Syringe Exchange/Harm Reduction Program Mid-Year Report

Transcription

1 1 Syringe Exchange/Harm Reduction Program Mid-Year Report

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4 4 Ashland-Boyd County Health Department Syringe Exchange Workgroup Fiscal Year Maria Hardy Cathy Anderson Kristy Bolen Jennifer Burchett Erin Crace Laura Redden Public Health Director Health Educator/Public Health Nurse Epidemiologist/Information Officer Nurse Administrator Nursing Supervisor/Reportable Disease Nurse Clinic Supervisor

5 5 The Ashland-Boyd County Health Department has partnered with the Neighborhood, a local community assistance group to provide a location for the Exchange. The Neighborhood is a safe, secure, clean, and convenient one-stop center for those in need of assistance. Five nonprofit agencies are located in the Neighborhood building and provide a multitude of services to hundreds of people each year. The Community Assistance and Referral Service (CAReS) has graciously donated their conference room for the Exchange to setup and operate each week. By partnering with the Neighborhood and CAReS, the Exchange has become just another service offered at the Neighborhood. This destigmatizes the Exchange and makes it easier for clients to access the service.

6 6 The Ashland-Boyd County Health Department has formed a partnership with Addiction Recovery Care, LLC (ARC) to provide a counselor at the Exchange site each week. ARC operates a network of state-licensed Residential and Outpatient Drug & Alcohol Abuse Treatment Centers in Kentucky. The network includes four residential treatment centers including; a women s center in Northeast Kentucky near Ashland, a women s center in Southeast Kentucky near London, a men s center in Northeast Kentucky near Morehead and a men s residential center in Southeast Kentucky near Somerset, Kentucky. Each week at least two or three Exchange clients speak with Carla about rehab programs or other issues. In the first six months of the Exchange program, four clients have sought rehab services through ARC. This partnership is a wonderful addition to our Exchange program. More information on Addiction Recovery Care (ARC) can be found at:

7 7 The Ashland-Boyd County Health Department is the housing agency for the Ashland-Boyd County-Catlettsburg Medical Reserve Corps (ABCMRC). The Medical Reserve Corps is a national network of local groups of volunteers engaging local communities to strengthen public health, reduce vulnerability, build resilience and improve preparedness response and recovery capabilities. The ABCMRC unit provides volunteer workers for the Exchange on the third Friday of each month. Currently two MRC members (both retired public health nurses) rotate months and also provide assistance as needed to the Exchange. The use of volunteers saves the local health department salary time and allows volunteers to stay engaged with the community. More information on the national MRC program can be found at

8 Each client at the Exchange receives the following items each visit: * A new, clean non-descript sharps container for used syringes * Three latex condoms * Educational materials on HIV prevention and safe injection practices * Clean syringes * Visits 1-5 each client receives 40 syringes even if they bring zero used syringes to the Exchange * Visits 6 and up each client receives the same number of clean syringes as used syringes he/she returns (1 for 1 exchange) 8

9 9 Item Cost Syringes $3, Sharps Containers $2, NEO 360 Software $1, ipads and Cases $ Wireless Cards $ Educational Materials $1, Naloxone $ Emergency Kit Supplies $ Miscellaneous Supplies $1, Staff Salary & Fringe $16, Total Costs $28,284.66

10 10 The following pages contain an analysis of data obtained at the Exchange. Data contained in this report is from July 1 through December 31, The data was obtained from NEO 360, an online data collection tool. For data collection purposes each client is given a unique identifier at registration made up of his/her initials and date of birth. All demographic data and disease data is self-reported by the client. Clients are asked each time if they would like to make any changes to his/her information. Data included in the six-month report was obtained from a query of the NEO 360 system completed on January 3, 2017 and represents the latest client updates. From July 1 through December 31, 2016 the Exchange saw 147 individual or unduplicated clients. These clients had 377 visits to the exchange with each client averaging four visits.

11 The following charts depict the total number of clients served each week at the exchange from July 1-December 31, The average number of clients served each week at the Exchange is 14. October, November and December saw dramatic increases in clients served. November and December also include five days (two in November, three in December) where the date of service was moved due to a holiday or staff meeting. 11

12 December saw the greatest number of return clients and July say the greatest number of new clients (as expected). Sixty-five (44.2%) out of 147 clients had at least 2 visits. Six clients (4.1%) had ten or more visits over the six-month period. The highest number of visits for one individual client was

13 13 Each client is given a five-time grace period for returning syringes to the Exchange. On the sixth visit, the client enters a one for one exchange program meaning that he/she receives the same number of new, clean syringes as used, dirty ones that are returned. During the first six months of the program, the number of used syringes returned has increased each month. This correlates with the number of clients entering the one for one exchange. At the end of the first six-month period, 19 out of 147 clients (12.9%) had reached the sixth visit and were on a one for one exchange. Overall, 40.6% of syringes dispensed were returned to the Exchange. In December, 56.3% (2,137) of syringes were returned, the highest number to date. As more clients reach his/her sixth visit, the number of returned syringes is expected to increase and become closer to 100%. Anecdotally, the Neighborhood (where the Exchange is housed) has reported that they have not found a used syringe on the property since September. This was a common occurrence prior to the Exchange opening in July.

