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In particular, after the introduction of government restrictions, both SIFs implemented changes to the routine of their operations which gave rise to some questions about whether this was more an instance of a one-off intervention or a more sustainable change in how the services delivered. We have answered this conundrum by carefully tracking changes in the two SIFs over time and comparing outcomes of these changes to existing evidence about the impact of SIF changes on outcomes such as syringe retention and drug-related HIV and HCV infections.
We found that although the change in SIF operations was motivated by the introduction of new government restrictions, much of the tailored advice provided and changes made to service operations was informed by existing research on the effects of service changes on outcomes, including the role of service context.
More specifically, SIFs that had been studied in previous research presented a higher level of service delivering, including more face-to-face interactions, higher training of staff, and a broader and more intensive education program. This was accompanied by changes in their design and layout, allowing greater access to injecting equipment and a more open and welcoming environment. These features are likely reflective of the social attitudes towards injecting in the contexts from which the two SIFs draw their clientele (see (Jibb 2012) for a comprehensive review of literature on Australian injecting communities).
Since the change to the routine at both SIFs, retention of the maximum daily dose of supervised injecting equipment has remained high. However, retention of items in preparation tanks has not remained high as shown in previous research, suggesting that modifications to instrument storage at the SIF are necessary.
This study, alongside others like it, has demonstrated that even in the absence of clear guidance on policies and restrictions, Australian SIFs have shown adaptability and continued to provide a safer service for their clients. As the global response to the COVID-19 pandemic evolves, as new questions arise, and as policies change, the work described here presents a template for the future. d2c66b5586
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