Assessing IDU prevalence and health consequences (HCV, overdose and drug-related mortality) in a primary care trust: implications for public health action

Hickman, Matthew; Hope, Vivian; Coleman, Barbara; Parry, John; Telfer, Maggie; Twigger, John; Irish, Charles; Macleod, John; Annett, Hugh

doi:10.1093/pubmed/fdp067

Cited by 49 publications

(50 citation statements)

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“…In Bristol and Walsall, size estimation data suggest that the PWID population has decreased by between 10% and 30% between 2009 and 2011. [104][105][106]108 Concurrently, survey data 44,70,73,88,89 suggest that the proportion of PWID injecting for > 10 years has increased, whereas the proportion injecting for between 3 and 10 years has decreased ( Figure 18). There has been little change in the proportion injecting for < 3 years.…”

Section: Model Calibration and Uncertaintymentioning

confidence: 99%

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

et al. 2017

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Background There is limited evidence of the impact of needle and syringe programmes (NSPs) and opioid substitution therapy (OST) on hepatitis C virus (HCV) incidence among people who inject drugs (PWID), nor have there been any economic evaluations. Objective(s) To measure (1) the impact of NSP and OST, (2) changes in the extent of provision of both interventions, and (3) costs and cost-effectiveness of NSPs on HCV infection transmission. Design We conducted (1) a systematic review; (2) an analysis of existing data sets, including collating costs of NSPs; and (3) a dynamic deterministic model to estimate the impact of differing OST/NSP intervention coverage levels for reducing HCV infection prevalence, incidence and disease burden, and incremental cost-effectiveness ratios to measure the cost-effectiveness of current NSP provision versus no provision. Setting Cost-effectiveness analysis and impact modelling in three UK sites. The pooled analysis drew on data from the UK and Australia. The review was international. Participants PWID. Interventions NSP coverage (proportion of injections covered by clean needles) and OST. Outcome New cases of HCV infection. Results The review suggested that OST reduced the risk of HCV infection acquisition by 50% [rate ratio (RR) 0.50, 95% confidence interval (CI) 0.40 to 0.63]. Weaker evidence was found in areas of high (≥ 100%) NSP coverage (RR 0.77, 95% CI 0.38 to 1.54) internationally. There was moderate evidence for combined high coverage of NSPs and OST (RR 0.29, 95% CI 0.13 to 0.65). The pooled analysis showed that combined high coverage of NSPs and OST reduced the risk of HCV infection acquisition by 29–71% compared with those on minimal harm reduction (no OST, ≤ 100% NSP coverage). NSPs are likely to be cost-effective and are cost-saving in some settings. The impact modelling suggest that removing OST (current coverage 81%) and NSPs (coverage 54%) in one site would increase HCV infection incidence by 329% [95% credible interval (CrI) 110% to 953%] in 2031 and at least double (132% increase; 95% CrI 51% to 306%) the number of new infections over 15 years. Increasing NSP coverage to 80% has the largest impact in the site with the lowest current NSP coverage (35%), resulting in a 27% (95% CrI 7% to 43%) decrease in new infections and 41% (95% CrI 11% to 72%) decrease in incidence by 2031 compared with 2016. Addressing homelessness and reducing the harm associated with the injection of crack cocaine could avert approximately 60% of HCV infections over the next 15 years. Limitations Findings are limited by the misclassification of NSP coverage and the simplified intervention definition that fails to capture the integrated services that address other social and health needs as part of this. Conclusions There is moderate evidence of the effectiveness of OST and NSPs, especially in combination, on HCV infection acquisition risk. Policies to ensure that NSPs can be accessed alongside OST are needed. NSPs are cost-saving in some sites and cost-effective in others. NSPs and OST are likely to prevent considerable rates of HCV infection in the UK. Increasing NSP coverage will have most impact in settings with low coverage. Scaling up other interventions such as HCV infection treatment are needed to decrease epidemics to low levels in higher prevalence settings. Future work To understand the mechanisms through which NSPs and OST achieve their effect and the optimum contexts to support implementation. Funding The National Institute for Health Research Public Health Research programme.

