Sofia Zaragoza

Harm reduction services save lives and facilitate treatment uptake for people who are unhoused and use drugs. It is unknown whether provision of harm reduction services within a transitional housing environment affects treatment uptake, drug supply, or drug using behaviors. This study focused on mitigation of the impacts of mass relocation and uptake of services by residents of harm reduction housing (HRH) to generate novel insights on individual drug use, social cohesion, collective efficacy, and health outcomes resulting from HRH. We used a mixed-methods study leveraging our prior Rapid Assessment of Consumer Knowledge findings and ongoing drug checking capacity to gather data on response to rapid rehousing in Boston’s “Mass and Cass” neighborhood. First, we developed an inventory of harm reduction services offered and accessible to HRH residents to sufficiently measure exposure. Second, we launched an observational cohort following 106 HRH residents at 2 time periods over 12 months. Finally, we invited a subset of 28 cohort members to take part in repeated, longitudinal one-on-one interviews to gain greater insight into HRH, development of social cohesion and collective efficacy, and drug-related outcomes. Protocol adaptations due to housing shifts, over policing, and serendipity were applied.

Illicitly manufactured fentanyl within the drug supply has substantially increased opioid-related overdose deaths and driven infectious disease outbreaks among people who use drugs (PWUD). Local jurisdictions often lack the data and tools necessary to detect and translate such moments into actionable and effective responses. Informed by a risk environment framework, this case study adopted a mixed-methods design spanning two rapid assessment studies with PWUD in Lowell (n = 90) and Lawrence (n = 40), Massachusetts, during an HIV outbreak (2017, Study 1) and following the outbreak (2019, Study 2). Survey responses (n = 130) were summarized by computing descriptive statistics, ethnographic field notes were reviewed, and qualitative interviews (n = 34) were thematically analyzed to contextualize quantitative findings. Study 1 participants reported constrained syringe access, high injecting frequency, syringe reuse, and unsafe syringe disposal practices, and uncovered entrenched social and structural factors exacerbating existing substance use and HIV risks: housing instability, limited harm reduction supplies and services (e.g., MOUD access), and tensions between law enforcement and PWUD. Following the outbreak and substantial local investments in harm reduction and treatment infrastructures, Study 2 participants indicated lower injection risk reporting fewer syringe reuse episodes, improved syringe disposal practices, high frequency of naloxone administration at recent overdoses, frequent testing for HIV and HCV, and greater engagement with syringe services programs. A rapid assessment approach to fentanyl’s emergence and a concomitant HIV outbreak provided time-sensitive, critical insights and identified needed and local response strategies. However, unless social and structural risk factors are also addressed, community vulnerability to future HIV outbreaks remains.