Table 4 Guiding principles for REACT intervention
Design objectives that address each key issue | Key intervention features relevant to each design objective |
|---|---|
(i) To address priorities of people who inject drugs by making changes to their injecting practices to keep their veins healthier for longer and minimise pain | Provide tailored harm reduction advice to include discussion of the following topics:   (i) Environment person injects in  (ii) Handwashing/swabbing  (iii) Use of acids  (iv) Use of water  (v) Reuse of equipment (needles, cookers, filters)  (vi) Rotating sites Positive, non-judgemental conversation between service provider and client |
(ii) To provide appropriate resources to enable less harmful injecting practices and overcome barriers to safer injecting practice at the structural level | Provision of the following resources to help support harm reduction behaviours:   Hand sanitisers and wipes (with  instructions for use)   Injecting tips: #1 bacterial  infections Exchange supplies leaflet    Injecting tips: #2 prevention and care:  abscesses and ulcers Exchange supplies  leaflet    Injecting tips: #3 staying safe on the street Exchange supplies leaflet Be wise, sterilise poster Exchange Supplies / NIHR ARC West poster Citric acid poster Exchange Supplies:    Water ampoules    Street injecting kit    Citric packets (with instructions for use) |
(iii) Flexible approach to delivery of intervention to meet needs of target population |  Use of intervention ‘cards’ as appropriate to act as a prompt to discussion on different topics  Delivery of shorter version to fit within constraints of appointment time or priorities of client  Tailor provision of resources depending on needs of client (e.g. previous experience of bacterial infections; difficulties prioritising safer injecting practice due to dependence; lack of opportunities to follow safer injecting practices; entrenched injecting practices; good knowledge of ‘best practice’; experience of stigma and shame meaning conversations about injecting behaviours are difficult)  Intervention delivery should be within the context of a confidential space to facilitate open discussion about stigmatised behaviours  Utilise existing relationship between client and service provider to overcome shame in open discussions about behaviours |