(102) Rural Versus Urban SSP Utilization in Maine: A Harm Reduction Study

PURPOSE AND

Background:
Syringe service programs (SSPs) decrease HIV and viral hepatitis, decrease the prevalence of improperly disposed needles and reduce needle stick injuries among first responders in those areas. IDU-associated infections are rising in rural areas. In Maine, viral hepatitis and infective endocarditis rates have increased over recent years. Because Maine is predominantly a rural state, these trends have led to concerns that SSP services are difficult to access for rural residents. The purpose of this study is to examine differences in demographics and health characteristics of PWID (people who inject drugs) stratified by urban and rural locations in Maine.

Methods:
Data were obtained from a cross-sectional survey of 101 participants hospitalized with IDU-associated infections at four Maine hospitals. An Audio Computer-Assisted Self-Interview survey and medical record review were used to collect data over a 15 month time period. Descriptive analyses of demographics, health characteristics, and syringe service acquisition and disposal were performed. Using rural urban community area (RUCA) codes, urban was defined as metropolitan, and rural was defined as large, small, or isolated rural areas. Statistical analysis was completed using Fisher's exact tests; Pearson's Chi-squared tests and Kruskal-Wallis rank sum tests.

Results:
Out of 101 study participants, n=66 (65%) lived in urban areas and n=35 (35%) lived rurally. Those living in rural areas reported less SSP use in the previous three months (77% vs. 46%, p=0.0001). In terms of demographics, participants living in urban areas were more like to report experiencing homelessness (56% vs. 26%, p=0.004) and history of incarceration (94% vs. 80%, p=0.045) compared to rural participants. As far as health characteristics those living in urban areas were more likely to have a known negative HIV status (89% vs. 74%, p=0.038). Injection drug of choice was also different between the two groups showing a higher prevalence of injecting buprenorphine in the rural group (6% v. 12%, p=0.11) as well as cocaine and heroin (“speedball; 15% v. 39%, p=0.023). In terms of SSP acquisition and disposal practices, compared to rural residents, urban respondents were more likely to acquire their equipment from SSPs (54% vs. 11%, p< 0.001) and also more likely to dispose their needles away in a safe disposal box (56% v. 32%, p=0.024). Rural respondents were more likely to acquire new needles from pharmacies as opposed to SSPs (40% v. 71%). There were also significant differences in those respondents interested in using a supervised injection facility/overdose prevention site, with more interest among urban respondents (82% v. 54%, p=0.004).

Conclusions:
Our study sheds light on differences in demographics, health characteristics, and syringe acquisition and disposal practices of rural and urban PWID in the state of Maine. These differences highlight the need for development and enhancement of SSP programs for the unique populations that reside rurally. Our study can also inform the development of future studies of SSPs and other health care utilization for people who inject drugs.

References:
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