Burnet Institute

Within Canadian federal prisons, the "Threat Risk Assessment" (TRA) appears to be a structural process obstacle within the prison needle exchange program (PNEP) policy that fails to provide low threshold access to PNEPs due to the prioritization of institutional safety at the cost of public health. Alternative options to the current TRA process clarify actionable levels for policy refinement that preserve safety, improve access and better align with evidence and public health goals.

ABSTRACTIntroductionWe are at a critical juncture for drug policy reform. Toxic drug supply is driving unprecedented deaths in North America, with countries calling for decriminalisation. Policy reform in Australia has occurred in some states (e.g., decriminalisation in the Australian Capital Territory), stalling in others (e.g., the second supervised injecting facility [SIF] in Victoria). The objectives of this paper are to present trends in attitudes to drug policy in Australia, 2001–2022/23 and media reporting of related policies, to explore how public opinion and media attention have changed over time.MethodsAnalysis of (i) National Drug Strategy Household Survey data on attitudes to drugs/drug policies; and (ii) Factiva for media reporting.ResultsIn 2022/23, Australians supported needle and syringe programs (67.8%), SIFs (58.3%), take home naloxone (60.9%) and drug checking services (64.4%). They opposed legalisation of methamphetamine (86.6%), heroin (85.6%), cocaine (78.2%) and ecstasy (75.8%), while a larger proportion supported cannabis legalisation (44.6%). Australians supported a health response to possession of drugs (57.3% for methamphetamine, 80.9% for cannabis) rather than a criminal response. Methamphetamine was increasingly reported as the drug of most concern (2.9%–42.5%), decreasing for heroin (44.9%–11.4%), 2001–2022/23. Methamphetamine media articles increased (272–2426); heroin decreased (2136–973), 2000–2023. Mentions increased for SIFs (spiking at 175, 2019) and decriminalisation/legalisation (spiking at 242, 2019).Discussion and ConclusionsSupport for harm reduction remains high and low for legalisation. Media focused on methamphetamine, SIFs and decriminalisation/legalisation. Despite opposition towards legalisation, most Australians favoured a health response to drug use.

Health workers providing maternal and newborn care can experience burnout and emotional distress, which harms their well-being and, consequently, their ability to deliver respectful care. The World Health Organization (WHO) Compendium on respectful maternal and newborn care identifies health workers’ well-being as a critical area for intervention, but no specific definition or domains of well-being exist for this group. We conducted a qualitative evidence synthesis to synthesise key domains of well-being for health workers providing maternal and newborn care, by exploring health workers’ perceptions and experiences about their well-being. We searched MEDLINE, CINAHL and MIDIRS from 2010 to 20 August 2025 to identify studies reporting health workers’ perceptions and experiences of well-being while providing routine maternal and newborn care in any context. Using maximum variation purposive sampling, we sampled papers for data extraction. Thematic synthesis was employed for analysis, with GRADE-CERQual assessing confidence in findings. A mixed inductive-deductive approach informed the development of well-being domains. Potential implementation strategies to improve well-being were developed using Theoretical Domains Framework (TDF); Capability, Opportunity, and Motivation Model of Behaviour (COM-B); and Behaviour Change Wheel (BCW). Consultations with health workers validated findings and implementation strategies. We analysed 51 papers from five WHO regions, except the South-East Asia Region, with 61% from high-income and 39% from low-middle-income countries. We identified 18 findings on factors influencing health workers’ well-being. Eight key domains of well-being identified: 1) physical health and access to care and support, 2) emotional and psychological health and access to care and support, 3) fair, safe, and supportive environment, 4) fair and equitable remuneration, 5) adequate housing and a safe community, 6) strong professional identity, 7) positive relationship with women and their families, and 8) work and personal life harmony. The TDF, COM-B, and BCW mapping suggest that interventions should address motivation and external influences.

Human primary muscle cell (HPMC) lines derived from skeletal muscle biopsies are potentially powerful tools to interrogate the molecular pathways underlying fundamental muscle mechanisms. HPMCs retain their genome in culture, but many endogenous circulating factors are not present in the in vitro environment, or at concentrations that do not mirror physiological levels. To address the assumption that HPMCs are valid models of age and sex-specificity in human muscle research, we examined to what extent differentiated HPMC lines retain their source phenotype in culture. Biopsies from the vastus lateralis muscle were collected from ten males aged 18-30, ten females aged 18-30 and ten males aged 60-75 recruited from a healthy population. A portion of the muscle was used for the establishment of 30 individual HMPC lines. The remaining sample was immediately snap frozen and stored for further analysis. RNA was extracted from muscle tissue samples and their corresponding, fully differentiated HMPCs and analysed using RNA Sequencing. To compare their transcriptomic signature, principal component analysis (PCA), differential expression analysis, single-cell deconvolution and pathway enrichment analysis were conducted in R. A comparison of the transcriptomic signature of 30 human muscle biopsies and their corresponding differentiated HPMCs indicated a near-complete lack of retention of the genes and pathways differentially regulated in vivo when compared to their in vitro equivalent, with the exception of several genes encoded on the Y-chromosome. The diversity of resident cell populations in muscle tissue and the lack of sex- and age-dependent circulating factors in the cellular milieu likely contribute to these observations, which call for caution when using differentiated HPMCs as an experimental model of human muscle sex or age.

