Process Evaluation of the Street Outreach/Needle Exchange Project
Laurie, Maureen L.
Public Health Services, Saskatoon District Health operates a street outreach project. Begun in 1990, the project goal is to address HIV risk reduction among street oriented youth, sex trade workers, and injection drug users and their sexual partners. In 1993 a needle exchange service was added. Although evaluation was part of the original proposal for this service, it has never been completed. An evaluability assessment completed in 1995 determined that the needle exchange component was ready for a process evaluation. This thesis reports the results of a process evaluation of the Street Outreach needle exchange service, A descriptive study design was used to determine who the service was reaching and how the service was delivered, particularly the services which are delivered from a mobile van. The objectives of the study were: i) to describe some aspects of service delivery, focusing on the service provided from the van; ii) to describe the Street Outreach needle exchange clients who are injection drug users (or have been within the last 6 months) and their risks for HIV, other blood-borne pathogens and sexually transmitted diseases; and, iii) to describe the clients' perceptions of Street Outreach; Three methods of data collection were utilized in this evaluation study: i) observation and discussion with staff about service delivery; ii) a user survey to gather information on demographics, sexual and injection characteristics of the clients, as well as clients' perception of the services; and, iii) review of client statistical information, clinic statistical data, policy and procedures, inventory and management records. Program documents were reviewed and conversational interviews with selected key informants were conducted in order to describe the history of the Street Outreach program. This process, evaluation provided a clear description of the clients receiving the service, service delivery methods, and the clients' satisfaction with the Street Outreach service. The findings indicated that Street Outreach needle exchange clients are at risk for acquiring HIV and other blood-borne pathogens because of their injection and sexual practices. Although knowledge of HIV transmission is high, clients do not always protect themselves and the findings suggest situations in which risky behaviours tend to occur. Most clients use the needle exchange service because they are assured of getting clean needles and as many as one third have used all the services provided by the mobile van. Satisfaction with Street Outreach service was high due to the staff and delivery of services from the mobile van. The findings confirmed that the Street Outreach service is providing valuable services to a group at high risk for HIV and other blood-borne pathogens. The trusting relationship between the Street Outreach staff and the clients, in addition to the Street Outreach method of service delivery, provides a good opportunity to affect change within this hard-to-reach population. The program is reaching those it intended to reach when it was implemented. Suggestions for enhancing and improving the program are offered. An outcome evaluation to determine effectiveness would be beneficial to support continuation and funding of the Street Outreach needle exchange program.