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. 2024 Jun:5:100421.
doi: 10.1016/j.ssmqr.2024.100421. Epub 2024 Mar 20.

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

Christopher F Akiba  1 , Jessica Smith  1 , Lynn D Wenger  1 , Terry Morris  1 , Sheila V Patel  1 , Ricky N Bluthenthal  2 , Hansel E Tookes  3 , Paul LaKosky  4 , Alex H Kral  1 , Barrot H Lambdin  1
Affiliations

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

Christopher F Akiba et al. SSM Qual Res Health. 2024 Jun.

Abstract

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.

Keywords: Harm reduction; Implementation research; Syringe services programs.

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Conflict of interest statement

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.

Figures

Fig. 1.
Fig. 1.
Relationships between thematic barriers and implementation and health outcomes.
See this image and copyright information in PMC

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