Strengthening harm reduction services for Aboriginal and Torres Strait Islander people who inject drugs: a reflexive...

Accessible, culturally responsive, and high-quality harm reduction services, including needle and syringe programs and regional services, are essential for addressing disproportionate rates of blood-borne viruses (BBVs) and STIs among Aboriginal and Torres Strait Islander people who inject drugs. However, there is limited understanding of stakeholder perspectives to guide service design, and this is exacerbated by limited engagement with Aboriginal and Torres Strait Islander people who inject drugs. This project used the CONSolIDated critERia for Strengthening the Reporting of Health Research Involving Indigenous Peoples (CONSIDER statement) domains to critically reflect on this project's research design and governance, as a foundation for increased stakeholder engagement.

The research was a partnership between university-based researchers, Aboriginal and Torres Strait Islander community-controlled health organisations, and community-based harm reduction services. Participants were Aboriginal and Torres Strait Islander people who had injected drugs within the previous 12 months, recruited at needle and syringe progams in two regional sites, and one major city in Australia. Meeting notes, stakeholder feedback from fieldwork activities, correspondence with research partners, and stakeholder interviews were analysed using a reflexive thematic approach and the 17 CONSIDER statement domains.

Using the CONSIDER statement as a reflexive tool, we identified establishing equal research governance and partnerships with Aboriginal and Torres Islander organisations and people helped ensure that our research processes and activities honoured cultural safety and meaningful engagement with communities. Collaborating with local service providers, we identified community-led strategies for developing culturally safe and accessible harm-reduction programs, supporting participant recruitment, establishing treatment referral pathways, and adapting research to community priorities. Preliminary stakeholder interviews provided a safe space for service providers and a consumer representative to voice their perspectives on service and policy development to address community needs and offer their advice on research activities. To date, positive outcomes of the project include capacity-building opportunities for stakeholders and Aboriginal project team members to exchange cultural knowledge, develop research skills, and present findings at conferences and policy forums.

Researchers identified that project timelines should be flexible and adapt to community events and circumstances. Future research should allow feasible time frames for consultation with local health services and service providers. Engaging with research projects can be challenging for people with lived experience; it is recommended that researchers engage meaningfully and transparently throughout the research process, allowing adequate time to develop trust and build reciprocity. Using Indigenous research methodology with yarning as a method strengthened cultural safety and supported ethical research practices.

Stakeholder and consumer involvement can provide guidance on how to effectively engage with Aboriginal and Torres Strait Islander people who inject drugs. Our findings will inform guidelines for enhancing harm-reduction services for Aboriginal and Torres Strait Islander people who inject drugs.