Hepatitis C infection among recent initiates to injecting in England 2000–2008: Is a national hepatitis C action plan making a difference?

Abstract

Around 80% of hepatitis C virus (HCV) infections in England are among injecting drug users (IDUs). The HCV Action Plan launched in 2004 includes targets to reduce HCV prevalence in recent initiates (those starting injecting in the preceding 3 years), and to increase HCV voluntary confidential testing (VCT). The Action Plan's impact is examined using surveillance data from recent initiates participating in an annual survey of IDUs in contact with specialist services across England, 2000-2008. Participants provided an oral fluid sample (tested for anti-HCV) and completed a short questionnaire (including HCV VCT and result of last test). Overall, anti-HCV prevalence among the recent initiates was 18% (619/3463); in 2004, it was 20% (59/291), other than being lower in 2000 [11%, 73/672, adjusted odds ratio (AOR) = 0.63 95%CI 0.42-0.93] there was no change over time. Prevalence increased with age; was higher among those ever imprisoned, using a needle exchange, and having a HCV VCT; and varied by region. Overall, 42% (1460) had ever had a HCV VCT; in 2004 uptake was 45% (130/291) having increased from 26% (175/672, AOR = 0.57 95%CI 0.42-0.77) in 2000, and it rose to 62% (197/320, AOR = 2.12 95%CI 1.50-2.99) in 2008. The proportion of anti-HCV-positive IDUs aware of their infection was higher in 2006-2008 than in earlier years. The HCV Action Plan has probably helped increase recent initiates' uptake of HCV VCT and the proportion of those diagnosed with HCV infection. However, its impact on HCV transmission is unclear. There is a need to reinvigorate, and improve coverage of, interventions to prevent HCV transmission.

Prevalence and associated clinical characteristics of hepatitis B, C, and HIV infections among injecting drug users in Korea

“…The association between older age and the increased risk for HCV infection was consistent with those of earlier studies [Removille et al, 2011;Hope et al, 2012]. Since older age also regarded as a cofactor that accelerates the progression of liver disease [Shepard et al, 2005], older injecting drug users would be regarded as the risk group in which early detection of HCV is important.…”

Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis

“…Results from these studies were mixed with one study finding no effect from NEP participation (OR, 1.54, 95% CI, 0.73–3.24) [50], one study finding a preventative effect (OR, 0.59, 95% CI, 0.43–0.77) [53], and three studies demonstrating a harmful effect (OR, 2.17, 95% CI, 1.38–3.40 [51]; OR, 2.1, 95% CI, 1.54–2.89 [52]; OR, 2.54, 95% CI, 1.36–4.74 [54]). Similar to the findings from the current review, not all studies adjusted odds ratios for confounding, and the various adjustments made were not uniform between studies.…”

Hepatitis C Virus Infection Epidemiology among People Who Inject Drugs in Europe: A Systematic Review of Data for Scaling Up Treatment and Prevention

“…Of particular interest is the HCV antibody prevalence in new injectors (injecting for less than 2 years) (Figure 8). This may provide a relatively cost-effective indicator of levels of new infection in PWID [44], [192], as an addition to the regular prevalence data (Figure 9), particularly if it is supported and regularly validated by incidence studies using direct methods as here reviewed, or, in addition, indirect methods [211], [230]. Finally, it should be noted that, although population size estimates of PWID are routinely monitored in Europe [49], few countries have estimates that are reasonably recent.…”