dataesr/scientific-paragraphs-categorization huggingface dataset:
To our knowledge HaRePo was the very rst program in the world to propose such kind of services to PWUD. The programme looks to build new HR alternatives for PWUD. The HaRePo program is managed by the SAFE association who has developed for the last 25 years several HR strategies in France. SAFE is a pioneer in the creation and evolution of HR paraphernalia: ltration tools  [19] , injection kits (including an e cient lter against bacteria), inhalation material (proposing free street-based automatic inhalation kit dispensers) and others. SAFE also manages 90 of 300 street-based automatic injection kit dispensers (AIKD) in France. SAFE has contributed to the evaluation of the AIKD as a part of a comprehensive HR strategy  [20]. It has also participated in the development of a method using mass spectrometry detection to analyse residual content of used syringes  [21, 22]  and has provided information for HCV studies  [23].
How does HaRePo work? In 2011, SAFE advertised HaRePo by a short message on their website (http://www. safe. asso. fr) and on the most frequented online forum of drug consumers in France (Psyccoactif, https://www. psychoactif. org). Since then, the number of consumers has consistently increases, mainly by word of mouth. PWUD can access the program via a 24/7 telephone line (a voice box records orders outside working hours) and/or by e-mail. Professionals are available to answer questions, deliver HR counselling and connect consumers with other services when necessary (e. g. face-to-face HR services, diverse healthcare services). Then, professionals record orders of HR tools according to the consumer's needs (e. g. substance consumed, consummation frequency, practices) and tailor the quantity of HR tools sent out.
The applicants are identi ed by a code to prevent recording of personal information is recorded. Thus, con dentiality is ensured, and strictly follows the guidelines of the National Commission for Informatics and Liberties (CNIL). Once the HR tools order is registered, a logistical team prepares the parcels following strict hygiene preparation conditions. Parcels are nally sent in unmarked packaging through the French postal service to consumers registered across France including French overseas territories. Each parcel has a tracking number to track delivery and delays. Usually, consumers receive parcels 48 hours after the initial contact (Fig. 1 ). The HR tools list provided by HaRePo program is presented in an additional le [see Additional le 1]. In order to monitor the entire program, and to ensure consumers' con dentiality, software was developed by the company TAGALIS (www.
tagalis. com) speci cally for this program. Each consumer is anonymised by encoding a speci c ID code. This software allows us to (i) register consumer information (e. g. , gender, age, consumer housing and working situation), (ii) HR item delivery history (iii) psychoactive substances used, (iv) characteristics and improvement in consumers HR practices (e. g. , sharing paraphernalia, reusing syringes) and (v) HR advice and references provided. This allows for a secure but accessible data structure for monitoring. So far, all such information has been recorded for 1,920 PWUD during the 7 years of the study. The study including questionnaires development, data analysis and writing was performed by the association SAFE who developed and delivered the HaRePo program.
Evaluation of the program by PWUD In order to evaluate the program and its impact on PWUD behaviour, we randomly distributed 300 Multiple Choice Questionnaire (MCQ) with comment boxes from April to June 2018 to HaRePo consumers. Each questionnaire was distributed with a short instruction manual. The only inclusion criterion was for the respondent to be registered in the HaRePo program since 2017. The questionnaires were sent within the parcels with a pre-stamped envelope. PWUD answered the questionnaire without the presence of any HR professional (questionnaires were answered remotely and anonymously). The response rate was 32%. We analysed and present below results based on 96 answers. It is important to note that our results are based on self-reporting questionnaires and the practices/health improvements were not monitored independently.
Statistical analysis All analyses were performed using the software R. 3. 5. 1 (R Core Team, 2018). We use a linear model to study the correlation between two parameters. For instance, we correlate the time since the program creation and the number of PWUD using the slope of the linear model as a proxy for the adherence rate. We estimated correlation as well as its 95% con dence interval. We then divided our database into four parts, depending on the population density in the consumer living area (with 1 indicating a city and We considered that adherence rates for two different zones are signi cantly different when their respective 95% con dence interval do not overlap. We also studied the correlation between PWUD motivations to join the program and their residence [population density zone as de ned above].
Qualitative data All the qualitative data showed here (mainly testimonies) were collected through e-mails exchanges that were then combined into anonymous reports. They are used only to contextualize the quantitative data. During these exchanges, the discussion is free and the HR professional follow strict rules to avoid judgment and induce trust with the consumer (if is needed HR professional can use motivational interviewing techniques). Thus, consumers can speak freely and share personal feelings. In order to select quotas presented here we made a key word research in the reports (chemsex, pharmacy problems, CAARUD/CSAPA problems…). Quotas showed here were chosen randomly thus we noticed that most of the testimonies are similar and converge into similar topics and opinions.
