title: Acceptability of low dead space syringes and implications for their introduction: A qualitative study in the West of England.
abstract: It is recommended that needle and syringe programmes (NSP) distribute low dead space syringes (LDSS) to reduce blood-borne virus transmission. We explored the acceptability of detachable LDSS among people who inject drugs (PWID) and staff who work to support them.
  
  
  
  Semi-structured interviews were performed with 23 PWID (15 men and 8 women) and 13 NSP staff members (6 men and 7 women) in Bath and Bristol, England. Recruited PWID reflected varying demographic characteristics, drug use and injecting preferences. Interviews explored experiences of different types of injecting equipment, facilitators and barriers of changing this equipment and attitudes towards detachable LDSS. Interviews were audio recorded, transcribed verbatim and analysed using the Framework Method.
  
  
  
  Decisions about injecting practices were underpinned by several factors, including early experiences and peer initiation; awareness and availability of alternatives; and the ability to inject successfully. Rinsing and re-using syringes represented a quandary where rinsing could encourage re-use, but not rinsing could result in the re-use of unclean equipment. Most PWID were reluctant to change equipment particularly in the absence of any problems injecting. Prioritising getting a 'hit' over the prevention of potential problems was an important barrier to change. Overall detachable LDSS are likely to be acceptable. Lower risk of transferring infections and reduced drug wastage were valued benefits of detachable LDSS. There was a preference for a gradual introduction of detachable LDSS in which PWID are given an opportunity to try the new equipment alongside their usual equipment.
  
  
  
  Detachable LDSS are likely to be acceptable and should therefore be offered to those using detachable high dead space syringes and/or fixed 1ml LDSS syringes to inject into deeper femoral veins. An intervention is needed to support their introduction with 'training', 'education', 'persuasion' and eventual 'restriction' components.
authors: NIHR Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; NIHR Health Protection Research Unit on Evaluation of Interventions, University of Bristol, UK; School of Social and Community Medicine, University of Bristol, UK. Electronic address: jo.kesten@bristol.ac.uk.
authors: Joanna M
authors: JM
authors: Kesten
authors: Bristol Drugs Project, Bristol, UK.
authors: Rachel
authors: R
authors: Ayres
authors: Bristol Drugs Project, Bristol, UK.
authors: Jane
authors: J
authors: Neale
authors: Bristol City Council, Bristol, UK.
authors: Jody
authors: J
authors: Clark
authors: NIHR Health Protection Research Unit on Evaluation of Interventions, University of Bristol, UK; School of Social and Community Medicine, University of Bristol, UK.
authors: Peter
authors: P
authors: Vickerman
authors: NIHR Health Protection Research Unit on Evaluation of Interventions, University of Bristol, UK; School of Social and Community Medicine, University of Bristol, UK.
authors: Matthew
authors: M
authors: Hickman
authors: NIHR Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, UK; School of Social and Community Medicine, University of Bristol, UK.
authors: Sabi
authors: S
authors: Redwood
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004739:England; D015658:HIV Infections / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006526:Hepatitis C / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs / Q000379:methods*; D036301:Qualitative Research; D015819:Substance Abuse, Intravenous / Q000523:psychology*; D013594:Syringes
keywords: Acceptability; Low dead space syringes; Qualitative research