Practice Title: Data-Driven Syringe Services and Naloxone Distribution Programming
Department: Hennepin County Public Health
Size: Large (Population of 500,000+ people)
State: Minnesota
Summary of Practice:
Hennepin County Public Health is the largest local public health department in Minnesota.
Minneapolis, Minnesota’s largest city, is located in Hennepin County. Hennepin County, the most populous in the state, comprises 22% (1,266,000/5,640,000) of Minnesota’s population. The county is situated in the Minneapolis-St. Paul-Bloomington Metropolitan Statistical Area (MSA), which has a population of 3,657,477 as of 2020. It is the second largest MSA in the upper Mid-West.
According to the 2020 census, Hennepin County’s population is 66% White (Not Hispanic), 13% Black/African American, 7.6% Asian/Pacific Islander (API), 7.6% Latinx, 5.0% multi-racial, 0.6% Native American, and 0.47% other. The greatest concentrations of Black, Latinx, API, and men who have sex with men (MSM) in Minnesota reside in Hennepin County, and Minneapolis has the third largest urban population of Native Americans in the U.S. An Emory University study estimates the MSM population in Hennepin County to be 8.5% of the male population. In addition, despite having 22% of the state’s population, 51% of Minnesota’s HIV cases are in Hennepin County. An HIV outbreak among people who inject drugs and/or experiencing unsheltered homelessness began in December 2018 in Hennepin and neighboring Ramsey (St. Paul) Counties and was recently expanded to include MSM who inject drugs.
Hennepin County’s Public Health Clinic which houses the Red Door Clinic (RDC), offers a variety of services including refugee health screenings, tuberculosis testing and treatment, sexual health checkups, PrEP administration, and a syringe services program (SSP). The RDC diagnoses 20-25% of Minnesota’s annual HIV cases.
In addition to providing competent, culturally informed services, the RDC is uniquely positioned to deliver exceptional care coordination, wrap-around services, syringe services and naloxone distribution because of its proximity, relationship, and integration with other county-based services. Relationships with Hennepin Healthcare (Hennepin County’s safety-net hospital), and county services including Healthcare for the Homeless, Child Protection, and Adult Behavioral Health provide leverage to strategically deliver care coordination, wrap-around services, naloxone trainings, supplies, and support outside of the clinic. According to the CDC, SSPs are considered effective public health programming for preventing infectious disease, public safety, and linkage to substance use treatment, naloxone, and other healthcare services. RDC’s SSP data collection provides evidence of its effectiveness in these areas as well.
The RDC’s SSP operates out of the RDC in downtown Minneapolis. Service hours are Monday-Wed 8am-4pm, Thursday 10am-4pm, and Friday 8am-4pm. A range of syringe sizes, including tips and barrels, as well as safer injection supplies (alcohol pads, cookers, tourniquets, cottons, band aids, antibiotic ointment) are offered. In addition, participants can access hygiene kits, wound care kits, protein-based snacks, bottled water, condoms, lubricant, and other basic needs items as available.
In addition to serving clients at the clinic, the SSP serves Native American community members through established partnerships with the Minneapolis-based Little Earth Residents Association (the only Native American preference Section 8 rental assistance community in the U.S.) and families receiving services through Hennepin County Indian Child Welfare (ICWA). Because the opioid epidemic disproportionately affects the Native American community, it is imperative to have a seamless continuum of care for clients through these partnerships.
Syringe service programs entail the safe collection and disposal of used needles and syringes to ensure the health and safety of the larger community. According to the CDC, in 2020, 7% (2,055) of the 30,635 HIV diagnoses in the United States were attributed to intravenous drug use. CDC also reports the majority of new hepatitis C (HCV) infections have been associated with injection drug use. People who inject drugs are at higher risk for HIV and HCV due to sharing injection drug equipment and increased incidents of unprotected sexual encounters. Proper distribution and disposal create safer and healthier communities. A 2014 study published in the International Journal of Epidemiology and several replicated studies have shown that communities with syringe service programs have lower rates of HIV infection in persons who inject drugs. RDC offers syringe disposal services and access to new syringes and injection equipment to clients who either request supplies or have been identified by staff to have risk.
A unique aspect of this program is its data and tracking practices. When an individual arrives at the clinic for syringe services, naloxone, or has been identified by staff to have risk, they will complete a standard questionnaire and receive an anonymous participant ID. The standard questionnaire collects demographic information, data on syringe and naloxone distribution, client reported overdose reversals, and referrals to clinical services such as sexual health testing and vaccination. The questionnaire is updated to respond to emerging community concerns, such as whether clients follow up with emergency services after administering naloxone in the community or if they experience homelessness. Staff enter this information into a Sharepoint form, tracking data dating back to 2018, which automatically populates to a Power BI dashboard. This dashboard displays up-to-date information, refreshing every day at midnight. This year, we have given over 167,000 syringes, disposed of 87,000 syringes, and distributed over 3,000 Narcan kits which have contributed to over 900 overdose reversals. We also expanded the reach of the program, with 583 individual participants in 2021 and 861 in 2022, a 48% increase.
The public health impact of the RDC SSP is vast as the county and state continue to respond to one of the largest HIV outbreaks in the nation. Stopping transmission of HIV is essential to ending the outbreak and ultimately the epidemic. RDC programming, including the SSP, commits serving disproportionately affected communities in a setting that is welcoming, client-centered, harm reduction-focused, and nonjudgmental. The success and innovation of this program is its merging of harm reduction interventions and practices with clinical services and resources.
Data-Driven Syringe Services and Naloxone Distribution Programming
Category
Infectious Disease Prevention and Control
Description