Wound care practices among people who inject drugs in Austin, Texas

Abstract

Background: People who inject drugs (PWID) may develop skin and soft tissue infections because of limited access to sterile injection supplies and education regarding safer injection techniques. The purpose of this study was to assess wound care experiences, knowledge, and practices among individuals accessing community-based services and inform service provision for PWID.Methods: Using convenience sampling, participants of an organization that engages with PWID in Austin, Texas, were engaged in a multiphase mixed-methods study. Phase 1 (N = 39) included completion of a 23-item quantitative survey; eligibility required injection drug use in the past 30 days. Phase 2 (N = 20) included brief semi-structured interviews to explore wound care practices. Participants received $20 grocery store gift cards for participating in each phase. Qualitative data were analyzed using an analytic matrix to identify themes.Results: PWID reported injecting methamphetamine, heroin, and fentanyl; 53.8% (21/39) injected more than 1 substance. The same proportion (21/39) had experienced at least 1 injection-related wound in the past 6 months and reported often or always self-treating injection-related wounds. Their reasons included confidence in self-treating, lack of perceived wound severity, and experience of stigma. Interview participants described their experiences with infections, how they cleaned wounds and obtained antibiotics, how they decided when to seek medical care (eg, wound severity, confidence in self-treatment), and barriers to seeking care (eg, stigma, financial concerns).Conclusions: Needs for wound care treatment and education among PWID are currently unmet, and stigma from health care providers remains a challenge to seeking early intervention for infections. Delivering wound care services and education through community-based organizations that have established credibility and connection may enhance access to care.