Needle and syringe programmes (NSP) provide comprehensive harm reduction interventions for the population of people who use drugs. NSP provision is a vital tool in minimising the transmission of blood-borne viruses and bacterial infections through providing access to sterile injecting equipment. NSP also provide harm reduction advice on overdose prevention, take-home naloxone, and pathways into wider health and social care.

Data from the Harm Reduction Database (HRD) has shown a significant decline in NSP activity across Wales over several years and this prompted a comprehensive review of contextual and social factors influencing NSP activity. This report is one of three and focuses on NSP provision from specialist sites provided by statutory organisations and third-sector services. The other two reports present peer perspectives of the factors contributing to the decline in NSP activity and examine the social and contextual factors influencing NSP activity in community pharmacies.

This review covers 95% of specialist NSP sites across Wales and 104 staff members were interviewed. The following 4 key themes were identified:

• Barriers and facilitators impacting utilisation of specialist NSP services
• Social and contextual factors impacting activity at specialist NSP services
• Increasing health and social care need: Implications for specialist NSP service delivery
• Workforce training needs to strengthen NSP service delivery

Each theme will be discussed in turn.