Syringe services programmes face operational challenges to provide life-sustaining services to people who use substances and those who have substance use disorders. COVID-19 has disrupted operations at these programmes and is a threat to people with substance use disorder because of severe poverty, de-prioritisation of COVID-19 safety and high prevalence of comorbidities. This phenomenological qualitative study describes 16 in-depth interviews with staff of one of the largest syringe services programme in North America—Prevention Point Philadelphia, located in the Kensington neighbourhood of Philadelphia, Pennsylvania. Interviews were conducted from December 2020 to February 2021, audio-recorded, transcribed and coded to develop a thematic framework. Participants were mostly white (71.4%) and female (68.8%) with a median age of 31.5. Three main and four sub-themes related to the impact of COVID-19 on the syringe services programme were identified: (1) COVID-19 altered services provision (sub-theme: select service changes should be retained); (2) unclear or absent COVID-19 response guidance which compromised mitigation (sub-themes: COVID-19 messaging was difficult to translate to practice, learn-as-we-go); and (3) staff and clients experienced elevated mental anguish during the pandemic (sub-theme: already limited resources were further strained). COVID-19 presented complex challenges to an organisation normally strained in pre-pandemic times. A staff culture of resourcefulness and resiliency aided the syringe services programme to balance client needs and staff safety. However, staff experienced a serious psychological impact, largely attributable to being unable to find reprieve from the stressors of COVID-19 and the difficulties associated with navigating and acting-on contradictory public health messaging. Staff also shared a belief that the relaxing of some pre-pandemic barriers allowed staff to link clients more readily with services. Syringe services programmes should embrace the potential for lasting changes to health services delivery brought about by wide-scale changes in service provisions because of COVID-19.

中文翻译：

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“我们边走边想”：工作人员对北美大型注射器服务计划中 COVID-19 响应工作的看法

注射器服务计划面临运营挑战，无法为使用物质的人和有物质使用障碍的人提供维持生命的服务。COVID-19 已经扰乱了这些项目的运营，并且由于严重贫困、COVID-19 安全性的低优先级和合并症的高患病率，对有物质使用障碍的人构成威胁。这项现象学定性研究描述了对位于宾夕法尼亚州费城肯辛顿附近的北美最大注射器服务计划之一费城预防点的工作人员进行的 16 次深入访谈。采访于 2020 年 12 月至 2021 年 2 月进行，录音、转录和编码以开发主题框架。参与者大多是白人 (71.4%) 和女性 (68.8%)，中位年龄为 31.5 岁。确定了与 COVID-19 对注射器服务计划的影响相关的三个主要主题和四个子主题：(1) COVID-19 改变了服务提供（子主题：应保留部分服务更改）；(2) COVID-19 响应指南不明确或不存在，这会影响缓解措施（子主题：COVID-19 消息传递难以转化为实践，边走边学）；(3) 工作人员和客户在大流行期间经历了更高的精神痛苦（子主题：本已有限的资源进一步紧张）。COVID-19 给通常在大流行前时期紧张的组织带来了复杂的挑战。机智和弹性的员工文化有助于注射器服务计划平衡客户需求和员工安全。然而，工作人员经历了严重的心理影响，很大程度上是由于无法从 COVID-19 的压力源中找到缓解的方法，以及与导航和采取相互矛盾的公共卫生信息相关的困难。工作人员还相信，放宽一些大流行前的障碍可以让工作人员更容易地将客户与服务联系起来。注射器服务计划应考虑到因 COVID-19 导致的服务供应的大规模变化所带来的卫生服务提供持久变化的可能性。