A socio-structural approach to preventing injection drug use initiation: Rationale for the PRIMER study
Harm Reduct J. 2016-09-15; 13(1):
DOI: 10.1186/s12954-016-0114-1
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1. Harm Reduct J. 2016 Sep 15;13(1):25. doi: 10.1186/s12954-016-0114-1.
A socio-structural approach to preventing injection drug use initiation:
rationale for the PRIMER study.
Werb D(1)(2), Garfein R(3), Kerr T(4), Davidson P(3), Roux P(5),
Jauffret-Roustide M(6), Auriacombe M(7), Small W(4), Strathdee SA(3).
Author information:
(1)Division of Global Public Health, Department of Medicine, University of
California San Diego, San Diego, USA. .
(2)Division of Global Public Health, University of California School of Medicine,
University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0507,
USA. .
(3)Division of Global Public Health, Department of Medicine, University of
California San Diego, San Diego, USA.
(4)Urban Health Research Initiative, British Columbia Centre for Excellence in
HIV/AIDS, Vancouver, Canada.
(5)INSERM, UMR_S 912, Sciences Economiques & Sociales de la Santé et Traitement
de l’Information Médicale (SESSTIM), F-13385, Marseille, France.
(6)Inserm U988/CNRS UMR 8211, Ecole des Hautes Etudes en Sciences Sociales,
Université de Paris Descartes, Paris, France.
(7)SANSPY/CNRS USR 3413, Université de Bordeaux, Bordeaux, France.
BACKGROUND: Injection drug use remains a primary driver of HIV and HCV-related
harms globally. However, there is a gap in efforts to prevent individuals from
transitioning into injecting. People who inject drugs (PWID) play a key role in
the transition of others into injecting, and while behavioral interventions have
been developed to address this phenomenon, socio-structural approaches remain
unexplored. To that end, we hypothesize that certain interventions designed to
reduce injecting-related risk behaviors may also reduce the risk that PWID expose
and introduce others into injecting. Identifying the preventive potential of
existing interventions will inform broader efforts to prevent injecting and
related harms.
METHODS: The Preventing Injecting by Modifying Existing Responses (PRIMER) study
is a multi-country mixed methods study with an aim to investigate whether
specific interventions (e.g., opioid substitution therapy, supervised injection
facilities, stable housing, incarceration environments) and related factors
(e.g., public injecting and gender) influence the likelihood that PWID initiate
others into injecting. This study will (1) investigate the PWID participation in
injection initiation; (2) identify factors influencing the risk that PWID expose
others to or facilitate injection initiation; (3) describe drug scene roles that
increase the risk of PWID facilitating injection initiation; and (4) evaluate the
impact of structural, social, or biomedical interventions on the risk that PWID
facilitate injection initiation. It does so by pooling observational data from
cohort studies of PWID in six cities: Vancouver, Canada; San Diego, USA; Tijuana,
Mexico; Paris, Marseille, and Bordeaux, France.
RESULTS: Team members are conducting a prospective, multi-site study of PWID (n =
3050) in North America and France that includes quantitative and qualitative data
collection through four separate cohort studies of PWID (San Diego, STAHR II;
Tijuana, El Cuete IV; Vancouver, V-DUS; Bordeaux, Marseille, Paris and
Strasbourg, COSINUS).
CONCLUSIONS: PRIMER is the largest study of injection initiation to date and the
first to investigate structural approaches to preventing injection drug use
initiation. Findings have the potential to inform the development and scale up of
new and existing interventions to prevent transitions into injecting.
TRIAL REGISTRATION: Preventing Injecting by Modifying Existing Responses
(PRIMER), NIDA DP2-DA040256-01 .
DOI: 10.1186/s12954-016-0114-1
PMCID: PMC5024479
PMID: 27629248 [Indexed for MEDLINE]