Amsterdam 2015
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| Abstract #2206 - Research to implementation science and practice | ||||
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Session: 26.2: Research to implementation science and practice (Parallel) on Thursday @ 11.30-13.00 in C104 Chaired by Wendee Wechsberg Authors: Presenting Author: Dr. William Zule - RTI International, United States |
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| Additional Authors: | ||||
| Aim: Findings from laboratory tests, bio-behavioral surveys, and ecological studies suggest that the probability of HIV and hepatitis C virus (HCV) transmission associated with sharing high dead space needles and syringes is greater than the probability of transmission associated with sharing low dead space syringes. Predictive simulation models suggest that low dead space syringes may prevent or reverse HIV epidemics among people who inject drugs (PWID). In 2012 the World Health Organization (WHO) recommended that needle and syringe programs (NSP) offer low dead space syringes to their clients. In healthcare applications, high dead space needles and syringes waste medications, lead to dosing errors, and reduce the reliability of diagnostic tests. This presentation examines the range of activities that are currently underway to begin implementing the WHO recommendation. It also describes more general activities to phase out high dead space needles and syringes and replace them with low dead space alternatives. | ||||
| Method / Issue: We contacted researchers, service providers, harm reduction suppliers, and multilateral organizations (e.g. WHO, Global Fund) to assess progress and barriers in implementing efforts to transition PWID from high dead space to low dead space needles and syringes in NSP. We also reviewed the medical literature on problems caused by dead space in needles and syringes. | ||||
| Results / Comments: The major barrier in many countries to transitioning PWID from high dead space to low dead space needles and syringes is that the largest low dead space syringes have a barrel capacity of 1-mL, and they have permanently attached needles. New low dead space detachable needles that fit on larger syringes were developed to reduce these barriers. Findings from focus groups in Tajikistan indicate that these are an acceptable alternative. However, the volume of the dead space is higher than in syringes with permanently attached needles. A pilot social marketing campaign in Vietnam, demonstrated the feasibility of increasing access to low dead space syringes by working with NSP, pharmacies and other sources of syringes. The same campaign also demonstrated that it is feasible to persuade PWID to try low dead space syringes. A recent study in the US found that most of the needles and syringes sold by pharmacies are high dead space. Other problems associated with dead space in needles and syringes include: medication waste, dosing errors including fatal overdoses among infants born to addicted mothers errors in blood gas measurements due to heparin in the dead space and errors in radionuclide angiography due to radioactive material that remains concentrated in the dead space. | ||||
| Discussion: Dead space in needles and syringes causes a wide range of problems. Global efforts to phase out standard high dead space needles and replace them with low dead space needles have the potential to: reduce injection-related HIV and HCV transmission among PWID reduce medication waste and improve medical care. This will require new standards for the height and wall thickness of syringe nozzles coupled with efforts to increase demand for low dead space needles and reduce demand for high dead space needles. | ||||
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