The U.S. overdose crisis is surging. More than half a million Americans have died of an opioid-related overdose since 2000. Over the past 20 years, opioid overdose mortality rates increased fivefold, and in 2020, the COVID-19 pandemic accelerated the crisis—April 2021 marked the first time in the U.S. when over 100,000 people died from an overdose in the last year. In addition, people who inject drugs (PWID) in the U.S. have faced disproportionately high rates of hepatitis4 and endocarditis5 and HIV outbreaks.6
Providing PWID sufficient supplies for sterile injections and access to medications for opioid use disorder (MOUD) reduces HIV7, 8 and hepatitis C transmission.9 Studies show that MOUD access is associated with significant and meaningful reductions in all-cause mortality,10 overdose mortality,11, 12 and risk behaviors, even among syringe service program (SSP) participants.11, 13, 14 Additional evidence-based interventions for eligible PWID include hepatitis A and B vaccinations15, 16; pre-exposure prophylaxis (PrEP); and treatment for people living with hepatitis B17, hepatitis C 18 or HIV.19
SSPs have been the mainstay for community-based efforts that reach PWID. They provide evidence-based interventions to people who have historically faced inadequate access. SSPs provide access to and disposal of sterile syringes and injection equipment21 and are ideal settings for delivering evidence-based interventions for PWID—their staff are culturally competent in providing services for PWID, who already engage with and trust these organizations to care for their health. PWID report acceptability and comfort with accessing services at SSPs.22-24 Compared with PWID with limited/no access to SSPs, SSP participants receiving sterile injection equipment are less likely to practice unsafe injections.25-27 SSPs are places where participants can access naloxone,28 vaccinations,29, 30 testing, treatment for infectious diseases, 23, 30-33 MOUD,34-36and PrEP.37 Improved SSP access can mitigate health disparities experienced by PWID, and integrated service delivery is the ideal mechanism for increasing that access.38 It is imperative that we understand the experiences, scale, and challenges that SSPs face in delivering these services.
RTI’s proposed team has devoted their work over the last 30 years to global initiatives that improve equitable access to evidence-based interventions for PWID. Our team includes leading experts who are eminently qualified to carry out the proposed work. Our team has implemented and disseminated an annual National Survey of Syringe Service Programs (NSSSP), achieving ~80% response rates over the last 2 rounds. Our team excels at convening and communicating to SSPs for virtual and in-person events.
Responding to Component 1 of CDC-RFA-PS22-2208, RTI will continue to expand these partnerships to support a national SSP network. RTI’s team will conduct up to 40 in-depth interviews annually to identify emerging communication structures, explore new communication mechanisms, and understand other emerging issues faced by SSPs. RTI’s team will oversee implementation and use of an annual NSSSP, leveraging procedures that have helped us achieve an ~80% response rate in prior surveys. Our strategies to assess and improve communication strategies will ensure all voices are heard and will center the voices of people with lived drug use experience, including BIPOC and LGBTQ individuals.
Our approach will yield access to high-quality information about the current state of SSP services in the U.S. We will support and strengthen communication structures such that the dissemination of survey findings (and other emerging information) reaches a broad audience and optimizes service delivery. Working closely with the Component 2 recipient and technical assistance providers, our activities will contribute to increased access to harm reduction services, reducing incidence complications and infections related to injection drug use.