Pilot Trial of an Intervention Aimed at Modifying Drug Preparation Practices Among Injection Drug Users in Puerto Rico

Abstract

Injection drug users (IDUs) contaminate preparation materials with blood-borne pathogens by using syringes as measuring and dispensing devices. In collaboration with IDUs, we developed a preventive intervention consisting of four new preparation practices aimed at avoiding the use of syringes in the preparation, and reducing the contamination of the materials. This report describes the results of a pilot trial introducing the new practices to ascertain their adoption potential and their potential efficacy in reducing contamination. Participants comprised 37 active IDUs among whom the new practices were promoted during 16 weeks. In addition to self-reported behaviors, the study collected cookers and plastic caps from shooting galleries and tested them for the presence of blood residues. Adoption rates were: (1) cleaning of skin area with hand sanitizer—65.6%; (2) directly pouring water with a dropper into the cooker—56.3%; (3) drawing drug solution with a preparation syringe and syringe filter—34.4%; and, (4) backload rinsing syringes—53.1%. Rates of blood residues detected in cookers and plastic caps were 41.7% prior to the trial, 28.6% at week 8, 24.6% at week 14, and 12.0% at week 18. We believe the results of the pilot trial are compelling and suggest that this intervention merits further formal testing.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. Booth, R. E., Kwiatkowski, C. F., Mikulich-Gilbertson, S. K., Brewster, J. T., Salomonsen-Sautel, S., Corsi, K. F., et al. (2006). Predictors of risky needle use following interventions with injection drug users in Ukraine. Drug and Alcohol Dependence, 82(Suppl 1), S49–S55. doi:10.1016/S0376-8716(06)80009-8.

    PubMed  Article  Google Scholar 

  2. Burt, R. D., Hagan, H., Garfein, R. S., Sabin, K., Weinbaum, C., & Thiede, H. (2007). Trends in hepatitis B virus, hepatitis C virus, and human immunodeficiency virus prevalence, risk behaviors, and preventive measures among Seattle injection drug users aged 18–30 years, 1994–2004. Journal of Urban Health, 84, 436–454. doi:10.1007/s11524-007-9178-2.

    PubMed  Article  Google Scholar 

  3. Colon, H. M., Finlinson, A., Negron, J., Sosa, I., Rios-Olivares, E., & Robles, R. R. (2008). Participatory research with injection drug users to modify drug preparation practices I: Intervention Development. Unpublished manuscript.

  4. Finlinson, H. A., Colon, H. M., Lopez, M. S., Robles, R. R., & Cant, J. G. (2005). Injecting shared drugs: An observational study of the process of drug acquisition, preparation, and injection by Puerto Rican drug users. Journal of Psychoactive Drugs, 37, 37–49.

    PubMed  Google Scholar 

  5. Finlinson, H. A., Oliver-Velez, D., Deren, S., Cant, J. G., Colon, H. M., Robles, R. R., et al. (2006). A longitudinal study of syringe acquisition by Puerto Rican injection drug users in New York and Puerto Rico: Implications for syringe exchange and distribution programs. Substance Use and Misuse, 41, 1313–1336. doi:10.1080/10826080600885092.

    PubMed  Article  Google Scholar 

  6. Huo, D., Bailey, S. L., Garfein, R. S., & Ouellet, L. J. (2005). Changes in the sharing of drug injection equipment among street-recruited injection drug users in Chicago, Illinois, 1994–1996. Substance Use and Misuse, 40, 63–76. doi:10.1081/JA-200030495.

    PubMed  Article  Google Scholar 

  7. Kapadia, F., Latka, M. H., Hagan, H., Golub, E. T., Campbell, J. V., Coady, M. H., et al. (2007). Design and feasibility of a randomized behavioral intervention to reduce distributive injection risk and improve health-care access among hepatitis C virus positive injection drug users: The study to reduce intravenous exposures (STRIVE). Journal of Urban Health, 84, 99–115. doi:10.1007/s11524-006-9133-7.

    PubMed  Article  Google Scholar 

  8. Koester, S. (1998). Following the blood: Syringe reuse leads to blood-borne virus transmission among injection drug users. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 18(Suppl 1), S139–S140.

    PubMed  Google Scholar 

  9. Koester, S., Glanz, J., & Baron, A. (2005). Drug sharing among heroin networks: Implications for HIV and hepatitis B and C prevention. AIDS and Behavior, 9, 27–39. doi:10.1007/s10461-005-1679-y.

    PubMed  Article  Google Scholar 

  10. Ksobiech, K. (2006). Beyond needle sharing: Meta-analyses of social context risk behaviors of injection drug users attending needle exchange programs. Substance Use and Misuse, 41, 1379–1394. doi:10.1080/10826080600846219.

    PubMed  Article  Google Scholar 

  11. Mathei, C., Shkedy, Z., Denis, B., Kabali, C., Aerts, M., Molenberghs, G., et al. (2006). Evidence for a substantial role of sharing of injecting paraphernalia other than syringes/needles to the spread of hepatitis C among injecting drug users. Journal of Viral Hepatitis, 13, 560–570. doi:10.1111/j.1365-2893.2006.00725.x.

    PubMed  Article  CAS  Google Scholar 

  12. Middelthon, A. L. (2005). A room for reflection: Self-observation and transformation in participatory HIV prevention work. Medical Anthropology Quarterly, 19, 419–436. doi:10.1525/maq.2005.19.4.419.

    PubMed  Article  Google Scholar 

  13. Morissette, C., Cox, J., De, P., Tremblay, C., Roy, E., Allard, R., et al. (2007). Minimal uptake of sterile drug preparation equipment in a predominantly cocaine injecting population: Implications for HIV and hepatitis C prevention. The International Journal on Drug Policy, 18, 204–212. doi:10.1016/j.drugpo.2006.08.004.

    PubMed  Article  Google Scholar 

  14. Racz, J., Gyarmathy, V. A., Neaigus, A., & Ujhelyi, E. (2007). Injecting equipment sharing and perception of HIV and hepatitis risk among injecting drug users in Budapest. AIDS Care, 19, 59–66. doi:10.1080/09540120600722742.

    PubMed  Article  CAS  Google Scholar 

  15. Rogers, E. M. (2003a). Diffusion networks. In E. M. Rogers (Ed.), Diffusion of innovations (pp. 281–334). New York: Free Press.

    Google Scholar 

  16. Rogers, E. M. (2003b). Innovativeness and adopter categories. In E. M. Rogers (Ed.), Diffusion of innovations (pp. 252–280). New York: Free Press.

    Google Scholar 

  17. Thiede, H., Hagan, H., Campbell, J. V., Strathdee, S. A., Bailey, S. L., Hudson, S. M., et al. (2007). Prevalence and correlates of indirect sharing practices among young adult injection drug users in five U.S. cities. Drug and Alcohol Dependence, 91(Suppl 1), S39–S47. doi:10.1016/j.drugalcdep.2007.03.001.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The authors wish to recognize the highly committed community work of David Benjamin, Mayra Soto, Rafael Quiñones, Wanda Trinidad, Patricia Alvarez, and Antonio Arencibia. José Venegas prepared the figure for this report.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Hector M. Colon.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Colon, H.M., Finlinson, H.A., Negron, J. et al. Pilot Trial of an Intervention Aimed at Modifying Drug Preparation Practices Among Injection Drug Users in Puerto Rico. AIDS Behav 13, 523–531 (2009). https://doi.org/10.1007/s10461-009-9540-3

Download citation

Keywords

  • Injection drug users
  • Puerto Rico
  • Participatory research
  • HIV
  • HCV
  • Drug preparation practices