The harm reduction professionals reported difficulties in managing service users' compliance with the security measures at the beginning of the lockdown and having had to focus primarily on providing food and shelter for the PUD. CONCLUSIONS: It is important to keep PUD in mind and maintain a harm reduction perspective when implementing confinement measures in situations such as those experienced during the COVID pandemic. Guaranteeing that PUD have their basic needs such as food, hygiene and shelter covered is key.

Temporal relationship between a sudden disruption of a local illicit drug market in a deprived neighborhood of the Barcelona Metropolitan Area and the number of discarded syringes collected from public space.

BACKGROUND: The objective of this study was to describe the temporal relationship between an illicit drug market abrupt disruption and the number of discarded syringes collected from public space in Barcelona. METHODS: The monthly number of discarded syringes collected and interrupted time-series analyses were used to analyze changes and trends from January 2014 to December 2017, before and after an illicit drug market disruption comparing three different areas of the city: intervened (A) and not intervened (B) high trafficking areas and, as a reference, a low trafficking area (C). RESULTS: After the disruption, a decrease in the average number of syringes collected in area A was observed, although the trend was not significant (p value 0.09). In area B, there was a significant increase with an upward trend in the average number of collected syringes (p value <0.001). A flat trend was observed throughout the period in area C (p value 0.62) The systematic counting of discarded syringes collected from public places is confirmed as a useful indicator to monitor drug dealing and use in urban areas. It may help public health services strengthen safe needle disposal practices and harm reduction interventions in these areas.

Implementation of rapid HIV and HCV testing within harm reduction programmes for people who inject drugs: a pilot study.

UNLABELLED: Including HCV and HIV rapid tests in harm reduction programmes (HRP) for people who inject drugs (PWID) can increase detection of these infections in high-risk populations who do not seek conventional health care. AIMS: To assess acceptability and feasibility of rapid HIV and HCV tests in HRP; to identify HIV and HCV prevalence rates in HRP; to identify the percentage of PWID with a reactive test that attend hospital for confirmation and follow-up. Rapid oral tests for HCV and HIV were offered to users of 13 HRP from both mobile units and facility-based centres. A total of 172 HCV and 198 HIV tests were performed, with a refusal rate of 1.7% and 10.4%, respectively. Injectors made up 64.9% of all drug users and 35.1% did not inject drugs. Overall, 20.3% of HCV tests and 2.5% of HIV test were reactive. Only 24 of the 35 reactive HCV could be confirmed (68.6%) and one was false-negative. Of the five HIV reactive cases, only two could be confirmed (40%) with 1 false-positive case. Acceptability of rapid HIV and HCV tests among HRP users was high. The usefulness of oral rapid tests in HRP has been demonstrated, especially in mobile HRP.