Background: An HIV/HCV surveillance network is ongoing among people who inject drugs (PWID) in Eastern Central Canada (province of Québec and City of Ottawa) since 1995. Data were analysed to estimate HIV and HCV prevalence (2003-2019) and examine trends (over available years) in HIV and HCV incidence and use of syringes previously used by someone else (“used syringes”).

Methods: PWID having injected recently (past 6 months) are recruited in harm reduction and health programs. They complete an interviewer-administered questionnaire and provide saliva samples for antibody testing. Multiple visits by a repeater are linked through a unique identifier to measure incidence. The bootstrap method was used for incidence trend analyses. Generalized estimating equations were used for other trend analyses.

Results: As of 03/31/2019, 15,416 PWID had completed 30,086 interviews. Overall, 75.5% were males with a median age of 36 years (females: 30 years). From 2009 to 2019, 68.7% had recently injected cocaine, 63.7% prescription opioids, and 33.7% heroin. HIV prevalence was 12.8% [95% Confidence Interval (95%CI): 12.1-13.5%] and the prevalence of HCV antibodies was 62.1% [95%CI: 61.1-63.2%], with a co-infection rate of 10.9%. Overall HIV incidence (1995-2019) was 1.7 per 100 person-years (PY) [95%CI: 1.5-1.9 per 100 PY; 329 seroconversions among 3,935 repeaters initially HIV-negative] but decreased significantly from 5.0 to 0.3 per 100 PY (1995-2017; p<0.001). Overall HCV incidence (1997-2019) was 19.6 per 100 PY [95%CI: 18.0-21.1 per 100 PY; 633 seroconversions among 1,343 repeaters initially HCV-negative] but oscillated between 28.3 (1999) and 10.0 (2016) per 100 PY for a significant overall decrease (1998-2017; p<0.001). Recent injection with “used syringes” significantly decreased from 43.4% to 12.7% (1995-2018; p<0.001).

Conclusions: The decreasing trends are encouraging. However, the proportion of recent injection with “used syringes” remains a concern. Harm reduction programs must be strengthened to curb both epidemics among PWID.

Background: Spotting is an informal practice among people who use drugs (PWUD) where they witness drug use and respond if overdose occurs for each other. During COVID-19 restrictions, remote spotting (eg., telephone) emerged to address physical distancing requirements and reduced access to harm reduction/HIV prevention services. A few organizations now offer formal spotting services. We explore spotting implementation issues from the perspective of PWUD spotters/spottees.

Methods: Research assistants with lived experience used personal networks/word of mouth to recruit from Ontario and Nova Scotia 21 PWUDs who provided or used informal spotting and 9 who provided or used a formal spotting service. All completed a semi-structured, audio-recorded telephone interview about service design, benefits, challenges and recommendations. Recordings were transcribed and thematic analysis was used.

Results: Spotting is provided on varied platforms (e.g., telephone, facetime, texts) and locations (e.g. home, car), and offers connection, community support, and addresses barriers (e.g., location, stigma, confidentiality, safety, availability, COVID related closures) to the use of supervised consumption sites. Spotting calls often begin with setting an overdose plan (i.e., when and who to call). Many participants noted that due to the criminalization of drug use and fear of arrest they preferred that roommates/family members be called instead of 911 in case of an overdose. Formal spotters are required to call 911 for suspected overdoses. Concerns were raised about the timeliness of overdose response. Almost none of the calls included discussion of HIV prevention and while willing, spotters felt unsure about how to offer HIV/HCV prevention and other harm reduction tips during calls.

Conclusions: Spotting is a novel addition to, but not replacement for, existing harm reduction services. To optimize overdose/COVID-19/HIV prevention services, additional supports (e.g., guidelines, home delivery, changes to Good Samaritan Law) are needed. Criminalization of drug use may limit uptake of formal spotting services.

Background: Drug checking services (DCS) provide people who use drugs with information on the composition of their drugs to allow for more educated choices about their drug use and increase their capacity to avoid consuming lethal amounts of toxic substances. Given recent increasing interest in DCS to address rising overdose fatalities in Canada and elsewhere, we sought to identify and synthesize existing literature on outcomes associated with 1) the influence of DCS on behaviour; 2) use of DCS for drug market monitoring; and 3) models of DCS.

Methods: This review followed PRISMA guidelines and was pre-registered in PROSPERO (CRD42018105366). A systematic literature search was conducted in Medline, Embase, PsycINFO, Scopus, Web of Science, the Cochrane Library, and ProQuest. Eligible studies were peer-reviewed articles or conference abstracts published in any language since 1990 and including empirical research on the outcomes of interest. Grey literature reporting original research related to the primary outcome of interest was also included. We appraised study quality for peer-reviewed articles and conference abstracts reporting on the primary or tertiary outcomes of interest using study quality assessment tools from the National Institutes of Health.

Results: 2,463 titles and abstracts and 156 full texts were screened, with 90 articles meeting inclusion criteria. Most studies (n=63, 70%) were from Europe and used cross-sectional (n=49, 54.4%) and repeated cross-sectional (n=30, 33.3%) designs. Use of DCS for drug market monitoring (n=63, 70%) was most commonly reported, followed by the influence of DCS on behaviour (n=31, 34.4%) and outcomes related to models of DCS (n=17, 18.9%). Behaviour change measures commonly focused on intended behaviours.

Conclusion: Evaluations of DCS are limited in scope and there is a need to expand their designs and outcome measures, with attention to actual behaviours as well as overdose risk behaviours given the use of DCS in overdose prevention.

HIV and Hepatitis C rates continue to be on the rise in Saskatchewan. Harm reduction best practices models may suggest there is merit in the exploration of alternative options such as formal secondary distribution and use of vending machines (CATIE, 2015) to improve access of needle use equipment through building capacity of people who have lived experience with the use of injection drugs.

The Harm Reduction Peer Backpack and Vending Machine (PB & V) project is a peer-led improvement project that involves people who inject drugs (PWID) providing needle distribution via backpacks and harm reduction vending machines. The data collected includes surveying clients regarding sharing of used drug use equipment before and after the introduction of the project, and conducting focus groups re: implementation and ongoing use of the project to evaluate their effectiveness of decreasing Hepatitis C and HIV. It aims to increase access to needle equipment by 30% and to increase capacity of secondary distributors (peer backpackers) by 25% for PWID in three rural Saskatchewan communities. The peer backpackers also introduce a backpacker training manual in the form of YouTube videos to support informal secondary distribution amongst PWID in rural communities. The project has also unveiled unexpected benefit of improved relationship amongst PWID and health care professionals. It is the intention that the project will provide important insights, learning lessons and future considerations regarding the effectiveness of formal secondary distribution and harm reduction vending machines on addressing the high rates of Hepatitis C and HIV in rural Saskatchewan.