Willingness to use a mobile syringe service program among people who inject drugs in rural Appalachia

Alex Elswick; Amanda Fallin-Bennett; Tasfia Jahangir; Susan Westneat; April M. Young

doi:10.1186/s12954-026-01461-7

Willingness to use a mobile syringe service program among people who inject drugs in rural Appalachia

Alex Elswick
, Amanda Fallin-Bennett
, Tasfia Jahangir
, Susan Westneat
, April M. Young

Producción científica: Article › revisión exhaustiva

Resumen

Background: Rural people who use drugs face a litany of structural and psychosocial barriers to SSP utilization (e.g., unreliable transportation, stigma). Mobile SSPs may mitigate some barriers, but little is known about acceptability among rural people who use drugs and their preferences for mobile SSP design. This study examines (1) factors associated with willingness to use a mobile SSP among rural people who use drugs, and (2) their desired attributes and services. Methods: Data were collected from 259 participants who inject drugs that were recruited through outreach and respondent-driven sampling (RDS) in Appalachian Kentucky. In addition to descriptive analyses, independent variables’ associations with the outcome (i.e., being willing to use a mobile SSP) were estimated using generalized estimating equations. All models controlled for lifetime use of a fixed-site SSP. Results: Overall, 59.9% (n = 155) endorsed mobile SSPs as a program they would be willing to use. People with lower income, had less reliable access to transportation, were using methamphetamine, were engaging in syringe sharing and reuse, and who had experienced more overdoses in their lifetime were more willing to use a mobile SSP than were their counterparts. Those who experienced more shame around their drug use were less likely to use a mobile SSP than those who experienced no shame. Participants were receptive to a variety of locations, unit sizes, and staffing models, but the most desired staffing and locations were clinical in nature and most preferred hours of operation were afternoon hours. Discussion: Findings suggest moderate willingness to engage in mobile SSP services among this population, particularly for people who use drugs who have challenges with transportation and who are engaging in behaviors that increase risk for HIV and HCV. Mobile SSPs may increase accessibility, acceptability, and ultimately, the utilization of critical harm reduction services in Appalachia.

Idioma original	English
Número de artículo	101
Publicación	Harm Reduction Journal
Volumen	23
N.º	1
DOI	https://doi.org/10.1186/s12954-026-01461-7
Estado	Published - abr 22 2026

Nota bibliográfica

Publisher Copyright:
© The Author(s) 2026.

Financiación

We want to thank the participants and community advisory board members who took part in this study and shared their experiences with the study team. We also want to thank the field staff for their invaluable contributions to the project. This study was supported by two grants from the National Institute on Drug Abuse (UG3DA044798; UH3DA044798; PIs: Young/Cooper). The manuscript’s content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, CDC, SAMHSA, or the Appalachian Regional Commission.

Financiadores	Número del financiador
Substance Abuse and Mental Health Services Administration
Centers for Disease Control and Prevention
National Institutes of Health (NIH)
Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse	UH3DA044798

ODS de las Naciones Unidas

Este resultado contribuye a los siguientes Objetivos de Desarrollo Sostenible

Good health and well being

ASJC Scopus subject areas

Medicine (miscellaneous)
Public Health, Environmental and Occupational Health
Psychiatry and Mental health

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10.1186/s12954-026-01461-7

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abstract = "Background: Rural people who use drugs face a litany of structural and psychosocial barriers to SSP utilization (e.g., unreliable transportation, stigma). Mobile SSPs may mitigate some barriers, but little is known about acceptability among rural people who use drugs and their preferences for mobile SSP design. This study examines (1) factors associated with willingness to use a mobile SSP among rural people who use drugs, and (2) their desired attributes and services. Methods: Data were collected from 259 participants who inject drugs that were recruited through outreach and respondent-driven sampling (RDS) in Appalachian Kentucky. In addition to descriptive analyses, independent variables{\textquoteright} associations with the outcome (i.e., being willing to use a mobile SSP) were estimated using generalized estimating equations. All models controlled for lifetime use of a fixed-site SSP. Results: Overall, 59.9\% (n = 155) endorsed mobile SSPs as a program they would be willing to use. People with lower income, had less reliable access to transportation, were using methamphetamine, were engaging in syringe sharing and reuse, and who had experienced more overdoses in their lifetime were more willing to use a mobile SSP than were their counterparts. Those who experienced more shame around their drug use were less likely to use a mobile SSP than those who experienced no shame. Participants were receptive to a variety of locations, unit sizes, and staffing models, but the most desired staffing and locations were clinical in nature and most preferred hours of operation were afternoon hours. Discussion: Findings suggest moderate willingness to engage in mobile SSP services among this population, particularly for people who use drugs who have challenges with transportation and who are engaging in behaviors that increase risk for HIV and HCV. Mobile SSPs may increase accessibility, acceptability, and ultimately, the utilization of critical harm reduction services in Appalachia.",

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note = "Publisher Copyright: {\textcopyright} The Author(s) 2026.",

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AU - Elswick, Alex

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AU - Jahangir, Tasfia

AU - Westneat, Susan

AU - Young, April M.

N1 - Publisher Copyright: © The Author(s) 2026.

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AB - Background: Rural people who use drugs face a litany of structural and psychosocial barriers to SSP utilization (e.g., unreliable transportation, stigma). Mobile SSPs may mitigate some barriers, but little is known about acceptability among rural people who use drugs and their preferences for mobile SSP design. This study examines (1) factors associated with willingness to use a mobile SSP among rural people who use drugs, and (2) their desired attributes and services. Methods: Data were collected from 259 participants who inject drugs that were recruited through outreach and respondent-driven sampling (RDS) in Appalachian Kentucky. In addition to descriptive analyses, independent variables’ associations with the outcome (i.e., being willing to use a mobile SSP) were estimated using generalized estimating equations. All models controlled for lifetime use of a fixed-site SSP. Results: Overall, 59.9% (n = 155) endorsed mobile SSPs as a program they would be willing to use. People with lower income, had less reliable access to transportation, were using methamphetamine, were engaging in syringe sharing and reuse, and who had experienced more overdoses in their lifetime were more willing to use a mobile SSP than were their counterparts. Those who experienced more shame around their drug use were less likely to use a mobile SSP than those who experienced no shame. Participants were receptive to a variety of locations, unit sizes, and staffing models, but the most desired staffing and locations were clinical in nature and most preferred hours of operation were afternoon hours. Discussion: Findings suggest moderate willingness to engage in mobile SSP services among this population, particularly for people who use drugs who have challenges with transportation and who are engaging in behaviors that increase risk for HIV and HCV. Mobile SSPs may increase accessibility, acceptability, and ultimately, the utilization of critical harm reduction services in Appalachia.

KW - Appalachia

KW - Harm reduction

KW - Mobile syringe exchange

KW - Needle and syringe program

KW - Rural

KW - Syringe service programs

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DO - 10.1186/s12954-026-01461-7

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C2 - 42015272

AN - SCOPUS:105041322148

SN - 1477-7517

VL - 23

JO - Harm Reduction Journal

JF - Harm Reduction Journal

IS - 1

M1 - 101

ER -

Willingness to use a mobile syringe service program among people who inject drugs in rural Appalachia

Resumen

Nota bibliográfica

Financiación

ODS de las Naciones Unidas

ASJC Scopus subject areas

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