Risk of transmission associated with sharing drug injecting paraphernalia: analysis of recent hepatitis C virus (HCV) infection using cross‐sectional survey data

Abstract

Sharing injecting paraphernalia (containers, filters and water) poses a risk of transmitting the hepatitis C virus (HCV). The prevalence of, and risk of HCV from, such behaviour has not been extensively reported in Europe. People who inject drugs (PWID) were recruited in cross-sectional surveys from services providing sterile injecting equipment across Scotland between 2008 and 2010. Participants completed a questionnaire and provided a blood spot for anonymous testing. Logistic regression was used to examine the association between recent HCV infection (anti-HCV negative and HCV-RNA positive) and self-reported measures of injecting equipment sharing in the 6 months preceding interview. Twelve per cent of the sample reported sharing needles/syringes, and 40% reported sharing paraphernalia in the previous 6 months. The adjusted odds ratios (AOR) for sharing needles/syringes (+/- paraphernalia), and sharing only paraphernalia in the last 6 months were 6.7 (95% CI 2.6-17.1) and 3.0 (95% CI 1.2-7.5), respectively. Among those who reported not sharing needles/syringes, sharing containers and filters were both significantly associated with recent HCV infection (AOR 3.1, 95% CI 1.3-7.8 and 3.1, 95% CI 1.3-7.5, respectively); sharing water was not. We present the first study to apply a cross-sectional approach to the analysis of the association between sharing paraphernalia and incident HCV infection and demonstrate consistent results with previous longitudinal studies. The prevalence of paraphernalia sharing in our study population is high, representing significant potential for HCV transmission.

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

“…33 One study looked at the impact of distributing injecting paraphernalia (defined as spoons and filters) by itself, with needles/syringes and in combination with OST. 47 …”

“…[33][34][35][36][37]59,60 Seventeen studies reported the impact of NSPs, 14,20,[41][42][43][44]47,48,50,54,56,58 including five unpublished sources, [33][34][35]59,60 and four reported combined measures of NSPs with OST, 14,33,44,47 including one unpublished data source. 33 One study looked at the impact of distributing injecting paraphernalia (defined as spoons and filters) by itself, with needles/syringes and in combination with OST.…”

“…In total, we included 21 published studies 14,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] and seven unpublished studies [33][34][35][36][37]59,60 comprising 1827 HCV incident infections and 8789.7 person-years of follow-up. Overall HCV infection incidence ranged between 0.09 and 42 cases per 100 person-years across the studies.…”

“…Twenty-one of the included studies reported the impact of OST, 14,20,39,40,[45][46][47]49,[51][52][53]55,57,58 including seven unpublished estimates. [33][34][35][36][37]59,60 Seventeen studies reported the impact of NSPs, 14,20,[41][42][43][44]47,48,50,54,56,58 including five unpublished sources, [33][34][35]59,60 and four reported combined measures of NSPs with OST, 14,33,44,47 including one unpublished data source.…”

“…Of the 28 studies, we pooled data from a total of 17 studies to assess the impact of current OST use on HCV infection incidence, 14,39,40,[45][46][47]49,52,53,55,56,58 including five unpublished estimates. 33,36,37,59,60 Current use of OST was defined as reporting use of OST within the past 6 months (yes or no) 33,46,49,58,60 or as reporting use of OST either within 6 months or > 6 months ago, 36 use of methadone at the time of survey, 39,47,52,59 continuous use of OST throughout the follow-up period, 40,45,53 with one study defining continuous use as daily use of methadone (any dosage) in the past 6 months 14 or in the past month.…”