Gender differences in hepatitis C seroprevalence and suboptimal vaccination and hepatology services uptake amongst substance misusers

Abstract

Injecting drug users are the principal at risk group for blood borne viruses. The aim was to assess the feasibility of screening substance misusers for blood borne viruses, and to offer appropriate vaccinations/referral to hepatology services. This was a nurse led prospective 6-month study based at a large Substance Misuse Service in south east England. Of the 196 consecutive individuals assessed, 81 were eligible for HBV immunization of whom only 33.3% completed a vaccination course. Prevalence of positive serological markers were: anti-HBc 14.4%, HBsAg 1.5%, and HCV antibody 37.9%. Compared to men, women were more likely to accept blood borne virus testing (83.3% vs. 62.3%), have ever injected (89.6% vs. 76.3%), overdose (54.2% vs. 23.6%), be anti-HBc positive (27.5% vs. 8.8%), drink alcohol above national recommended guidelines (41.7% vs. 25.7%), and have a positive HCV serology (55% vs. 30.4%) (P ≤ 0.05 for all). Of the 73 individuals identified with a positive HBsAg and or HCV antibody, only 14 (19.1%) were known to hepatology services and 8 (20%) of those eligible subsequently accepted a specialist referral. In conclusion, serological markers for blood borne viruses remain high in substance misusers (anti-HBc 14.4%, HCV antibody 37.9%), with women more likely to be positive. Overall, only 33.3% and 20%, respectively, complete HBV vaccination and accept a hepatology referral. A multidisciplinary approach is paramount to address both the blood borne viruses and the substance misuse and realignment of hepatitis services to Substance Misuse Services may offer such a strategy.

ITTREAT (Integrated Community Test ‐ Stage ‐ TREAT) Hepatitis C service for people who use drugs: Real‐world outcomes

“…In contrast, prior to setup of ITTREAT, only 5% of individuals with HCV infection referred from our drug alcohol treatment centre attended their local hospital appointment, none eventually being treated. ( 10 )…”

“…( 9 ) This is a marginalised/disenfranchised cohort with suboptimal engagement with health services. ( 10 ) Nationally, while 50% with HCV being diagnosed by 2020 has probably been achieved, substantial work is needed to reach the 90% WHO target. ( 1,8 ) Low treatment uptake amongst people who use drugs (PWUDs) (<5‐25/1000) ( 11 ) is a key factor hindering reduction in HCV disease burden.…”

High Rates of Hepatitis C Virus Reinfection and Spontaneous Clearance of Reinfection in People Who Inject Drugs: A Prospective Cohort Study

“…Further, while the attrition rate was similar to other community-based studies of PWID [31,41] and socio-demographic characteristics were similar amongst those retained and those lost to follow-up, it is possible that attrition led to selection bias. Nonetheless, given that few PWID receive medical care for HCV, study participants may be more representative of PWID than those attending health services for care [42,43]. In addition, the participants of this study were recruited from street illicit drug markets and report high risk behaviour.…”

Rates of HIV and Hepatitis Infections in Clients Entering Heroin-Assisted Treatment between 2003 and 2013 and Risk Factors for Hepatitis C Infection

“…Similarly, it could be assumed that women tend to have older sexual or injecting partners with longer drug careers and thus with a higher risk of HCV, thereby enhancing women's risk of infection. In addition, female substance abusers were more likely to have a history of overdose, psychiatric illness, and alcohol intake above the national recommended guidelines, all of which might facilitate high-risk behaviour [29] . Our analysis is unaffected by the finding that women are more likely to clear HCV than men [30] because in our dependent variable, we summarised individuals with current or past infection.…”