14 During the five-visit grace period each client is given 40 syringes regardless of the number of used syringes that are returned. Over the first six months of the Exchange program 15,549 new syringes were dispensed. 14

15 15 The following demographic variables are collected on each client: * Age * Employment Status * Gender * Housing Status * Race * Zip Code This data is obtained on the clients first visit to the Exchange and is updated as needed. Ninety-eight percent of clients have identified their race as Caucasian/white. This is consistent with Boyd County s current US Census data. Due to low numbers and wide variation of other races selected, a graph is not available for this demographic data set.

16 The age listed is the client s age at registration. Forty percent of Exchange clients are between the ages of years. This is typical of other syringe exchange programs across the United States. Only five percent of clients are 55 years or older. 16

17 Seventy percent of program clients report being currently unemployed. Seventeen percent of clients report being employed (part-time or full-time). The two percent unknown is from clients who did not want to provide an answer. 17

18 Slightly more male clients have visited the Exchange than female clients. Clients are asked to self-identify gender and are given the option of male, female, transgender male-female or transgender female-male. 18

19 Clients have reported a wide variation of living arrangements. Thirty-one percent of clients rent an apartment or home. Several clients have indicated that they rent rooms at local motels or hotels. Twenty-two percent of clients report that they are home owners, most in Boyd County. Nineteen percent report sofa surfing as a living arrangement. Sofa surfing is defined as moving from place to place, friend to friend, frequently or as not routinely knowing where you will sleep each night. Finally, twenty-five percent of clients report that they are currently homeless. 19

20 20 The following medical variables are collected on each client: * Hepatitis B Status * Hepatitis C Status and Last Known Test * HIV Status and Last Known Test This data is obtained on the clients first visit to the Exchange and is updated as needed. All clients have reported being HIV negative as of December 31, There is not a chart available for this data set.

21 Fifty-seven percent of clients report that they do not know their Hepatitis B status. Most clients are also unsure of their Hepatitis B vaccination status. 21

22 Forty-three percent of clients report that they are Hepatitis C positive. Many clients report that they have been Hepatitis C positive for many years. Nineteen percent of clients do not know their Hepatitis C status. Some reasons given for not knowing were: they had never been tested, they had been tested a long time ago, so they couldn't remember or they chose not to answer the question that day. 22

23 The Centers for Disease Control and Prevention (CDC) recommends that all injection drug users be tested annually for Hepatitis C. Fifty-nine percent of Exchange clients have met the CDC guideline in Ten percent of clients have never been tested and do not know their Hepatitis C status. 23

24 The Centers for Disease Control and Prevention (CDC) recommends that all injection drug users be tested annually for HIV. Fifty-four percent of Exchange clients have met the CDC guideline in Fourteen percent of clients have never been tested and do not know their HIV status. 24

25 Seventy-eight percent of clients report that they currently reuse syringes. Only seven percent have never reused syringes. Thirty percent of clients report sharing syringes with others, mostly with significant others and family. Twenty-nine percent of clients report sharing at one time but are not currently sharing. 25

26 26 Ashland-Boyd County Health Department uses various communication mechanisms to reach potential and current Exchange clients. The health department Facebook and Twitter pages are updated weekly with Exchange statistics and operating times for the Exchange. The local newspaper, the Daily Independent has run multiple stories on the Exchange since July. Clients report that they most often hear about the Exchange program from their friends. The local newspaper is the second most popular way for clients to learn about the program.

27 27 Exchange clients were asked to complete a satisfaction survey at visits between November 18 and December 31, % of clients completed the survey during this time frame. The survey asked each client if the they currently have insurance, if the current day of the week/time were good for them, if they could pick a new day of the week/time what would it be, if they were satisfied with the items they receive and other items they would like to receive. Also, due to numerous requests for short needled syringes, they were asked what size needles they preferred. Of the surveyed clients, thirty-one clients (79.5%) reported that they have some form of health insurance. Most clients (69.2%) chose Friday as the preferred day of operation for the Exchange and 11:00 am to 2:00 pm as the preferred time of operation (51.3%). 89.7% of clients were satisfied or highly satisfied with the items they receive at the Exchange. 53.8% of clients preferred the short needled syringes to the long ones currently being dispensed. Clients were asked what additional items they would like to receive each week. Most (93%) clients did not answer this question or were satisfied with the items they currently receive at the Exchange. Clients listed the following additional items they would like to receive: Cotton, Water, Microfilter, Alcohol pads, Spoons, Tourniquet, Snacks, Toiletries. Clients were also given the opportunity to provide suggestions or comments at the end of the survey. Clients listed the following comments: Thank you, You do help, I think it is a really good program, We appreciate you all, Staff is helpful and nice, Wonderful job, and Staff is respectful. The only suggestions were to only use the BD brand of syringes and to notify clients when Exchange will be closed for holidays, etc. Another client satisfaction survey will be completed in June 2017.

28 28 This report was prepared by on January 31, 2017 by Kristy M. Bolen, MPA Senior Regional Epidemiologist for the Ashland- Boyd County Health Department. Statistical information was obtained for the NEO 360 data collection software and analyzed in Microsoft Excel. Questions about the data analysis can be sent to Questions about the syringe exchange program can be sent to and/or Further information about the program and current data reports can be found at