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we then received survey responses from three harm reduction programs from newfoundland and labrador, and one program each from alberta, manitoba, and quebec. using the list of programs that emailed us, we sent a formal request for program information and described the study in a second formal email. we received no response to the first request and received the second request from all programs except one in which the program manager told us that it had closed in late august 2016. the program could not be contacted again, so we have only baseline information on its services. we received a total of 20 completed surveys, which was deemed an adequate sample size given that it included five different canadian provinces and the atlantic region. we then created a database in excel, which was imported into stata v14 (statacorp, college station, tx).
we extracted data on harm reduction program characteristics, including the number of employees, services provided, total number of clients seen in the past year, total number of clients who smoke crack cocaine per year, and the type of harm reduction services implemented.
in the last few decades, the prevalence of idu in the netherlands has declined significantly, mainly as a result of interventions that target this risk group [ 10 27 ]. in 2005, the prevalence of hcv infection among injecting drug users was estimated at 0.86 [ 28 ]. moreover, in 2008, nearly 30,000 hcv-infected injecting drug users (0.58% of this risk group) died in the netherlands, and of these, almost 80% were in the 45-64 age group [ 29 ]. this study is part of a series of studies aimed at developing and testing the feasibility of national guidance for practice in the field of harm reduction for idu. to further our understanding of the association between the ‘harm reduction’ measures recommended by nsps and increased education and distribution of safer crack cocaine smoking equipment among clients, we restricted our analysis to nsps only. currently, there are 26 nsps in the netherlands that offer a range of harm reduction services and that are registered with the terug naar genomen foundation. each of these nsps adheres to a set of policy documents which are, in general, developed by the nsps themselves. these documents largely reflect existing international guidelines and recommendations concerning harm reduction for idu that are endorsed by international associations such as the european monitoring centre for drugs and drug addiction, the european monitoring centre for drugs and drug addiction, the national institute on drug abuse, and the world health organization [ 31 ]. the most recent version of the nsps’ policy documents in the netherlands was updated in december 2010 [ 30 ]. although the world health organization has not established clear parameters for establishing the risk of hcv transmission during the idu process, these guidelines generally focus on the prevention of injection-related needle stick injuries, addressing such issues as the prevention of blood-borne pathogens, sterilization and recapping of needles, the use of condoms, education of clients, and provision of clean needles and syringes.
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