Determinants of Cutaneous Injection-Related Infection Care at a Supervised Injecting Facility

Lloyd-Smith, Elisa; Wood, Evan; Zhang, Ruth; Tyndall, Mark W.; Montaner, Julio S.; Kerr, Thomas

doi:10.1016/j.annepidem.2009.03.007

« Previous Next »Annals of Epidemiology
Volume 19, Issue 6 , Pages 404-409, June 2009

Determinants of Cutaneous Injection-Related Infection Care at a Supervised Injecting Facility

Elisa Lloyd-Smith
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
Evan Wood, MD, PhD
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
Ruth Zhang, MSc
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
Mark W. Tyndall, MD, ScD
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
Julio S. Montaner, MD, FRCPC
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
Thomas Kerr, PhD
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Address correspondence to: Thomas Kerr, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital 608-1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada. Tel: (604) 806-9116. fax: (604) 806-9044.

Received 8 September 2008; accepted 2 March 2009. published online 13 April 2009.

Purpose

To evaluate the factors associated with receiving cutaneous injection-related infection (CIRI) care among a representative cohort of supervised injecting facility (SIF) users.

Methods

Data were collected biannually as part of a prospective cohort, the Scientific Evaluation of Supervised Injection study. Kaplan-Meier methods and Cox proportional hazards regression with recurrent events were used to examine incidence and factors associated with CIRI care, respectively.

Results

One thousand eighty individuals were recruited between December 1, 2003 and January 31, 2008. The incidence density of participants receiving CIRI care was 22.0 per 100 person-years (95% confidence interval [CI]: 19.6–24.6). In the adjusted Cox proportional hazard model, female sex (adjusted hazard ratio [AHR]=1.87 [95% CI: 1.32–2.64]), unstable housing (AHR=1.39 [95% CI: 1.02–1.88]), and daily heroin injection (AHR=1.52 [95% CI: 1.13–2.04]) were independently associated with receiving CIRI care at the SIF.

Conclusions

These results describe who is more likely to receive CIRI care, which is of use to those engaged with policy and practice of treatment regimens involving this population.

Key Words: Statistical Methods, Infectious Disease, Nursing, IV Drug User

Selected Abbreviations and Acronyms: CIRI, cutaneous injection-related infection, IDU, injection drug user, ED, emergency department, ISIS, Integrated Soft Tissue Infection Services, SIF, safer injection facilities, DTES, Downtown Eastside, IQR, interquartile range, HR, hazard ratio, AHR, adjusted hazard ratio