title: Guidelines for better harm reduction: evaluating implementation of best practice recommendations for needle and syringe programs (NSPs).
abstract: BACKGROUND
  The objective of this study was to evaluate needle and syringe program (NSP) policies and procedures before and after the dissemination of a set of best practice recommendations.
  
  
  METHODS
  An on-line survey of 32 core NSP managers (100% response rate) and 62 satellite NSP managers (63% response rate). The survey included items about the distribution of needles/syringes, other injection-related equipment and inhalation equipment, and use of a best practice recommendations document.
  
  
  RESULTS
  The majority of NSPs reported following needle and syringe best practice recommendations. Most core NSPs (88%, n=28) and satellite NSPs (84%, n=52) distributed cookers following the dissemination of the document. All core NSPs (100%, n=32) and nearly all satellite NSPs (97%, n=60) distributed sterile water ampoules in 2008, many more than in 2006. Although more NSPs distributed safer inhalation equipment in 2008, the majority did not distribute these items. More satellite NSPs (44%, n=27) distributed glass stems than the core NSPs (16%, n=5). Commonly cited implementation barriers included funding, senior management and decision-making.
  
  
  CONCLUSIONS
  Our findings demonstrate that NSPs will implement empirically based best practice recommendations and welcome such guidance. The managers we surveyed not only reported increased implementation of practices that have been empirically shown to help reduce disease transmission among injection drug users (IDUs), they also used the best practices document for additional purposes, such as planning and advocacy, and expressed interest in having sets of recommendations developed for other areas of harm reduction. Ensuring high-quality and consistent NSP services is essential to prevent transmission of HIV among people who inject drugs and others in the community. Best practice recommendations can assist in achieving these goals.
authors.affiliation: Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario, Canada. Carol_Strike@camh.net
authors.forename: Carol
authors.initials: C
authors.lastname: Strike
authors.forename: Tara Marie
authors.initials: TM
authors.lastname: Watson
authors.forename: Paul
authors.initials: P
authors.lastname: Lavigne
authors.forename: Shaun
authors.initials: S
authors.lastname: Hopkins
authors.forename: Ron
authors.initials: R
authors.lastname: Shore
authors.forename: Don
authors.initials: D
authors.lastname: Young
authors.forename: Lynne
authors.initials: L
authors.lastname: Leonard
authors.forename: Peggy
authors.initials: P
authors.lastname: Millson
mesh_terms: D019985:Benchmarking; D003625:Data Collection; D055030:Drug Users; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D040261:Harm Reduction; D006801:Humans; D009330:Nebulizers and Vaporizers / Q000600:supply & distribution; D016485:Needle Sharing / Q000009:adverse effects*; D018671:Needle-Exchange Programs / Q000191:economics / Q000379:methods / Q000458:organization & administration; D009339:Needles; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013594:Syringes