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Predictors of needle exchange program utilization during its implementation and expansion in Tijuana, Mexico
Author(s) -
Smith Danielle M.,
Werb Dan,
Abramovitz Daniela,
MagisRodriguez Carlos,
Vera Alicia,
Patterson Thomas L.,
Strathdee Steffanie A.
Publication year - 2016
Publication title -
the american journal on addictions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.997
H-Index - 76
eISSN - 1521-0391
pISSN - 1055-0496
DOI - 10.1111/ajad.12326
Subject(s) - interquartile range , medicine , demography , relative risk , poisson regression , confidence interval , generalized estimating equation , environmental health , statistics , population , mathematics , sociology
Objective Until the early 2000s, there was only one needle exchange program (NEP) offered in Mexico. In 2004, the second Mexican NEP opened in Tijuana, but its utilization has not been studied. We studied predictors of initiating NEP during its early expansion in Tijuana, Mexico. Methods From April 2006 to April 2007, people who inject drugs (PWID) residing in Tijuana who had injected within the last month were recruited using respondent‐driven sampling. Weighted Poisson regression incorporating generalized estimating equations was used to identify predictors of initiating NEP, while accounting for correlation between recruiter and recruits. Results NEP uptake increased from 20% at baseline to 59% after 6 months. Among a subsample of PWID not accessing NEP at baseline ( n = 480), 83% were male and median age was 37 years (Interquartile Range: 32–43). At baseline, 4.4% were HIV‐infected and 5.9% had syphilis titers >1:8. In multivariate models, factors associated with NEP initiation ( p < .05) were attending shooting galleries (Adjusted Relative Risk [ARR]: 1.54); arrest for track‐marks (ARR: 1.38); having a family member that ever used drugs (ARR: 1.37); and having a larger PWID network (ARR: 1.01 per 10 persons). NEP initiation was inversely associated with obtaining syringes at pharmacies (ARR: .56); earning >2500 pesos/month (ARR: .66); and reporting needle sharing (ARR: .71). Conclusions Uptake of NEP expansion in Tijuana was vigorous among PWID. We identified a range of factors that influenced the likelihood of NEP initiation, including police interaction. These findings have important implications for the scale‐up of NEP in Mexico. (Am J Addict 2016;25:118–124)