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Rapid decline in HCV incidence among people who inject drugs associated with national scale-up in coverage of a combination of harm reduction interventions.

Palmateer NE, Taylor A, Goldberg DJ, Munro A, Aitken C, Shepherd SJ, McAllister G, Gunson R, Hutchinson SJ - PLoS ONE (2014)

Bottom Line: We observed a decline in HCV incidence, per 100 person-years, from 13.6 (95% CI: 8.1-20.1) in 2008-09 to 7.3 (3.0-12.9) in 2011-12; a period during which increases in the coverage of OST and IEP, and decreases in the frequency of injecting and sharing of injecting equipment, were observed.Individual-level evidence demonstrated that combined high coverage of needles/syringes and OST were associated with reduced risk of recent HCV in analyses that were unweighted (AOR 0.29, 95%CI 0.11-0.74) and weighted for frequency of injecting (AORw 0.05, 95%CI 0.01-0.18).This is the first study to demonstrate that impressive reductions in HCV incidence can be achieved among PWID over a relatively short time period through high coverage of a combination of interventions.

View Article: PubMed Central - PubMed

Affiliation: Blood-borne Viruses and Sexually Transmitted Infections Section, Health Protection Scotland, Glasgow, United Kingdom.

ABSTRACT

Background: Government policy has precipitated recent changes in the provision of harm reduction interventions - injecting equipment provision (IEP) and opiate substitution therapy (OST) - for people who inject drugs (PWID) in Scotland. We sought to examine the potential impact of these changes on hepatitis C virus (HCV) transmission among PWID.

Methods and findings: We used a framework to triangulate different types of evidence: 'group-level/ecological' and 'individual-level'. Evidence was primarily generated from bio-behavioural cross-sectional surveys of PWID, undertaken during 2008-2012. Individuals in the window period (1-2 months) where the virus is present, but antibodies have not yet been formed, were considered to have recent infection. The survey data were supplemented with service data on the provision of injecting equipment and OST. Ecological analyses examined changes in intervention provision, self-reported intervention uptake, self-reported risk behaviour and HCV incidence; individual-level analyses investigated relationships within the pooled survey data. Nearly 8,000 PWID were recruited in the surveys. We observed a decline in HCV incidence, per 100 person-years, from 13.6 (95% CI: 8.1-20.1) in 2008-09 to 7.3 (3.0-12.9) in 2011-12; a period during which increases in the coverage of OST and IEP, and decreases in the frequency of injecting and sharing of injecting equipment, were observed. Individual-level evidence demonstrated that combined high coverage of needles/syringes and OST were associated with reduced risk of recent HCV in analyses that were unweighted (AOR 0.29, 95%CI 0.11-0.74) and weighted for frequency of injecting (AORw 0.05, 95%CI 0.01-0.18). We estimate the combination of harm reduction interventions may have averted 1400 new HCV infections during 2008-2012.

Conclusions: This is the first study to demonstrate that impressive reductions in HCV incidence can be achieved among PWID over a relatively short time period through high coverage of a combination of interventions.

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Related in: MedlinePlus

Prevalence (among recent onset injectors) and derived incidence of HCV among people who inject drugs in Scotland, 2008 to 2012.The diamonds/circles represent the point estimate and the bars represent the upper and lower 95% confidence intervals. aanti-HCV prevalence among those who commenced injecting within the past 12 months. bDetermined by applying the estimated pre-seroconversion window period to the observed number of anti-HCV negative and HCV-RNA positive individuals (see methods for details). Restricted to those who had injected in the last 6 months.
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pone-0104515-g002: Prevalence (among recent onset injectors) and derived incidence of HCV among people who inject drugs in Scotland, 2008 to 2012.The diamonds/circles represent the point estimate and the bars represent the upper and lower 95% confidence intervals. aanti-HCV prevalence among those who commenced injecting within the past 12 months. bDetermined by applying the estimated pre-seroconversion window period to the observed number of anti-HCV negative and HCV-RNA positive individuals (see methods for details). Restricted to those who had injected in the last 6 months.

Mentions: A total of 53 recent infections were detected among 3,459 susceptible (i.e. anti-HCV negative) individuals. The proportion of recent HCV infections decreased from 2.1% (95% CI: 1.3%–3.3%) in 2008–09 to 0.9% (95% CI: 0.4%–1.7%) in 2011–12 (X2 test for trend: P = 0.02) (Table 4). The derived incidence rates per 100 person-years (among PWID, current) reduced from 13.6 (95% CI 8.1–20.1) in 2008–09, to 7.3 (3.0–12.9) in 2011–12. HCV prevalence among those who commenced injecting within the last year was comparable to the derived incidence rates for the respective years (Figure 2), declining from 20.1% (95% CI 13.9%–27.6%) in 2008–09 to 8.2% (95% CI 3.4%–16.2%) (P = 0.03).


