Table 6 REACT logic model

To reduce bacterial infections among people who inject drugs by:

(i) Making changes to injecting practices to keep veins healthier for longer and minimise pain

(ii) Providing appropriate resources to overcome structural barriers to safer injecting practice

(iii) Being flexible in approach to delivery of intervention to meet needs of target population

 Training of service providers

 Staff time and expertise

 Private/confidential space for brief motivational interview during appointment

Intervention materials:

 Intervention ‘cards’ and resources to facilitate conversation about safer injecting practices

Education:

Instruction on how to perform a behaviour

Training:

Instruction on how to perform a behaviour

Persuasion:

Information about health consequences

Anticipated regret

Number of organisations in which the intervention is delivered.

Number of organisations and individuals who received training to deliver the intervention.

Number and length of appointments delivered by each service provider.

Number of people who inject drugs who did not attend appointment (reach) or refused offer of taking part and reasons (e.g. competing priorities, illness).

Content covered in each appointment (e.g. handwashing/swabbing, use of acids)

Intervention resources provided during appointment (e.g. hand sanitiser, sterile water, information leaflets)

Primary outcome:

 Reduction in development of bacterial infections (people who inject drugs)

Mechanisms of change:

 Acceptability of intervention delivery and materials (service providers and people who inject drugs)

 Increase in knowledge/understanding of safer injecting practices to keep veins healthier for longer and reduce pain (service providers and people who inject drugs)

 Increase in confidence to support people who inject drugs to use drugs more safely (service providers)

 Increase in safer injecting practices to keep veins healthier for longer and reduce pain (people who inject drugs)

Environment restructuring:

 Resources to support behaviour change (e.g. hand sanitiser, sterile water, information leaflets)

Environmental restructuring:

Prompts / cues

Adding objects to the physical environment

National policies, initiatives and campaigns; local policies, initiatives and campaigns; impact of COVID-19 pandemic; social norms and values; professional norms and values; and organisational policies and procedures, structural barriers to safer injecting

People who inject drugs who access a range of services may have: previous experience of bacterial infections; difficulties prioritising safer injecting practice due to dependence; lack of opportunities to follow safer injecting practices (e.g. injecting outdoors); entrenched injecting practices; good knowledge of ‘best practice’; and experience of stigma and shame meaning conversations about injecting behaviours are difficult. Attending to immediate priorities of people who inject drugs has potential