TY - JOUR
T1 - Time-series analysis of presentations to four syringe dispensing machines and a needle and syringe programme during COVID-19 lockdowns in Melbourne, Australia
AU - O’Keefe, Daniel
AU - Livingston, Michael
AU - Cossar, Reece D.
AU - Kerr, Phoebe
AU - Jacka, David
AU - Dietze, Paul
N1 - Funding Information:
PD is supported by NHMRC Research Fellowships (#1136908). PD has received Investigator-Initiated Research funding from Gilead Sciences and an untied educational grant from Indivior unrelated to this study. PD has served as an unpaid member of an advisory board for an intranasal naloxone product. All other authors have nothing to declare.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Australian harm reduction services are provided via a mix of modalities, including fixed-site needle and syringe programmes (NSP) and syringe-dispensing machines (SDMs). SDMs are cost-effective and provide 24-h anonymous access to needles/syringes, often to underserved geographic areas, and can attract clientele who may choose not to use NSPs. The introduction of COVID-19 control measures saw disruptions and adaptations to the provision of harm reduction services. It is possible that SDMs filled the gap in otherwise disrupted harm reduction services in Melbourne. In this paper, we use data from four SDMs and an NSP to explore changes to harm reduction usage during periods of COVID-19 lockdowns in Melbourne, Australia, in 2020. Methods: Our data span September 2017–December 2020. We analysed daily counts of SDM use and monthly counts of NSP use, according to unique presentations to both. Auto-regressive integrated moving average (ARIMA) time-series models were fitted to the data with the effects of lockdowns estimated via a step function. Results: Across the study period, we estimated 85,851 SDM presentations and 29,051 NSP presentations. Usage across both the SDMs and the NSP declined during the COVID-19 lockdowns, but only the decline in SDM usage was significant in ARIMA analysis. Conclusions: The slight, but significant decline in SDM use suggests barriers to access, though this may have been mitigated by SDM users acquiring needles/syringes from other sources. The decline, however, may be a concern if it led to lowered needle/syringe coverage and a subsequent increase in injecting risk. Further work is needed to properly explore potential changes in preference for needle/syringe acquisition site and associated barriers. Importantly, this work adds to the body of literature around the impacts of COVID-19 on harm reduction provision and potential areas of improvement.
AB - Background: Australian harm reduction services are provided via a mix of modalities, including fixed-site needle and syringe programmes (NSP) and syringe-dispensing machines (SDMs). SDMs are cost-effective and provide 24-h anonymous access to needles/syringes, often to underserved geographic areas, and can attract clientele who may choose not to use NSPs. The introduction of COVID-19 control measures saw disruptions and adaptations to the provision of harm reduction services. It is possible that SDMs filled the gap in otherwise disrupted harm reduction services in Melbourne. In this paper, we use data from four SDMs and an NSP to explore changes to harm reduction usage during periods of COVID-19 lockdowns in Melbourne, Australia, in 2020. Methods: Our data span September 2017–December 2020. We analysed daily counts of SDM use and monthly counts of NSP use, according to unique presentations to both. Auto-regressive integrated moving average (ARIMA) time-series models were fitted to the data with the effects of lockdowns estimated via a step function. Results: Across the study period, we estimated 85,851 SDM presentations and 29,051 NSP presentations. Usage across both the SDMs and the NSP declined during the COVID-19 lockdowns, but only the decline in SDM usage was significant in ARIMA analysis. Conclusions: The slight, but significant decline in SDM use suggests barriers to access, though this may have been mitigated by SDM users acquiring needles/syringes from other sources. The decline, however, may be a concern if it led to lowered needle/syringe coverage and a subsequent increase in injecting risk. Further work is needed to properly explore potential changes in preference for needle/syringe acquisition site and associated barriers. Importantly, this work adds to the body of literature around the impacts of COVID-19 on harm reduction provision and potential areas of improvement.
KW - Harm reduction
KW - Needle and syringe programme
KW - Syringe vending machine
KW - Syringe-dispensing machine
UR - http://www.scopus.com/inward/record.url?scp=85137440060&partnerID=8YFLogxK
U2 - 10.1186/s12954-022-00683-9
DO - 10.1186/s12954-022-00683-9
M3 - Article
C2 - 36071500
AN - SCOPUS:85137440060
SN - 1477-7517
VL - 19
JO - Harm Reduction Journal
JF - Harm Reduction Journal
IS - 1
M1 - 101
ER -