Improving responses to skin & soft tissues infections among people who inject drugs.

Skin & soft tissues infections (SSTIs) among people who inject drugs (PWID) are a substantial health problem.[1] They result from the difficulties in maintaining good injection practice and hygiene in the environments were illicit psychoactive drugs (such as heroin) are typically consumed. Infection risks and issues with accessing healthcare are compounded among PWID by the high levels of homelessness, concurrent mental health issues, and marginalisation.[2] SSTIs can be due to wide range of micro-organisms, but they are often due to streptococcal (e.g. iGAS) and staphylococcal (e.g. MRSA) infections. There is evidence that hospital admissions for SSTIs among PWID have increased markedly during recent years[3] and there is also an ongoing problem with outbreaks of MRSA and iGAS infections among PWID.[5,6]
Annually more than a third of PWID in the UK report having an SSTIs,[1,6] and these infections, if untreated or poorly treated, can have severe sequalae (include septicaemia, endocarditis & necrotizing fasciitis).[1] Repeated infections are common, and are associated with long term health problems, disfigurement, disability, and psychological issues.[7] SSTIs among PWID thus result in a considerable burden for healthcare systems;[8] though no recent total UK cost estimates are available, estimates from 2009 indicated annual inpatient costs in England of between £54-84 million.[9]
Initial symptoms are typically abscesses, open sores, and/or cellulitis, and these can usually be easily treated through provision of appropriate ‘wound care’ in the community.[1] Delays in seeking treatment, which are common, and ineffective treatment (including self-treatment) can result in more severe infections and complications.[8] The factors impacting on healthcare seeking, and so effective wound care, are currently unclear as globally these have rarely been examined.
This PhD will look at how responses to SSTIs among people injecting psychoactive drugs can be improved. The focus would be on understanding the facilitators and barriers to promptly accessing, and appropriately utilising, healthcare for SSTIs among PWID in England or Wales, and how the barriers to care can be overcome. It would aim to identify incremental developments to community-based interventions that could improve effective early treatment of SSTIs among PWID, and then access the acceptability of such developments.

The research for this PhD would involve a mixed methods approach, including a literature review, quantitative and qualitative data collection and/or analyses. The research would focus on a defined geographic area (such as a local authority) and could use a realist evaluation framework.