Perspectives on syringe services programs among patients hospitalized with injection drug use-associated endocarditis: a qualitative study.

Background: Infective endocarditis (IE) has increased markedly among people who inject drugs (PWID). Harm reduction is a tool to help PWID improve health outcomes and mitigate IE.

Objectives: To understand the knowledge, perceptions, past engagement, and planned use of harm reduction services from syringe services programs (SSPs) for PWID hospitalized with IE.

Design: Qualitative study of PWID hospitalized with IE.

Methods: The research team conducted semi-structured interviews with 16 participants at a large academic hospital from June 2021 to May 2022. Two study personnel coded the interviews and analyzed the data using a combination of structural codes, applied thematic analysis, and thematic comparison.

Results: The majority of participants reported past experiences obtaining safe injection supplies from SSPs, and participants generally viewed SSPs as places for facilitating safer injecting practices, receiving sterile supplies, learning about harm reduction, and/or obtaining overdose reversal kits. However, some participants reported being unable to access SSPs because of their rurality, lack of SSP availability, or transportation barriers. In addition, some participants reported a lack of interest in receiving SSP information during hospitalization, believing that it would enable an undesired return to drug use, while others felt that SSP services would not be relevant for them post-hospitalization.

Conclusion: Patient past and planned use of harm reduction services offered by SSPs was impacted by geographic barriers to accessibility and patient concerns that SSPs would facilitate an undesired return to drug use. Health systems have an opportunity to improve patient usage of harm reduction services post-hospitalization by improving patient education and integrating harm reduction services as tools of care.