Rapid decline in HCV incidence among people who inject drugs associated with national scale-up in coverage of a combination of harm reduction interventions.

Palmateer NE, Taylor A, Goldberg DJ, Munro A, Aitken C, Shepherd SJ, McAllister G, Gunson R, Hutchinson SJ - PLoS ONE (2014)

Prevalence (among recent onset injectors) and derived incidence of HCV among people who inject drugs in Scotland, 2008 to 2012.The diamonds/circles represent the point estimate and the bars represent the upper and lower 95% confidence intervals. aanti-HCV prevalence among those who commenced injecting within the past 12 months. bDetermined by applying the estimated pre-seroconversion window period to the observed number of anti-HCV negative and HCV-RNA positive individuals (see methods for details). Restricted to those who had injected in the last 6 months.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4128763&req=5

pone-0104515-g002: Prevalence (among recent onset injectors) and derived incidence of HCV among people who inject drugs in Scotland, 2008 to 2012.The diamonds/circles represent the point estimate and the bars represent the upper and lower 95% confidence intervals. aanti-HCV prevalence among those who commenced injecting within the past 12 months. bDetermined by applying the estimated pre-seroconversion window period to the observed number of anti-HCV negative and HCV-RNA positive individuals (see methods for details). Restricted to those who had injected in the last 6 months.
Mentions: A total of 53 recent infections were detected among 3,459 susceptible (i.e. anti-HCV negative) individuals. The proportion of recent HCV infections decreased from 2.1% (95% CI: 1.3%–3.3%) in 2008–09 to 0.9% (95% CI: 0.4%–1.7%) in 2011–12 (X2 test for trend: P = 0.02) (Table 4). The derived incidence rates per 100 person-years (among PWID, current) reduced from 13.6 (95% CI 8.1–20.1) in 2008–09, to 7.3 (3.0–12.9) in 2011–12. HCV prevalence among those who commenced injecting within the last year was comparable to the derived incidence rates for the respective years (Figure 2), declining from 20.1% (95% CI 13.9%–27.6%) in 2008–09 to 8.2% (95% CI 3.4%–16.2%) (P = 0.03).

Bottom Line: We observed a decline in HCV incidence, per 100 person-years, from 13.6 (95% CI: 8.1-20.1) in 2008-09 to 7.3 (3.0-12.9) in 2011-12; a period during which increases in the coverage of OST and IEP, and decreases in the frequency of injecting and sharing of injecting equipment, were observed.Individual-level evidence demonstrated that combined high coverage of needles/syringes and OST were associated with reduced risk of recent HCV in analyses that were unweighted (AOR 0.29, 95%CI 0.11-0.74) and weighted for frequency of injecting (AORw 0.05, 95%CI 0.01-0.18).This is the first study to demonstrate that impressive reductions in HCV incidence can be achieved among PWID over a relatively short time period through high coverage of a combination of interventions.

View Article: PubMed Central - PubMed

Affiliation: Blood-borne Viruses and Sexually Transmitted Infections Section, Health Protection Scotland, Glasgow, United Kingdom.

ABSTRACT

Background: Government policy has precipitated recent changes in the provision of harm reduction interventions - injecting equipment provision (IEP) and opiate substitution therapy (OST) - for people who inject drugs (PWID) in Scotland. We sought to examine the potential impact of these changes on hepatitis C virus (HCV) transmission among PWID.

Methods and findings: We used a framework to triangulate different types of evidence: 'group-level/ecological' and 'individual-level'. Evidence was primarily generated from bio-behavioural cross-sectional surveys of PWID, undertaken during 2008-2012. Individuals in the window period (1-2 months) where the virus is present, but antibodies have not yet been formed, were considered to have recent infection. The survey data were supplemented with service data on the provision of injecting equipment and OST. Ecological analyses examined changes in intervention provision, self-reported intervention uptake, self-reported risk behaviour and HCV incidence; individual-level analyses investigated relationships within the pooled survey data. Nearly 8,000 PWID were recruited in the surveys. We observed a decline in HCV incidence, per 100 person-years, from 13.6 (95% CI: 8.1-20.1) in 2008-09 to 7.3 (3.0-12.9) in 2011-12; a period during which increases in the coverage of OST and IEP, and decreases in the frequency of injecting and sharing of injecting equipment, were observed. Individual-level evidence demonstrated that combined high coverage of needles/syringes and OST were associated with reduced risk of recent HCV in analyses that were unweighted (AOR 0.29, 95%CI 0.11-0.74) and weighted for frequency of injecting (AORw 0.05, 95%CI 0.01-0.18). We estimate the combination of harm reduction interventions may have averted 1400 new HCV infections during 2008-2012.

Conclusions: This is the first study to demonstrate that impressive reductions in HCV incidence can be achieved among PWID over a relatively short time period through high coverage of a combination of interventions.

Show MeSH
Related in: MedlinePlus