Brothers, Thomas Daniel;
(2023)
Understanding and preventing injecting-related bacterial and fungal infections among people who inject drugs.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Background: Injection drug use-associated bacterial and fungal infections (e.g., skin and soft tissue infections, endocarditis, osteomyelitis, septic arthritis, epidural abscess, etc.) are increasingly common. Risk factors include subcutaneous/intramuscular injecting and lack of skin cleaning, but individual-level educational interventions on safer injecting practices have shown limited effectiveness. There may be value in looking beyond individual injecting behaviours to understand risk and prevention opportunities. Aims: (1) identify social-structural factors that influence risk for injecting-related infections; (2) estimate the effect of opioid agonist treatment on all-cause mortality or infection-related rehospitalization, after hospital admissions with injecting-related infections; (3) assess how risk for injecting-related infections changes within-individuals over time, in relation to social (i.e., incarceration) and clinical (i.e., opioid agonist treatment) exposures. Methods: Qualitative systematic review with thematic synthesis; quantitative systematic review with meta-analysis; survival analysis and self-controlled case series using data from a cohort of people with opioid use disorder in New South Wales, Australia. Results: Injecting-related bacterial and fungal infections are shaped by modifiable social-structural factors, including poor quality unregulated drugs, criminalization and policing enforcement, insufficient housing, limited harm reduction services, and harmful health care practices. People who inject drugs navigate these barriers while attempting to protect themselves and their community. After a hospital admission, opioid agonist treatment is associated with a large reduction in mortality but a modest reduction in risk of infection-related rehospitalization. Risk of injecting-related infections changes substantially within-individuals over time; high-risk moments include release from incarceration and around initiation and discontinuation of opioid agonist treatment. Conclusions: Risk for injecting-related bacterial and fungal infections, and associated treatment outcomes, are shaped by social-structural factors beyond individuals’ control. Offering individual-level education and addiction treatment may be helpful, but is likely insufficient. Prevention and treatment strategies should engage more broadly with the social and material conditions within which people prepare and consume drugs, and access health care
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Understanding and preventing injecting-related bacterial and fungal infections among people who inject drugs |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10175963 |
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