Global efforts to control and eventually eliminate malaria have been less effective for Plasmodium vivax relative to Plasmodium falciparum due to its unique biology, including dormant liver stages that cause later relapse, and earlier commitment to transmission stages. After the nationwide distribution of long-lasting insecticide treated nets (LLIN) in Papua New Guinea (PNG), P. vivax initially reduced to low prevalence, but again resurged to levels similar to those before LLIN distributions. To explore changes in P. vivax population structure and identify sources of resurgence over this period, we applied a previously validated genome-wide SNP barcode to genotype 336 P. vivax isolates obtained from serial cross-sectional surveys conducted over a decade in East Sepik (2005, 2012, 2016) and Madang Province (2006, 2010, 2014). Population genetic analyses of the resulting parasite genotypes revealed contrasting spatiotemporal patterns between the two provinces. In Madang, the complexity of infection, genetic diversity, and population structure varied with prevalence, with a possible population bottleneck and early clonal expansion at low transmission, and rapid recovery of the population with resurgence. In East Sepik, there was a less dramatic impact on the parasite population after prevalence decline, and ongoing transmission of multiple residual lineages throughout the study period. P. vivax decline was also accompanied by an increase in genetic differentiation between the two areas, which reduced with resurgence suggesting changes in parasite migration between areas associated with prevalence. The earlier implementation of LLIN in East Sepik, smaller rebound, heterogeneity in transmission and relative isolation, compared to Madang may have contributed to these differing patterns. The results demonstrate that long term sustained control efforts are essential to make a lasting impact on the P. vivax population, and that SNP barcodes can provide valuable insights into parasite transmission dynamics as a result of control efforts.

The emergence and spread of antimicrobial-resistant organisms is a major global health challenge. We report on the approach and outcomes of a programme which aimed to take a One Health approach, incorporating an understanding that the health of humans, animals and the environment are linked. Combating the Threat of Antimicrobial Resistance in Pacific Island Countries (COMBAT-AMR) was funded by the Australian Department of Foreign Trade and designed to build capacity across human and animal health to address the threat of antimicrobial resistance (AMR) in Fiji, Samoa, Papua New Guinea and the Solomon Islands between 2020 and 2023.Semi-structured interviews were undertaken with implementers, key stakeholders and participants across the programme themes (n=53). Evaluation of specific activities included participant surveys, competency assessments and document reviews.Both the human health and animal health sectors made significant progress in capacity-building and mentoring of local staff and collection and analysis of surveillance data. However, the sectors largely operated in parallel, with limited planning or resources allocated for explicit intersectoral activities. Resources allocated to animal health were also insufficient to compensate for under-resourced animal health sectors in comparison to human health sectors in the target countries.The increasing use of One Health approaches to address AMR necessitates careful consideration of strategies to support intersectoral collaboration at the design and implementation stages. The comprehensive evaluation of the COMBAT-AMR programme contributes to the current evidence base regarding operationalising One Health principles in building capacity in AMR in low- and middle-income countries.

The Uniting Medically Supervised Injecting Centre (MSIC) in Sydney (Australia) provides a supervised space for people to inject pre-obtained drugs. We investigated injecting patterns among clients over time and the impact on overdose risk and client behaviours. MSIC holds information on visit-specific drug injected, overdose, and sanctions for disruptive behaviour. Data for May 2001 to December 2024 were analysed. Where amphetamines or opioids were injected, the study record was marked accordingly. Data were aggregated to an annual visit summary and drug categorised into Annual drug visits. In the study period the proportion of amphetamine injections increased from 2% to 7% between 2002 and 2011 to 50.1% in 2024 (Kendall's tau = 0.6, p < 0.001). The proportion of clients who exclusively inject amphetamines on-site has significantly increased from 8.9% in 2001 to 43.9% in 2024 (Kendall's tau = 0.8, p < 0.001), as has the proportion injecting both amphetamines and opioids (5.6% in 2001 to 33.2% in 2024) (Kendall's tau = 0.7, p < 0.001). People who inject both opioids and amphetamines had a lower likelihood of overdose compared to those who injected exclusively opioids (adjusted OR 0.64 (95% CI 0.54, 0.75); p < 0.001). Incidents of challenging behaviour appear unrelated to amphetamine injection. There has been an increase in amphetamine injection at MSIC, with the most frequent service attenders most likely to report injecting both opioids and amphetamines. There has been no parallel increase in disruptive behaviour. Those exclusively injecting amphetamines do not attend the service frequently. Strategies to support opportunistic intervention are clearly warranted.

There are increasing calls for cross-cutting approaches to reducing stigma in health systems that do not silo specific identities, conditions, or practices. In our previous work, we proposed a 'universal precautions' approach to addressing stigma and its negative effects (Treloar et al. in Harm Reduct J 19(1):74, 2022), whereby health systems assume that all people who enter a health service might be concerned about being treated negatively or excluded in some way. This paper explores the possibilities and limitations of such an approach to stigma reduction by canvassing key stakeholder perspectives. Qualitative interviews were conducted with 20 key stakeholders with extensive experience working within the alcohol and other drugs, blood-borne viruses, and sexually transmissible infections sectors. Participants were asked to reflect on the concept of a universal precautions approach to stigma reduction, including its acceptability, feasibility, utility in practice, and key challenges. Although interview participants strongly advocated for a need to address all stigma within health care, there were mixed attitudes towards the use of the term, 'universal precautions'. Some participants believed it would be useful to draw on a lexicon more familiar to health workers, while others expressed ambivalence and confusion about the term. Participants reflected on the possibilities of universality, in treating everyone with respect and providing non-judgemental care, while also emphasising that different client populations have specific needs that must be addressed. Many participants emphasised strongly that such an approach would need to be embedded at a systemic level, including having support from executive leadership, to address the structural forces that (re)produce stigma. Participants emphasised that centring the voices and perspectives of people with lived experience of stigma is integral to any approach to reducing stigma in health systems. Findings highlight the various possibilities of adopting a universal approach that recognises the diversity and intersections in experiences of stigma. This research informs the development and implementation of novel stigma reduction initiatives in health care settings.