When Will Eger, MPH, ’21, wanted to understand the challenges in implementing syringe services programs (SSPs) — which aim to address the spread of infectious diseases such as HIV — he focused his efforts on a city and state far from Yale’s campus.
Eger began studying SSPs as a second-year MPH student at the Yale School of Public Health (YSPH), and began writing a paper about SSPs as a student in Assistant Professor Kristina Talbert-Slagle’s capstone class (EPH 557), “Evidence-based decision-making in global health.” He later turned the paper into a published manuscript.
“At the time, I had just begun working at Yale’s syringe services program under the guidance of Professor of Medicine and Epidemiology Rick Altice, and wanted to learn more about SSPs, including their empirical evidence, and what factors impacted their implementation,” explained Eger, who was affiliated with the Department of Epidemiology of Microbial Diseases.
Instead of focusing on Connecticut, which has a robust harm-reduction network, Eger turned his attention to Mississippi, one of seven Southern U.S. states that account for more than 50% of new HIV infections nationwide.
By translating classwork into real-world solutions, Eger added to the body of knowledge around SSPs, said Talbert-Slagle, PhD ’10. “Not only did he gain meaningful expertise on the topic, his paper has the potential to change practice,” she added. Eger credited YSPH faculty as well as the school’s emphasis on scholarly excellence and its culture of collaboration.
Collaborating with Talbert-Slagle as well as Hannah Allen of the University of Mississippi, Eger developed his final paper for Talbert-Slagle’s class into a manuscript and presented his findings at the 2022 Symposium on Substance Use Research at the University of Nebraska.
Eger approached Allen, of the University of Mississippi in Jackson, and asked her to join his team. “Dr. Allen brought years of experience working in addiction science in Mississippi, which really strengthened our paper, and I believe, resulted in its publication,” he said.
The paper by Eger, Talbert-Slagle, and Allen, “Using an Evidence-based Framework to Guide the Implementation of Syringe Services Programs in Jackson, Mississippi,” was published in the Harvard Public Health Review (now HPHR Journal). The authors used the Consolidated Framework for Implementation Research (CFIR) to identify the potential factors that would impact a plan to bring an SSP to Jackson. Eger had learned about the framework while taking classes taught by Talbert-Slagle and Associate Professor Luke Davis at YSPH. Eger is currently a NIDA T32 Predoctoral Fellow in the Joint Doctoral Program in Interdisciplinary Research on Substance Use at the University of California San Diego School of Medicine, Division of Infectious Diseases & Global Public Health and San Diego State University School of Social Work.
In their published commentary, Eger, Talbert-Slagle, and Allen report that the opioid epidemic in the U.S. has been coupled with increases in blood-borne infections, such as viral hepatitis and HIV, which can be spread through the sharing of injection equipment, including needles and cotton filters. The Department of Health and Human Services recommends SSPs to address the spread of infectious diseases among communities of people who inject drugs (PWID) and to link PWID to appropriate care.
The paper outlines the necessary steps and implementation challenges toward the development of an SSP in Jackson. “SSPs are adaptable, cost-effective, and beneficial for individuals and communities engaged with the programs,” the authors said. A main obstacle to SSP development in Mississippi is that syringes are classified as drug paraphernalia. “In addition to revising laws relating to syringe exchange, implementation of an SSP in Jackson must be accompanied by a grassroots, broad-based marketing and communication campaign led by public health experts who can discuss the benefits of SSPs, and combat stigma surrounding injection drug use,” the authors wrote.
“This project took a lot of adapting, teamwork, and great collaboration to get it off the ground, but we’re hopeful it can serve as a resource for people in settings where resistance to harm-reduction programs is high,” Eger said. “This project took a lot of adapting, teamwork, and great collaboration to get it off the ground, but we’re hopeful it can serve as a resource for people in settings where resistance to harm-reduction programs is high,” Eger said.
Setting a Precedent
Although HIV incidence has decreased nationally over the last two decades, annual infections have increased among people who inject drugs. In addition to infection-related comorbidities, such as hepatitis C virus and HIV, people who inject drugs are at risk of drug overdose, “which has reached new heights since the COVID-19 pandemic,” Eger said.
Jackson is home to the University of Mississippi Medical Center, an R1 research institute, and the state’s department of health, which could serve as conduits of information and provide vital resources. “The development of a SSP in Jackson would set a precedent in Mississippi for the development of other SSPs statewide, and potentially decrease the burden of infection- and overdose-related deaths while saving the federal, state, and local governments millions of dollars in the process,” the authors concluded.
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- Frederick Lewis Altice, MD, MAProfessor of Medicine (Infectious Diseases) and of Epidemiology (Microbial Diseases); Affiliated Faculty, Yale Institute for Global Health; Director, Yale Center for Clinical and Community Research, Department of Medicine; Director, HIV in Prisons Program; Director, Community Health Care Van; Academic Icon Professor of Medicine, University of Malaya-Centre of Excellence for Research in AIDS (CERiA)