კვლევის ანგარიში, ზიანის შემცირების საქართველოს ქსელი, 2016

Assessment of the satisfaction with 1 ml syringes (IDA) among the beneficiaries of Harm Reduction Program

Study Brief Report

The Study was conducted by Georgian Harm Reduction Network within the Global Fund project ,,Delivering HIV prevention services to People Who Injects Drugs”.

The Study was provided by:

Maka Gogia Guranda Jikia Khatuna Kutateladze

May, 2016

კვლევის ანგარიში, ზიანის შემცირების საქართველოს ქსელი, 2016

Study Brief Report

Study Objectives

The primary objective of the study were: assessing the satisfaction with 1 ml syringes (IDA) among the beneficiaries of Harm Reduction Program, analyzing the problems related to this syringes and formulate needed requirements for it. The secondary objective of the study was assessing the satisfaction with other delivering materials (IDA) among program beneficiaries and identification their additional needs.

The Study was conducted in 13 harm reduction sites in 10 cities: (4 sites), , , Samtredia, , , , and . The study design included qualitative and quantitative research tools. Quantitative study was conducted by structured questionnaire, that included open and close questions. The sample size was determined 379 PWIDs. Random sampling was applied among program beneficiaries that came stationary to harm reduction sites. Qualitative study was conducted by focus groups among program beneficiaries. Totally 4 focus groups were conducted 2 in Tbilisi, 1 in Gori and 1 in Kutaisi.

Study results Quantitative study Totally 451 beneficiaries were interviewed by structured questionnaire. Almost 99% of program beneficiaries pointed out, that the syringe quality does not meet their needs. Among the reasons that were mostly applied for syringe dissatisfaction, there were revealed the following problematic issues: the syringe has a high ,,dead zone" (the space where the injection fluid remains)- 75%; Needle passage is bad - injection fluid hardly moves to veins 63%; the top of the syringe is blunt and damages the veins (52%).

Table 1 Reasons for 1 ml syringe-related dissatisfaction

# Reasons for dissatisfaction Quantity % The syringe does not allow to control are you in 1 vein or not. 222 49 Needle passage is bad - injection fluid hardly 2 moves to veins, the fluid comes back, accordingly the needle is often removed from the syringe. 282 63 3 the syringe has a high ,,dead zone" 338 75 It is difficult to fix the transfusion system 4 (Butterfly) on this syringe 119 26 5 The syringe has not a needle retainer 248 39 The needle is very soft, while entering in vein it 6 often is broken. 178 39 7 the top of the syringe is blunt and damages the 236 52 კვლევის ანგარიში, ზიანის შემცირების საქართველოს ქსელი, 2016

veins. 8 Other reasons 9 2.7

Among other reasons the beneficiaries pointed out the following problematic issues:

 The syringe has 2 ,,dead space”;  B-Braun 1 syringes is much more better that this one;  This syringe is difficult to be used among persons, who has problematic and damaged veins;;  As the needle is very soft, sometimes you need second attempt of injection, that damages the veins;  During making a ,,control” while injection, the blood clots in the syringe;  The metal of the needle is defective, does not glide in veins, badly enters the skin;  The needle has cracks.

Qualitative study results

Totally 36 PWIDs and 20 outreach workers were interviewed through focus groups. Direct communication with PWIDs and outreach workers made more possible to reveal level of dissatisfaction and depict some dangerous issues regarding this 1ml syringe. According to their comments all the reasons that were revealed during quantitative study was repeated. Significant is to mention the following comments of program beneficiaries:  ,,It is better for me to use B-Braun syringe, even it is already used by someone, than to use this poor quality syringe. I want to ,,enter the vein” by the first attempt, I don’t have so much time and nerves…”  ,,We hardly get drugs in this situation, we don’t have enough drugs to be left in the syringe. I refuse to use your syringe, I do anything else, either I will buy other syringe…”  ,,The top of the needle is too blunt, I used to try injection several times, accordingly all veins were disappeared, I suffered a lot. I don’t want this syringe and don’t take them for others. I take regularly other syringes, as they are good qualities, I take them for my boys of course…”  ,,In past, when this program has B-Braun syringes I took at least 10 syringes, but now I hardly take 1 or 2 ones, as I prefer to buy in drug store better quality 1 ml syringes. I never took these syringes for my friends, they will insult me…”  ,,Once the needle of this syringe was broken in my vein, urgently I applied to doctor for help. After this I have never used this syringe and my friends do the same because of it …”

კვლევის ანგარიში, ზიანის შემცირების საქართველოს ქსელი, 2016

As regarding other delivering materials, beneficiaries pointed out, that mostly they are satisfied by their quality. The final question that was given during focus group meetings was related to other injecting necessities. The beneficiaries expressed the following needs:  Injection water in glass bulb (5 ml), that will be used for ,,cooking” as well. Currently they sometimes use non-clean equipment for drug preparation;  Injection spoon for drug preparation, that has enough depth for liquid;  Rubber gloves for clean injection;  Acid for drug salutation.

Reccomendations

As the study revealed great level of dissatisfaction with 1mk (IDA) syringes among harm reduction program beneficiaries, it is significant to timely substitute them with other, good quality syringes. The effectiveness of Needle and Syringe program is highly dependent on the quality of delivering materials, mostly on 1 ml syringes that reveals the mostly used injecting equipment in the country. It is possible to lose the beneficiaries who are dissatisfied with delivering materials. The program should be more focused on the quality of each delivering materials, the assessment of the satisfaction among the beneficiaries of Harm Reduction Program should be carried out on a routine base (at least once in a year).

It is recommended that the tender, that is conducted before the procurement, is taken into account the opinion of PWIDs itself. The harm reduction program used this kind of practice during 2011-2014: all the identified bidding companies submitted their materials for visual discussion and assessment. Targeted meetings with program beneficiaries and outreach workers were conducted and submitted materials were evaluated. Only according to their assessment the final approval was given and tender winner was revealed. In case new injecting/delivering material procurement, it is better to order small quantities just to assess the needed specifications. Based on the results the big procurement should be executed in future.