Financial barriers, facilitators, and strategies among syringe services programs in the U.S., and their impact on implementation and health outcomes.

Autor:	Akiba CF; RTI International, Research Triangle Park, NC, United States., Smith J; RTI International, Research Triangle Park, NC, United States., Wenger LD; RTI International, Research Triangle Park, NC, United States., Morris T; RTI International, Research Triangle Park, NC, United States., Patel SV; RTI International, Research Triangle Park, NC, United States., Bluthenthal RN; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States., Tookes HE; Miller School of Medicine, University of Miami, Coral Gables, FL, United States., LaKosky P; Dave Purchase Project, North American Syringe Exchange Network, Tacoma, WA, United States., Kral AH; RTI International, Research Triangle Park, NC, United States., Lambdin BH; RTI International, Research Triangle Park, NC, United States.
Jazyk:	angličtina
Zdroj:	SSM. Qualitative research in health [SSM Qual Res Health] 2024 Jun; Vol. 5. Date of Electronic Publication: 2024 Mar 20.
DOI:	10.1016/j.ssmqr.2024.100421
Abstrakt:	Syringe Services Programs (SSPs) provide evidence-based services like drug use equipment to prevent infectious disease, overdose prevention education, and naloxone distribution to people who use drugs (PWUD). However, inadequate funding threatens provision of these interventions. This study aimed to document how the current funding landscape impacted determinants of SSP implementation, particularly describing financial and staffing barriers, facilitators, and proposed strategies, using qualitative methods informed by three implementation research frameworks. We interviewed 20 leaders of SSPs in the United States using a semi-structured interview guide. Participants described how structural stigma against PWUD led to insufficient and restrictive funding, and burdensome reporting for SSPs. This resulted in harming program implementation outcomes like reach, fidelity, and sustainability. Inadequate funding also led to insufficient staffing and subsequent staff stress, burnout, and turnover. Taken together, these barriers threatened the implementation of evidence-based interventions that SSPs provided, ultimately harming their ability to effectively address health outcomes like infectious disease transmission and opioid overdose mortality within their communities. Interviewees described how upstream policy strategies like political advocacy might address structural stigma at the federal level. Participants also highlighted state-level efforts like harm reduction-centered funding, technical assistance and capacity-building, and clearinghouse programs that may facilitate better implementation and health outcomes. A more robust understanding of the relationship between financial barriers, facilitators, and strategies on implementation and health outcomes represents a novel and vital area of research within harm reduction literature. Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Databáze:	MEDLINE
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