Characteristics of People Who Inject Drugs Approached for Injection Assistance in Rural Kentucky

OBJECTIVE: This study aims to understand the characteristics of people who inject drugs approached by others for injection assistance. METHOD: Peer-referral and outreach were used to recruit rural adults who recently injected drugs in Appalachian Kentucky (n=435). Interviewer-administered questionnaires elicited data on participant characteristics and injection assistance. Descriptive statistics and generalized estimating equations clustered on peer-referral recruitment chain were used for analysis. RESULTS: Nearly one-third (30.1%) reported others had come to them for injection assistance. People approached for assistance were slightly younger (prevalence ratio [PR]: 0.91, 95% confidence interval [CI]: 0.85-0.99) but otherwise, demographically similar to their counterparts. Those approached for assistance were more likely to have tested HCV antibody positive (PR: 1.65, 95%CI: 1.08-2.51), recently (past six months) engaged in distributive syringe sharing (PR: 1.33, 95%CI: 1.05-1.69), used buprenorphine "to get high" (PR: 1.32, 95%CI: 1.01-1.75), witnessed an overdose (PR: 1.71, 95%CI: 1.25-2.32), and used fentanyl test strips (PR: 1.54, 95%CI: 1.14-2.08). They were also more likely to have received safer injection education (PR: 1.43, 95%CI: 1.08-1.84) and less likely to believe that sterile syringes were easy to access (PR: 0.60, 95%CI: 0.40-0.88). Among those who visited the syringe services program (SSP), those approached for injection assistance provided more people with SSP-issued syringes (PR: 1.02, 95%CI: 1.01-1.03) than those not approached. CONCLUSIONS: Injection assistance is common in rural Appalachian Kentucky and those approached for assistance have unmet harm reduction needs. Interventions that improve syringe coverage and strengthen efforts to provide support to peers in this population are needed.