Individual-level harm reduction intervention coverage among people in Australia who inject drugs

Needle and syringe programs, opioid agonist treatment (OAT), and take-home naloxone (THN) are key harm reduction interventions that reduce bloodborne virus transmission and/or overdose. In this study, we provide updated individual-level coverage of these measures among people who inject drugs in Australia.

Data from cross-sectional surveys in 2018 and 2023 were used to report the percentage who: (a) had sufficient sterile needle/syringes to cover all past month injections; (b) received the monthly equivalent of the WHO recommended 200 needle/syringes per year; (c) reused their own needle/syringe during the past month; (d) received OAT during the past six months (among participants with possible opioid dependence); and (e) who had ever acquired THN. Coverage between years was compared using Chi-squared tests; coverage across subgroups in 2023 was compared using Poisson regression with a log link function.

In 2018 and 2023, most participants had sufficient past month needle/syringe coverage: 87 % (95 % confidence interval: 80-93 %) and 88 % (82-95 %), respectively (p = 0.338). In 2023, approximately one third of participants reported reuse of their own needle/syringes. OAT coverage was higher in 2023 (78 %, 70-87 %) compared to 2018 (71 %, 64-78 %; p = 0.015). THN coverage in 2023 (55 %, 50-60 %) was more than double the coverage in 2018 (24 %, 20-27 %; p < 0.001). People who reported no housing had lower OAT coverage compared to those with stable housing (adjusted prevalence ratio: 0.38, 95 % confidence interval: 0.16-0.90). People who predominantly injected methamphetamine had lower THN coverage (0.46; 0.38-0.57) compared to those who predominantly injected heroin.

Individual-level needle/syringe and OAT coverage among people who inject drugs in Australian capital cities is high relative to targets, but there are gaps in the implementation of THN. Despite high syringe coverage, a notable minority reported needle/syringe reuse.