BACKGROUND: Access to harm reduction services remains a significant challenge in rural areas, where geographic and structural barriers can prevent people who use drugs from engaging with fixed-site support. In response to declining service use during the COVID-19 pandemic, the Dyfed Drugs and Alcohol Service (DDAS), led by Barod, a Welsh harm reduction and treatment provider, developed a peer-led mobile intervention known as Spike on a Bike (SOAB), designed to deliver harm reduction equipment and relational support directly to service users in remote communities.

METHODS: This study draws on a mixed-methods evaluation of SOAB conducted between May 2022 and June 2024. Quantitative data on service uptake and demographics were analysed alongside qualitative data from semi-structured interviews, online surveys, and field observations. The evaluation was designed collaboratively with partners from Swansea University's Global Drug Policy Observatory, Public Health Wales, and local health boards.

RESULTS: SOAB significantly improved access to harm reduction support in rural West Wales, reaching individuals across diverse age groups and engaging a higher-than-typical proportion of female clients (36%). Service users reported positive experiences, particularly regarding ease of access and reduced stigma. However, uptake of blood-borne virus (BBV) testing and steroid harm reduction kits was low, indicating areas for targeted service development.

CONCLUSION: Mobile harm reduction services like SOAB offer a promising model for addressing service exclusion in rural areas. By tailoring delivery to local contexts and reducing barriers linked to transport, stigma, and service visibility, such models have the potential to reach populations underserved by conventional approaches and inform future harm reduction strategies grounded in community knowledge and context-specific practice.