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Social and structural determinants of injecting-related bacterial and fungal infections among people who inject drugs: protocol for a mixed studies systematic review

Brothers, Thomas D, Lewer, Dan, Bonn, Matthew, Webster, Duncan, Harris, Magdalena·2021·BMJ Open
DOI 10.1136/bmjopen-2021-049924PMC PMC8354281
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Abstract

Introduction: Injecting-related bacterial and fungal infections are a common complication among people who inject drugs (PWID), associated with significant morbidity and mortality. Invasive infections, including infective endocarditis, appear to be increasing in incidence. To date, preventive efforts have focused on modifying individual-level risk behaviours (eg, hand-washing and skin-cleaning) without much success in reducing the population-level impact of these infections. Learning from successes in HIV prevention, there may be great value in looking beyond individual-level risk behaviours to the social determinants of health. Specifically, the risk environment conceptual framework identifies how social, physical, economic and political environmental factors facilitate and constrain individual behaviour, and therefore influence health outcomes. Understanding the social and structural determinants of injecting-related bacterial and fungal infections could help to identify new targets for prevention efforts in the face of increasing incidence of severe disease. Methods and analysis: This is a protocol for a systematic review. We will review studies of PWID and investigate associations between risk factors (both individual-level and social/structural-level) and the incidence of hospitalisation or death due to injecting-related bacterial infections (skin and soft-tissue infections, bacteraemia, infective endocarditis, osteomyelitis, septic arthritis, epidural abscess and others). We will include quantitative, qualitative and mixed methods studies. Using directed content analysis, we will code risk factors for these infection-related outcomes according to their contributions to the risk environment in type (social, physical, economic or political) and level (microenvironmental or macroenvironmental). We will also code and present risk factors at each stage in the process of drug acquisition, preparation, injection, superficial infection care, severe infection care or hospitalisation, and outcomes after infection or hospital discharge. Ethics and dissemination: As an analysis of the published literature, no ethics approval is required. The findings will inform a research agenda to develop and implement social/structural interventions aimed at reducing the burden of disease. PROSPERO registration number: CRD42021231411.

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Figure 1 Illustrative schematic of a potential risk environment for injecting-related bacterial and fungal infections, as it may structure or create infection risk during the process of drug injection/consumption. Environmental factors, which are external to individuals, interact to influence individual-level factors and health behaviours across stages of a potential pathway: drug acquisition; drug preparation; drug injection; treatment of superficial injection-site bacterial and fungal infections (eg, in primary care or emergency departments); treatment of severe/invasive bacterial and fungal infections (eg, in hospital for intravenous antibiotics and/or surgery) and health outcomes after severe/invasive bacterial and fungal infections (eg, disability, death). IM, intramuscular; SC, subcutaneous.
Figure 1 Illustrative schematic of a potential risk environment for injecting-related bacterial and fungal infections, as it may structure or create infection risk during the process of drug injection/consumption. Environmental factors, which are external to individuals, interact to influence individual-level factors and health behaviours across stages of a potential pathway: drug acquisition; drug preparation; drug injection; treatment of superficial injection-site bacterial and fungal infections (eg, in primary care or emergency departments); treatment of severe/invasive bacterial and fungal infections (eg, in hospital for intravenous antibiotics and/or surgery) and health outcomes after severe/invasive bacterial and fungal infections (eg, disability, death). IM, intramuscular; SC, subcutaneous.CC BY · PubMed Central
Figure 2 Illustrative schematic of a potential risk environment for injecting-related bacterial and fungal infections, as it may structure or create infection risk during the process of recognition and adequate treatment of superficial injection-site infections. Environmental factors, which are external to individuals, interact to influence individual-level factors and health behaviours across stages of a potential pathway: drug acquisition; drug preparation; drug injection; treatment of superficial injection-site bacterial and fungal infections (eg, in primary care or emergency departments); treatment of severe/invasive bacterial and fungal infections (eg, in hospital for intravenous antibiotics and/or surgery) and health outcomes after severe/invasive bacterial and fungal infections (eg, disability, death).
Figure 2 Illustrative schematic of a potential risk environment for injecting-related bacterial and fungal infections, as it may structure or create infection risk during the process of recognition and adequate treatment of superficial injection-site infections. Environmental factors, which are external to individuals, interact to influence individual-level factors and health behaviours across stages of a potential pathway: drug acquisition; drug preparation; drug injection; treatment of superficial injection-site bacterial and fungal infections (eg, in primary care or emergency departments); treatment of severe/invasive bacterial and fungal infections (eg, in hospital for intravenous antibiotics and/or surgery) and health outcomes after severe/invasive bacterial and fungal infections (eg, disability, death).CC BY · PubMed Central

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Metadata

Authors
Brothers, T. D., Lewer, D., Bonn, M., Webster, D., & Harris, M.
Affiliations
  • UCL Collaborative Centre for Inclusion Health, Institue of Epidemiology and Health Care, University College London, London, UK
  • Canadian Association of People Who Use Drugs, Dartmouth, Nova Scotia, Canada
  • Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  • Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2021-08
Volume
11
Issue
8
Pages
e049924
ISSN
2044-6055
DOI
10.1136/bmjopen-2021-049924
PMC
PMC8354281
Cited by
16
References
10
Language
en
Licence
creativecommons.org/licenses/by/4.0/ (unspecified, 7 d)
Funders
  • Dalhousie University Faculty of Medicine (Killam Scholarship, Clinician Investigator Program)
  • National Institute for Health Research (CDF-2016-09-014, DRF-2018-11-ST2-016)
  • Dalhousie University Internal Medicine Research Foundation (Internal Fellowship)
  • Canadian Institutes of Health Research (FRN# 171259)
  • National Institute on Drug Abuse (R25DA033211)

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