title: An external evaluation of a peer-run outreach-based syringe exchange in Vancouver, Canada.
abstract: OBJECTIVE
  Vancouver, Canada has been the site of an epidemic of human immunodeficiency virus (HIV) amongst injection drug users (IDU). In response, the Vancouver Area Network of Drug Users (VANDU) initiated a peer-run outreach-based syringe exchange programme (SEP) called the Alley Patrol. We conducted an external evaluation of this programme, using data obtained from the Vancouver Injection Drug Users Study (VIDUS).
  
  
  METHODS
  Using generalised estimating equations (GEE) we examined the prevalence and correlates of use of the SEP amongst VIDUS participants followed from 1 December 2000 to 30 November 2003.
  
  
  RESULTS
  Of 854 IDU, 233 (27.3%) participants reported use of the SEP during the study period. In multivariate GEE analyses, service use was positively associated with living in unstable housing (adjusted odds ratio [AOR]=1.83, 95% confidence interval [CI]: 1.39-2.40), daily heroin injection (AOR=1.31, 95% CI: 1.01-1.70), daily cocaine injection (AOR=1.34, 95% CI: 1.03-1.73), injecting in public (AOR=3.07, 95% CI: 2.32-4.06), and negatively associated with needle reuse (AOR=0.65, 95% CI: 0.46-0.92).
  
  
  CONCLUSIONS
  The VANDU Alley Patrol SEP succeeded in reaching a group of IDU at heightened risk for adverse health outcomes. Importantly, access to this service was associated with lower levels of needle reuse. This form of peer-based SEP may extend the reach of HIV prevention programmes by contacting IDU traditionally underserved by conventional syringe exchange programmes.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada; Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, Canada.
authors.forename: Kanna
authors.initials: K
authors.lastname: Hayashi
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Lee
authors.initials: L
authors.lastname: Wiebe
authors.forename: Jiezhi
authors.initials: J
authors.lastname: Qi
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D055030:Drug Users; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000517:prevention & control; D006801:Humans; D008297:Male; D016485:Needle Sharing / Q000009:adverse effects; D018671:Needle-Exchange Programs; D010379:Peer Group; D015397:Program Evaluation; D012307:Risk Factors; D012309:Risk-Taking; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous