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Aims: People under age 18 who inject drugs represent a population at risk of health and social harms. Age restrictions at harm reduction programmes often formally exclude this population, but the reason behind such restrictions is lacking in the literature. To help fill this gap, we examine the perspectives of people who use drugs and various other stakeholders regarding whether supervised injection facilities (SIFs) should have age restrictions. Methods: Interviews and focus groups were conducted with a total of 95 people who use drugs and 141 other stakeholders (including police, fire and emergency services personnel, other city employees and officials, healthcare providers, residents and business representatives) in two Canadian cities without SIFs. Findings: We highlight the following thematic areas: mixed opinions regarding specific age restrictions; safety as a priority; different experiences and understandings of youth, agency and drug use; and ideas regarding maturity, ''help'' and other approaches. We note throughout that a familiar vulnerability--agency dichotomy often surfaced in the discussions. Conclusions: This paper contributes new empirical insights regarding youth access to SIFs. We offer considerations that may inform discussions occurring in other jurisdictions debating SIF implementation and may help remove or clarify age-related policies for harm reduction programmes.

Purpose: We assessed the sensibility, utility, and implementation considerations of the Short-Form HIV Disability Questionnaire (SF-HDQ) in community-based settings. Methods: We conducted a mixed-methods study with adults living with HIV and community providers in seven community sites in Canada. We administered the SF-HDQ, a sensibility questionnaire and conducted semi-structured interviews. The SF-HDQ was sensible if median scores were ≥5/7(adults living with HIV) and ≥4/7(community providers) for ≥80% of the sensibility questionnaire items. Qualitative interview data were analyzed using content analysis. Results: Median sensibility scores were ≥5 for adults living with HIV (n = 44) and ≥4 for community providers (n = 10) for 95% and 100% of items, respectively. The SF-HDQ is comprehensive, represented disability, captured its episodic nature, and was easy to complete. Community utility included: facilitating communication and engagement with community; taking a snapshot of disability and tracking changes over time; guiding referrals; fostering self-reflection; and informing community programs. Considerations for implementation included flexible, person-centered approaches to mode and processes of administration, and communicating scores based on personal preferences among persons living with HIV. Conclusion: The SF-HDQ possesses sensibility and utility for use in community-based settings. [ABSTRACT FROM AUTHOR]

Aims: Although opioid‐related harms have reached new heights across North America, the size of the gap in opioid agonist therapy (OAT) delivery for opioid‐related health problems is unknown in most jurisdictions. This study sought to characterize the gap in OAT treatment using a cascade of care framework, and determine factors associated with engagement and retention in treatment. Design: A population‐based retrospective cohort study. Setting: Ontario, Canada. Participants: Individuals who sought medical care for opioid‐related health problems or died from an opioid‐related cause between 2005 and 2019. Measurements: Monthly treatment status for buprenorphine/naloxone or methadone OAT between 2013 and 2019 (i.e. 'off OAT', 'retained on OAT < 6 months', 'retained on OAT ≥ 6 months'). Findings Of 122 811 individuals in the cohort, 97 516 (79.4%) received OAT at least once during the study period. There was decreasing 6‐month treatment retention over time. Model results indicated that males had higher odds of being on OAT each month [odds ratio (OR) = 1.26, 95% confidence interval (CI) = 1.23–1.28] but lower odds of OAT retention (OR = 0.90, 95% CI = 0.88–0.92), while the reverse was observed for older individuals (monthly: OR = 0.76 per 10‐year increase, 95% CI = 0.76–0.77; retention: OR = 1.36 per 10‐year increase, 95% CI = 1.34–1.38) and individuals with higher neighbourhood income (e.g. highest income quintile, monthly: OR = 0.79, 95% CI = 0.77–0.82; highest income quintile, retention: OR = 1.15, 95% CI = 1.11–1.20). Individuals residing in rural areas and with a history of mental health diagnoses had poorer outcomes overall, including lower odds of being on OAT each month (rural: OR = 0.75, 95% CI = 0.73–0.78; mental health: OR = 0.89, 95% CI = 0.87–0.92) and OAT retention (rural: OR = 0.79, 95% CI = 0.77–0.82; mental health: OR = 0.81, 95% CI = 0.78–0.83), as well as higher risk of starting/stopping OAT [rural, starting OAT: hazard ratio (HR) = 1.07, 95% CI = 1.05–1.10; mental health, starting OAT: HR = 1.20, 95% CI: 1.18–1.23; rural, stopping OAT: HR = 1.24, 95% CI: = 1.22–1.26; mental health, stopping OAT: HR = 1.11, 95% CI = 1.09–1.13]. Individuals with a history of mental health diagnoses also had a higher risk of death, regardless of OAT status (off OAT death: HR = 1.49, 95% CI = 1.33–1.66; on OAT death: HR = 1.20, 95% CI = 1.09–1.31). Conclusions: Factors influencing engagement and declining retention in treatment with opioid agonist therapy in Ontario's health system include age, sex and neighbourhood income, as well as mental health diagnoses or residing in rural regions. [ABSTRACT FROM AUTHOR]