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Section: Model Calibration and Uncertaintymentioning

confidence: 99%

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

et al. 2017

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“…In the presence of two or more datasets, like registration lists, C-RC can be used to estimate the size of the noncaptured part of the population (e.g., persons not in treatment) and then of the total population, being the sum of all captured and non-captured persons. In many countries, C-RC has been applied to estimate the national, regional, or local number of problem drug users (Comiskey, 2001;Hickman et al, 2006Hickman et al, , 2009Stimson, Hickman, Quirk, Frischer, & Taylor, 1997;Vaissade & Legleye, 2009). Sometimes crack users are included in the estimated number of problem drug users, a target population that is often estimated through C-RC in Europe.…”

Section: Introductionmentioning

confidence: 99%

Estimating the Prevalence of Crack Dependence Using Capture-Recapture With Institutional and Field Data: A Three-City Study in the Netherlands

Pérez

Cruyff

Benschop

et al. 2013

Substance Use & Misuse

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The aim of this study was to estimate the prevalence of crack dependence in the three largest Dutch cities (Amsterdam, Rotterdam, The Hague), stratified by gender and age. Three-sample capture-recapture, using data (collected between 2009 and 2011) from low threshold substitution treatment (n = 1,764), user rooms (n = 546), and a respondent-driven sample (n = 549), and applying log-linear modeling (covariates: gender, age, and city), provided a prevalence rate of 0.51% (95% CI: 0.46%-0.60%) for the population aged 15-64 years, with similar estimates for the three cities. Females (23.0% of total estimate) and younger crack users (12.8% aged <35 years) might be underrepresented in drug user treatment services.Keywords capture-recapture, crack dependence, prevalence, gender, respondent-driven sampling, mark-recapture, problem drug usersThe authors thank Petra Houwing for her indispensable assistance in the fieldwork; Wim Van de Brink (AMC), Vincent Hendriks, and Peter Blanken (Parnassia) for their valuable contributions to the project design; Filip Smit (Amsterdam Free University), Marcel Buster (Municipal Health Department, Amsterdam), and Peter Van der Heijden (Utrecht University) for their advice on statistical analysis; and all social and healthcare agencies that have collaborated with this study. 1 Treatment can be briefly and usefully defined as a unique, planned, goal directed, temporally structured, multi-dimensional change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.), and self-help ("natural recovery") models. There are no unique models or techniques used with substance users -of whatever types and heterogeneities -that aren't also used with non-substance users. Whether or not a treatment technique is indicated or contra-indicated -and its selection underpinnings are theory-based, empirically based, tradition-based, based on "principles of faith," etc. -continues to be a generic and key treatment issue. In the West, with the relatively new ideology of "harm reduction" and the even newer quality of life (QOL) and wellbeing treatment-driven models, there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Conflict-resolution models may stimulate an additional option for intervention. Each ideological model has its own criteria for success as well as failure. Treatment is implemented in a range of environments, ambulatory as well as within institutions, which can include controlled environments. Treatment includes a spectrum of clinician-caregiver-patient relationships representing various forms of decision-making traditions/models: (1) the hierarchical model, in which the clinician-treatment agent makes the decision(s) and the recipient is compliant and relatively passive; (2) shared decision-making, which facilitates the collaboration between clini...

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“…Our method over-selects injectors who may be engaged in greater injecting risk and this may have diluted the comparisons. Future studies may employ respondent-driven sampling methods to reduce this possible source of bias [5]. A further limitation was that, in non-IDUs, we intended to conduct a case-control study but we could not identify an appropriate control group.…”

Section: Discussionmentioning

confidence: 99%

“…The number of problem drug users has recently been estimated to be about 8500, with 3280-5540 IDUs [5], equivalent to 1 . 3-2 .…”

Section: Outbreak Settingmentioning

confidence: 99%

Investigation of a large community-based outbreak of hepatitis B infection in the United Kingdom

et al. 2011

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SUMMARYWe describe the largest outbreak of hepatitis B virus infection reported to date in the UK. Between July 2001 and December 2005, 237 cases were identified in Avon, South West England. The likely route of transmission was injecting drug use in 44% (104/237) and heterosexual intercourse in 30 % (71/237) of cases. A case-control study in injectors showed that injecting crack cocaine [adjusted odds ratio (aOR) 23 . 8, 95% confidence interval (CI) 3 . 04-186, P<0 . 001] and sharing injecting paraphernalia in the year before diagnosis (aOR 16 . 67, 95 % CI 1 . 78-100, P=0 . 010) were strongly associated with acute hepatitis B. In non-IDUs number of sexual partners and lack of consistent condom use were high compared to a national sample. We describe the control measures implemented in response to the outbreak. This outbreak has highlighted the problems associated with the low uptake from the national hepatitis B vaccination policy which targets high-risk groups, the difficulties of identifying those at risk of acquiring hepatitis B infection through heterosexual sex, and injecting crack cocaine as a risk factor for hepatitis B.

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Assessing IDU prevalence and health consequences (HCV, overdose and drug-related mortality) in a primary care trust: implications for public health action

Abstract: Locally specific and useful intelligence on injecting and its health consequence can be generated to inform local public health action, and may contribute information to validate national prevalence estimates.

Cited by 49 publications

References 30 publications

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

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

Estimating the Prevalence of Crack Dependence Using Capture-Recapture With Institutional and Field Data: A Three-City Study in the Netherlands

Investigation of a large community-based outbreak of hepatitis B infection in the United Kingdom

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