Abstract
Objective: Examine the challenges of four service delivery models (i.e., fixed, mobile, satellite and home visits) and how service delivery may impact on NEP HIV prevention efforts.
Methods: Using a modified ethnographic approach, semi-structured interviews concerning policies and procedures were conducted with staff (n=59) of NEPs (n=15) in Ontario. An iterative, inductive analytic process was used.
Results: According to workers and managers, effectiveness of NEP prevention efforts depend on client development and retention and service design. Fixed and satellite sites, home visits and mobile services provide varied levels of temporal and spatial accessibility. Combining modes of delivery can offset the disadvantages of individual modes.
Discussion: NEP evaluations that do not consider service and resource factors run the risk of concluding that NEPs are ineffective when it may be that the program works for a small proportion of IDUs whom the NEP has the resources to serve.
Résumé
Objectif: Nous avons examiné les défis de quatre modes de prestation de services (service fixe, mobile et par satellite et visites à domicile) et leurs incidences possibles sur les efforts de prévention du VIH des programmes d’échange de seringues (PES).
Méthode: Selon une démarche ethnographique modifiée, nous avons mené des entretiens semidirectifs avec 59 employés de 15 PES ontariens à propos des politiques et méthodes de ces PES, puis effectué une analyse itérative et inductive.
Résultats: Aux dires du personnel et des cadres, l’efficacité des efforts de prévention des PES dépend de l’élargissement et du maintien de leur clientèle et du mode de prestation choisi. L’accessibilité aux services, dans l’espace et dans le temps, varie selon qu’ils sont offerts au moyen d’installations fixes, mobiles ou par satellite ou lors de visites à domicile. En combinant plusieurs modes de prestation, on peut compenser leurs inconvénients respectifs.
Discussion: Les évaluations des PES qui font abstraction des différences dans les services et les ressources risquent de conclure à l’inefficacité de certains programmes, alors qu’ils peuvent donner des résultats pour la faible proportion d’utilisateurs de drogues injectables que le PES a les moyens de desservir.
Footnotes
Acknowledgements: This study would not have been possible without the generous participation of the needle exchange program staff and managers. In addition, Evelyn Wallace, Brenda Perkins, Victor Marshall and Joel Baum provided invaluable assistance.
This research was made possible in part through a National Health Research and Development Program (NHRDP) Research Training Award from Health Canada. Funding for the study was provided by the AIDS Bureau, Ontario Ministry of Health and Long-Term Care and the Prevention and Community Action Program, Health Canada.
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