Theme: Epidemiology & Public Health Research Year: 2025
Background:
Globally, non-fatal overdoses (NFODs) are rising. Research has identified that addiction severity, frequency of use, and years of injecting are associated with NFOD risk; however, these dynamics among people who inject drugs (PWID) in sub-Saharan Africa have yet to be thoroughly assessed.
Methods:
We recruited PWID from needle and syringe programs in Kenya using respondent driven sampling. Participants completed biobehavioral surveys and received Hepatitis C (HCV), Hepatitis B (HBV), and HIV testing. We used bivariate and multivariate logistic regression to examine the impact of location, disease status, and injection behaviors on self-reported NFODs.
Results:
Among those with NFOD data (n=3145); 13.6% reported experiencing a NFOD in the prior 6 months. In the univariate analysis, participants with a recent NFOD were significantly more likely to have HCV (23.3% vs. 18.7%, p=0.026), HIV-HCV co-infection (5.3% vs. 3.7%, p=0.026), reside in Coast (64.1% vs. 47.1%, p<0.001), and less likely to reside in Nairobi (21.9% vs. 34.5%, p<0.001) than those without a recent NFOD. Factors associated with recent NFOD in the multivariate model were greater years of injecting (OR=1.018 per year of injecting; 95%CI: [1.00-1.037]), more frequent injections in the last 30 days (OR=1.006 per additional injection in last 30 days, [1.003-1.008]), injecting in feet (vs. not; OR=1.433, [1.118-1.838]), and polysubstance use (vs. mono-substance use; OR=2.341, [1.603-3.421]) all in the same timeframe; as well as injecting alone at least half of the time (OR=1.801, [1.345-2.410]), receptive needle/syringe sharing at last injection (OR=3.480, [2.472-4.900]), and typically injecting in a basecamp/den (vs. not OR=1.796, [1.183-2.728]).
Conclusion:
NFOD was associated with physical and geographic injection locations, injecting alone, and other injection-related behaviors. These findings highlight a need for integrating overdose prevention efforts into existing harm reduction strategies, including outreach in high-risk injection locations, never use alone strategies, and easily accessible naloxone when available, particularly in settings with limited naloxone access.
Disclosure of Interest Statement:
MJA reports grants from the National Institute on Drug Abuse (DP2DA053730, R00DA043011, R61DA060627), National Institute on Minority Health and Health Disparities (R01MD016744), National Institutes of Allergy and Infectious Diseases Centers for AIDS Research (P30AI124414), and investigator-initiated research funding paid to his institution from Gilead Sciences and AbbVie.
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