See the published version of this article at Harm Reduction Journal.
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HaRePo (Harm Reduction by Post): An innovative and effective harm reduction program for people who use drugs using email, telephone and post-service.
Magally Torres Leguizamon
SAFE
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8054-0677
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Harm Reduction Journal.
Background: Despite multiple Harm Reduction (HR) programs worldwide, there are still an important number of people who use drugs (PWUD) who do not access those services. Their difficulties to obtain HR tools are due to their inability to reach such services (remoteness and/or limited customer service hours), costs, quantitative restrictions, fear of judgment, lack of confidentiality in pharmacy and unfamiliarity with HR programs. We tested an innovative approach using the power of remote online communication and the national postal distribution network to improve HR tools access and counselling.
Methods: Based on these observations, SAFE association created HaRePo in 2011, a free and confidential program designed for people who have difficulties accessing HR tools and counselling. PWUD can access the program by phone and/or email. An HR professional delivers HR counselling, HR tools and connects PWUD to other HR services, medical, and social workers. HR tools are prepared and sent according to the person’s needs through the French postal service to consumers across Metropolitan France and overseas territories.
Results: Since 2011, 1920 PWUD have benefited from HaRePo: 10,450 parcels were sent accounting for more than 1.7 million syringes and 6 million HR related items. HaRePo receives positive feedback from PWUD who have improved their practices through remote but trusted communication. The percentage of people that, after joining the program, never reuse and/or share HR tools have significantly increased. On average 71.5% of beneficiaries never reuse syringes and 81% do not reuse needles. And they are 98.5% consumers who never share syringes and 99% needles any longer. Between 44% and 80% HaRePo beneficiaries have reported that their drug-related practices (injection, inhalation and snorting) are now safer. Finally, between 39% and 53% HaRePo consumers declared that their overall physical state has improved (e.g., venous condition, the appearance of point of injection, swelling of arms, legs, and hands).
Conclusion: HaRePo is an innovative HR program efficient for hard-to-reach PWUD. It shows evidence of a positive feedback loop for PWUD in improving their practices. Finally, HaRePo represents a clear benefit for health authorities in France, who decided to expand the program in 2016.
Keywords
Harm reduction program, remotely service, HR counselling, HR tools distribution, HR by mail, HR by telephone, HR for hard to reach PWUD
Figure 1
Figure 2
Figure 3
Figure 4
Table 1: Slopes and their associated 95% CI of the linear model fitted between PWUD benefiting from the program each year and the time since the beginning of the program.
|
|
Slope (PWUD / 100,000 Habitants) |
95%CI |
|
Zone density 1 |
0.08 |
0.06 - 0.10 |
|
Zone density 2 |
0.05 |
0.04 - 0.06 |
|
Zone density 3 |
0.05 |
0.03 - 0.07 |
|
Zone density 4 |
0.07 |
0.04 - 0.09 |
|
TOTAL |
0.06 |
0.05 - 0.08 |
Due to technical limitations, Table 2 is only available as a download in the supplementary files.
This is a list of supplementary files associated with this preprint. Click to download.
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CURRENT STATUS: Published
Version 2
Posted 12 Aug, 2020
Published
On 24 Aug, 2020
No community comments so far
Editorial decision: Accept
On 10 Aug, 2020
Editor assigned
On 05 Aug, 2020
Submission checks complete
On 04 Aug, 2020
Editor invited
On 04 Aug, 2020
Community comments: 5
Editorial decision: Minor revision
On 03 Jun, 2020
Review #1 received
Received 02 Jun, 2020
Review #2 received
Received 28 May, 2020
Reviewer #2 agreed
On 24 May, 2020
Reviewers invited
Invitations sent on 21 May, 2020
Reviewer #1 agreed
On 21 May, 2020
Editor assigned
On 12 May, 2020
Submission checks complete
On 11 May, 2020
Editor invited
On 11 May, 2020
First submitted
On 07 May, 2020
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This preprint is under consideration at Harm Reduction Journal. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
HaRePo (Harm Reduction by Post): An innovative and effective harm reduction program for people who use drugs using email, telephone and post-service.
Magally Torres Leguizamon
SAFE
Corresponding Author
ORCiD: https://orcid.org/0000-0002-8054-0677
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 12 Aug, 2020
Published
On 24 Aug, 2020
No community comments so far
Editorial decision: Accept
On 10 Aug, 2020
Editor assigned
On 05 Aug, 2020
Submission checks complete
On 04 Aug, 2020
Editor invited
On 04 Aug, 2020
Community comments: 5
Editorial decision: Minor revision
On 03 Jun, 2020
Review #1 received
Received 02 Jun, 2020
Review #2 received
Received 28 May, 2020
Reviewer #2 agreed
On 24 May, 2020
Reviewers invited
Invitations sent on 21 May, 2020
Reviewer #1 agreed
On 21 May, 2020
Editor assigned
On 12 May, 2020
Submission checks complete
On 11 May, 2020
Editor invited
On 11 May, 2020
First submitted
On 07 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Harm Reduction Journal.
Background: Despite multiple Harm Reduction (HR) programs worldwide, there are still an important number of people who use drugs (PWUD) who do not access those services. Their difficulties to obtain HR tools are due to their inability to reach such services (remoteness and/or limited customer service hours), costs, quantitative restrictions, fear of judgment, lack of confidentiality in pharmacy and unfamiliarity with HR programs. We tested an innovative approach using the power of remote online communication and the national postal distribution network to improve HR tools access and counselling.
Methods: Based on these observations, SAFE association created HaRePo in 2011, a free and confidential program designed for people who have difficulties accessing HR tools and counselling. PWUD can access the program by phone and/or email. An HR professional delivers HR counselling, HR tools and connects PWUD to other HR services, medical, and social workers. HR tools are prepared and sent according to the person’s needs through the French postal service to consumers across Metropolitan France and overseas territories.
Results: Since 2011, 1920 PWUD have benefited from HaRePo: 10,450 parcels were sent accounting for more than 1.7 million syringes and 6 million HR related items. HaRePo receives positive feedback from PWUD who have improved their practices through remote but trusted communication. The percentage of people that, after joining the program, never reuse and/or share HR tools have significantly increased. On average 71.5% of beneficiaries never reuse syringes and 81% do not reuse needles. And they are 98.5% consumers who never share syringes and 99% needles any longer. Between 44% and 80% HaRePo beneficiaries have reported that their drug-related practices (injection, inhalation and snorting) are now safer. Finally, between 39% and 53% HaRePo consumers declared that their overall physical state has improved (e.g., venous condition, the appearance of point of injection, swelling of arms, legs, and hands).
Conclusion: HaRePo is an innovative HR program efficient for hard-to-reach PWUD. It shows evidence of a positive feedback loop for PWUD in improving their practices. Finally, HaRePo represents a clear benefit for health authorities in France, who decided to expand the program in 2016.
Figure 1
Figure 2
Figure 3
Figure 4
Table 1: Slopes and their associated 95% CI of the linear model fitted between PWUD benefiting from the program each year and the time since the beginning of the program.
|
|
Slope (PWUD / 100,000 Habitants) |
95%CI |
|
Zone density 1 |
0.08 |
0.06 - 0.10 |
|
Zone density 2 |
0.05 |
0.04 - 0.06 |
|
Zone density 3 |
0.05 |
0.03 - 0.07 |
|
Zone density 4 |
0.07 |
0.04 - 0.09 |
|
TOTAL |
0.06 |
0.05 - 0.08 |
Due to technical limitations, Table 2 is only available as a download in the supplementary files.