Consumer pro le HaRePo address the speci c needs of consumers who are not accessing classical HR centres HaRePo is more accessed by women (25%) than classical HR centres. Women represent 18% of the CAARUD consumer cohort  [26]. We did not identify a unique motivation for women to enter the program and the following testimonies suggest that motivations might be quite diverse: -"I am an eternal drug addict. I take subutex. I have the misfortune to shoot it. I appreciated your cream as my arms are now less marked. In addition I can lter the products and I have the HR equipment I need. I am not putting myself in danger. You have no idea how much you are relieving the weight of my guilt. Finally I really take into account that I need to get away from drugs. I am no longer alone facing all this.
-"I do not want to go to HR centres because I am afraid to lose my daughter's custody. I don't want to expose neither my child nor myself". Among program bene ciaries, the number of people engaging in chemsex (Drug use for or during sex) is increased steadily from one in 2012 to 119 in 2018. A total of 170 people engaging in chemsex have bene ted from the program. They represent 9% of the total HaRePo bene ciaries and 11% in 2018. The chemsex practice does not only concern consumers in the urban zones (18% of consumers live in areas of low or very low urban density). HaRePo consumers have a stable accommodation 87% versus 50% in CAARUD  [27]. Ten percent of consumers live in an accommodations belonging to a third party (i. e. family, friends…) and only 3% of consumers do not have a stable accommodation (Fig.
Consumers pro le Most consumers (82%) accessing the program are injectors and 94% of them have combined practices: injection and/or inhalation and/or snorting. Most of the people engaging in chemsex declared themselves to be 'slamming' (the action of injecting drugs in a sexual context). A small proportion of PWUD do not inject drugs. The structure of our dataset did not allow us estimating whether there are signi cant differences depending on their consumption practices. Therefore, we presented here results of both groups (injectors and non-injectors). The most common substances used are opioids (1035 consumers) like heroin (484 consumers), Buprenorphine (280 consumers), Skenan® (255 consumers) and methadone (16 consumers), in addition to oxycodone and Oxycontin®. Moreover, 735 respondents are stimulants consumers with 406 of them consuming cocaine and 329 consuming crack/freebase.
Consumer motivations Consumers decide to use the HaRePo program for different reasons. The rst reason declared by 680 consumers is because of the distance between where they live and the nearest HR centre. The majority of those consumers live in small towns where there are no low threshold structures. The second reason mentioned (442 consumers) is di culties with the local HR centres like non-compatible service hours, or when HR centres do not have materials or only in insu cient quantities. The third reason for consumers (310 consumers) to join HaRePo instead of HR centres is consumers seek for anonymity and fear of stigma. This result was con rmed by consumers' testimonies: "This service is really great, really suitable for people who, like me, want real anonymity. " "Very few people around me are aware of my drug use (two "friends"), and even my family does not know anything about my treatment and it is very good like that at the moment because I hardly need to speak about it.
Motivations to join the program vs. consumers' residential area Using linear models, we estimated how rapidly PWUD enter the program and if this entrance rate depends on their residential area (Fig. S2 ). We observed that on average, 0. 06 PWUD per 100,000 habitants enter the program each year (Table  1 ). Nevertheless, this rate was not signi cantly different between the four residential zones (density zones). This means that the density zone (urban or rural) does not play an important rule in new HaRePo consumers. Nevertheless, using Pearson's Chi-square tests, we found that residential area has an in uence on consumer motivations to join HaRePo. We observed that HaRePo consumers living in zones type 1 and 2 (large and intermediate cities) mainly use the program because they feel they do not t in with PWUD who frequent classical HR centres (p<0.
001) and because they need timely materials (ex: HR tools) (p<0. 05). Moreover, the principal reason for PWUD living in zones type 3 and 4 (semi-rural and rural areas, respectively) to join the program is their distance from classical HR centres (p<0. 0001) (Table  2 ). Results show that HaRePo receives PWUD from urban and rural population but the reasons to join the program are different.
Program impact The program seems to induce a positive feedback loop in its consumers. They improve their practices based on remote but trustworthy communication. Furthermore, the percentage of people that, after accessing the program, never reuse and/or share HR tools have increased. Indeed, 71% to 72% of bene ciaries never reuse syringes and 81% never reuse needles. Concerning other HR items, the level of improvement varies from 14% to 49% (Fig. 3a ). Regarding sharing practices, 98% to 99% of consumers declare never sharing syringes and 99% for needles. Moreover, the percentage of consumers that never share other kinds of HR paraphernalia once they have joined HaRePo improved from 9% to 26% (Fig. 3b ). In addition, between 39% and 53% of HaRePo consumers declared that the perception of their own health status and physical appearance (e.
