Injection drug users (IDU) are at risk for a host of medical complications including blood-borne viral (e.g., HIV, Hepatitis C) and bacterial (e.g., skin abscesses, endocarditis) infections. While prior studies have examined the effectiveness of risk reduction strategies to prevent HIV and Hepatitis C, there has been little focus on preventing bacterial infections among IDUs, despite the fact that these infections are very common, associated with costly emergency department visits and hospitalization, and lead to considerable morbidity and mortality. We recently developed and pilot-tested a promising brief, two-session risk reduction intervention aimed at reducing both bacterial and viral infections (Skin and Needle Hygiene Intervention or "Skin"). Six- month outcomes from the Skin R21 demonstrated feasibility and promising pilot results including excellent session and follow-up rates, sustained intervention effects on skin and needle cleaning skills, and lower bacterial infection risk among intervention participants. The current proposal is a randomized controlled trial (RCT) of the Skin intervention, compared to an assessment-only condition (both groups receive rapid HIV testing, a review of testing results, and brief HIV prevention counseling) among 350 hospitalized IDUs. In the general hospital setting, the prevalence of injection drug use is high, patients who otherwise might not seek care are accessible, and the presence of a drug-related illness can set the stage for patients to be more receptive to interventions. We hypothesize that the Skin intervention will produce better outcomes than assessment-only as shown by data collected at 1-, 3-, 6-, 9-, and 12-month(s) post-intervention. Primary outcomes include 1) bacterial infections, 2) participation in high-risk injection practices for bacterial infections (subcutaneous or intramuscular injection, no skin cleaning prior to injection) and viral infections (sharing injection equipment), and 3) health services use. We will also examine whether changes in skin hygiene and injection technique may be mediating the effect of the Skin intervention on acquisition of bacterial infections. The Skin intervention, if effective, will reduce the acquisition of bacterial and viral infections among IDUs, improving health outcomes for this population and producing health care cost savings. Recruitment of IDUs in the hospital setting broadens the possibility of widespread adoption of this novel intervention heightens the public health impact.
Nearly 70% of injection drug users (IDU) experience skin abscesses, the most common type of bacterial infection, as well as the viral infections HIV and HCV. We have developed a promising new risk reduction intervention aimed at reducing both bacterial and viral infections (Skin and Needle Hygiene Intervention or Skin) that we test in a randomized trial of 350 drug injectors recruited from a hospital inpatient service. Reducing the acquisition of bacterial infections and viral disease among IDUs will improve health outcomes for this population, producing health care cost savings and broad public health impact.