The positive impact of drug consumption rooms on HIV/HCV risk practices among people who inject drugs: results from the COSINUS cohort study

BACKGROUND: The effectiveness of drug consumption rooms (DCR) for people who inject drugs (PWID) has been demonstrated in several contexts, mainly on HIV-HCV risk practices. However, none of these studies has taken into account the potential bias related to specific characteristics of the group of PWID attending DCR by comparing the exposed group to a control one. The Cosinus cohort study conducted in France was designed to evaluate the impact of being exposed to DCR on the reduction of HIV-HCV risk practices by using a controlled cohort study.
METHODS: The COSINUS cohort is a 12-month longitudinal study among 665 PWID enrolled in Bordeaux, Marseilles, Paris and Strasbourg. We used data from face-to-face interviews at enrolment, 6- and 12-month visits conducted among participants recruited in addiction care and harm reduction programs in Bordeaux and Marseille and also in DCR in Strasbourg and Paris. We measured the impact of DCR exposure on HIV-HCV risk practices i.e. injecting equipment sharing (e.g., syringe, filter, spoon, water, etc.) during the previous month. We used a two-step Heckman mixed-effects probit model, which allowed us to take into account the correlation of repeated measures and to control for the potential bias due to non-randomization between the two groups (DCR-exposed vs. DCR-unexposed participants).
RESULTS: PWID exposed to DCR have 11% less HIV/HCV risk practices compared to those not exposed. After correction for the selection bias, being exposed to DCR was significantly associated with a lower risk of injection equipment sharing (adjusted coefficient (aCoeff) = -1.14; 95% confidence interval (95% CI) = [-1.91;-0.36]), after adjusting on being younger, having received food aid, using crack cocaine or free base daily, injecting daily, having harmful alcohol consumption, reporting being HCV seropositive and younger.
CONCLUSIONS: DCR that have been implemented in France have a positive impact on risk practices for infectious diseases such as HIV and HCV. This result confirms the previous studies published on the topic and provides additional strong argument to advocate for DCR implementation.

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