Discussion HaRePo shows evidence of a positive feedback loop as PWUD improve their practices through remote but trusted communication Establishing remote connections with patients who have di culty accessing classical health centres is an emerging practice in medicine that has been successful at improving access to health centres in several speci c countries such as Australia [28] and South Africa  [29]  but also seems general to other countries as showed by the review of  Win et al. , (2015). Remote support groups also help to satisfy the need for emotional support  [31]. These bene ts extend to the HaRePo program that has reached populations without easy access to HR structures or tools, including women and/or rural populations. Nevertheless, the bene ts of such remote programs may be limited to patients with relatively high digital literacy or at least with internet connection  [29].
HaRePo : a program adapted for women Women are among the priorities of HR strategies in France and in Europe  [32] , HaRePo seems to reach more women than low threshold structures (CAARUD) in France. A higher proportion of women are found among HaRePo consumers (25%) than PWUD frequenting CAARUD (18%)  [26]. Women have been estimated to represent about 40% of consumers in the United States and some parts of Europe, 20% in Eastern Europe, 17% in Central Asia and 40% in Latin America  [33]. Nevertheless, precise quantitative data on women who use drugs are rarely available. Furthermore, the stigma attached to women who use drugs and alcohol has been highly documented, for instance a survey in Russia  Gorshkova & Shurigina, (2003)  showed that 21% of those interviewed declared that a wife's drug or alcohol addiction was a valid reason for her husband to beat her.
HaRePo: a program adapted for people engaging in chemsex The most important reason to use HaRePo services declared by people engaging in chemsex is the fear of stigma as they seek anonymity. The second reason is that HR centres are not compatible with their needs (need speci c HR equipment and/or speci c quantities, non-compatible service hours…). The third reason is that some of them live in small towns far from HR centres. Other reasons often cited are the costs of material and/or the lack of con dentiality in pharmacy and nally the unfamiliarity with classical HR programs as indicated in consumer testimonies presented in the results section. A study about chemsex in France  [39]  pointed out the need to adapt HR equipment delivery for people injecting products in a sexual context. Indeed, their needs are not the same as those of consumers traditionally received in HR structures.
Is HaRePo a solution adapted to other countries? We showed that HaRePo is a successful program that reaches populations who do not have access to classical HR centres. We identi ed three main hard-to-reach populations: rural or semi-rural populations, women and people engaging in chemsex. These populations share the fear of stigma when going to classical harm reduction centres as shown by the consumers' testimonies presented in the results section. These populations are not exclusively observed in France and we consider that our program is a suitable response to the hard-to-reach populations problematic in other countries with some adaptations regarding local conditions and socio-cultural particularities. The di culty to access harm reduction tools for these populations was already identi ed in several countries (see  [43]  for review).
Moreover, several times a year PWUD in neighbouring countries (especially Belgium, Switzerland, and Spain) contact us to bene t from HaRePo. However, additional nancial resources are necessary to be able to send HR tools abroad. For instance, rural populations suffering from their distance to classical structures was observed in the USA  [44] , Canada  [10] , Australia  [45] , UK  [46, 47] , China  [12, 48] , Kenya  [49] , and Iran  [50]. This di culty due to the distance may in some cases be associated to gender issues  [51, 52]. Developing HaRePo-like program in those countries may partially answer this challenge. The key aspects of HaRePo are anonymity, a rapid adaptation to new types of consumption, and free access to a large diversity of harm reduction equipment adapted to most of the practices we observed.
Anonymity is particularly important because fear of stigma is a limiting factor to take advantage of classical HR centres and to directly access HR equipment in pharmacies  [53, 54]. Following these principles, HaRePo may be easily adapted to any other situations respecting some local socio-cultural particularities. Nevertheless, it must be noted that HaRePo bene ts from e cient post services which may not be the case in some countries. Moreover, the success of HaRePo is also partially due to the publicity made by PWUD on some self-managed Internet forums where they exchange information on different topics including harm reduction. We regularly present our program on the main forums and consequently countries where PWUD are internet-connected may be reached more e ciently. Finally, a similar program was developed in the USA in 2017 and is called NEXT DISTRO (https://nextdistro.
Conclusions HaRePo is an innovative HR program e cient for hard-to-reach PWUD including women, people engaging in chemsex and PWUD living in rural areas. We showed evidence that the program is e cient to improve PWUD practices through remote but trusted communication using social and digital media. PWUD engaged with HaRePo increase constantly despite it mainly expanding by word-of-mouth. Its success allows us to plan new remote access related projects: remote screening for hepatitis B and C, HIV by Dried Blood Spot test project and an online training called naloxone (www. naloxone. fr). We noted that most of the PWUD in HaRePo program are people injecting drugs often associated to other consumption practices (inhalation, snort, etc. ). A reduced proportion of PWUD do not inject drugs and the structure of our dataset did not allow us to estimate whether the HaRePo program has a different impact on injectors versus non-injectors.
