Predictors of Needle Exchange Program Utilization During Its Implementation & Expansion in Tijuana, Mexico
OBJECTIVE:
Until
the early 2000s, there was only one needle exchange program (NEP) offered in
Mexico. In 2004, the second Mexican NEP opened in Tijuana, but its utilization
has not been studied. We studied predictors of initiating NEP during its early
expansion in Tijuana, Mexico.
METHODS:
From
April 2006 to April 2007, people who inject drugs (PWID) residing in Tijuana
who had injected within the last month were recruited using respondent-driven
sampling. Weighted Poisson regression incorporating generalized estimating
equations was used to identify predictors of initiating NEP, while accounting
for correlation between recruiter and recruits.
RESULTS:
NEP
uptake increased from 20% at baseline to 59% after 6 months. Among a subsample
of PWID not accessing NEP at baseline (n = 480), 83% were male and median age
was 37 years (Interquartile Range: 32-43). At baseline, 4.4% were HIV-infected
and 5.9% had syphilis titers >1:8. In multivariate models, factors
associated with NEP initiation (p < .05) were attending shooting galleries
(Adjusted Relative Risk [ARR]: 1.54); arrest for track-marks (ARR: 1.38);
having a family member that ever used drugs (ARR: 1.37); and having a larger
PWID network (ARR: 1.01 per 10 persons). NEP initiation was inversely
associated with obtaining syringes at pharmacies (ARR: .56); earning >2500
pesos/month (ARR: .66); and reporting needle sharing (ARR: .71).
CONCLUSIONS:
Uptake
of NEP expansion in Tijuana was vigorous among PWID. We identified a range of
factors that influenced the likelihood of NEP initiation, including police
interaction. These findings have important implications for the scale-up of NEP
in Mexico
- 1Division of Global Public Health, Department of Medicine, University of California, San Diego.
- 2Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
- 3Centro Nacional parala Prevencion y Control del VIH/SIDA e ITS (CENSIDA), Mexico City, Mexico.
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