Availability of data materials datasets analysed during the current study are available at: https://www. dropbox. com/s/q4lwfci2eaqcpdh/Equipment%20distribution%20by%20year. xlsx?dl=0 and https://www. dropbox. com/s/9ohfaxpjwscnfxg/users%20information. xlsx?dl=0 Competing interests authors declare that they have no competing interests.
Using data from a global, crowd-sourced study deployed in 30+ languages (Global Consortium for Chemosensory Research survey, GCCR, see "Methods" section), we tested whether changes in smell/taste at the population level could be used as an early indicator for local COVID-19 outbreaks. As pre-registered (see "Methods" section), our primary aim was to test the association between self-reported smell and taste changes and indicators of pressure in hospitals (COVID-related hospitalizations, CCRU admissions, and mortality rates) for each French administrative region over the last 3 months. Our secondary aim was to examine temporal relationships between the peak of smell and taste changes in the population and the peak of COVID-19 cases and the application of lockdown measures. The potential for self-reported smell and taste loss to serve as an early indicator of the number of COVID-19 cases-and hence hospital stress-was tested in a natural experiment by comparing France with Italy and the UK, which implemented lockdown with different timing and levels of stringency.
As shown in Fig. 1d , the peak of the onset of changes in smell/taste appeared 4 days after the lockdown and for these individuals, the first reported COVID-19 symptoms occur even earlier. Conversely, the governmental indicator of ER consults only peaked 11 days after the lockdown, while the peak of CCRU admissions was shifted later by 14 days. This is consistent with emerging data showing that COVID-19-related changes in smell and taste occur in the first few days after infection  6, [12] [13] [14]. The robustness of smell and taste changes over time was assessed in two ways. First, we showed the peak of smell/taste changes remained the same regardless of our survey's completion date (Supplementary Fig. 1a ). Second, we observed the exact same peak when analyzing a separate French survey performed on 950 individuals and focusing on smell alterations in the French population independently of COVID-19 (see "Methods" section): the peak of olfactory changes again occurred 4 days after the lockdown decision, and this was independent of survey completion dates (Supplementary Fig.
Separately, another factor that mitigates concerns about a potential recall bias is the stable nature of participant's statements, regardless of their date of completion. That is, logic suggests, the longer the time between the onset date of smell and taste loss and the reporting date, the greater the recall bias should be. However, our data clearly show that regardless of the date of completion, the onset date falls within the same period (Supplementary Fig. 1 ). Finally, other evidence against a potential recall bias comes from Google Trends data. Analyzing real-time Google queries in March, we observed a very particular trend in France (Supplementary Fig. 4 ). We first observed a peak of queries for terms associated with early COVID-19 symptoms (fever, cough, aches) synchronized with the declared onset of the first symptoms in the survey (around March 18th).
However, additional analysis showed no differences in peaks of smell/taste changes across age or gender, minimizing concerns that such selection biases may have influenced present results (See Supplementary Fig. 2 ). We also tested the potential selection bias due to format and the advertising of the survey, by comparing the GCCR dataset with an independent second study performed on French residents (see "Methods" section). Remarkably we observed highly similar results across studies where advertising, inclusion criteria, and survey format were different. Based on the present findings, we highlight the paramount importance and robustness of associations between smell/taste changes and COVID-19 and we strongly endorse the need for additional large-scale validation studies to assess the causality between the observed association between smell/taste changes and indicators of the COVID-19 pandemic.
Methods Online survey. This study is mainly based on data from the Global Consortium for Chemosensory Research survey (GCCR, https://gcchemosensr. org/)a global, crowd-sourced online study deployed in 30+ languages  22. The data analyzed here were collected from April 7 to May 14, 2020. The protocol complies with the revised Declaration of Helsinki and was approved as an exempt study by the Office for Research Protections at The Pennsylvania Study University (Penn State) in the U. S. A. (STUDY00014904; PI Hayes). Participants in the GCCR questionnaire were recruited by word of mouth, as well as through social and traditional media (flyers, social media, television, radio) during the COVID-19 pandemic. It was well covered by the French press, as over 70 articles mentioned the project, at both the regional and national level (see Supplementary Table  3 ).
Therefore, Due to this inclusion criteria, "smell/taste change" is equivalent to a quantitative decrease of participant ability to smell and/or taste. We then extracted individuals from the full dataset who reported living in France, Italy or the UK. As the country of residence was completed as a text entry, we allowed for typical variations (e. g. , "United Kingdom" or "UK"), spelling mistakes, use of different languages (e. g. , "Italie" or "Italia"), as well as subdivisions (e. g. , "Scotland") and major cities ("Paris"). Metropolitan France was split into 13 so-called "regions" in 2016. However, we considered the former system where France was split into 22 regions here, since the organization of the health system mostly remains based on the structure built before 2016. An alternative, finer granularity, splits metropolitan France into 96 so-called "departments.