High hepatitis C virus prevalence and incidence among Canadian intravenous drug users

Roy, É; Alary, Michel; Morissette, Carole; Leclerc, Pascale; Jf, Boudreau; Parent, Robert; Rochefort, J. G.; Claessens, Christiane

doi:10.1258/095646207779949880

Cited by 80 publications

(92 citation statements)

References 11 publications

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“…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21 published studies 14,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] and seven unpublished studies [33][34][35][36][37]59,60 comprising 1827 HCV incident infections and 8789.7 person-years of follow-up.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.…”

Section: Study Selectionmentioning

confidence: 99%

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Seventeen studies reported the impact of NSPs, 14,20,[41][42][43][44]47,48,50,54,56,58 including five unpublished sources, [33][34][35]59,60 and four reported combined measures of NSPs with OST, 14,33,44,47 including one unpublished data source. 33 One study looked at the impact of distributing injecting paraphernalia (defined as spoons and filters) by itself, with needles/syringes and in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

Section: Type Of Interventionsmentioning

confidence: 99%

“…NIHR Journals Library www.journalslibrary.nihr.ac.uk Needle and syringe programmes versus lower or no needle and syringe programmes coverage A total of 15 studies reported measures of NSP exposure and HCV infection incidence, 14,20,[41][42][43][44]47,48,50,54,58 including five unpublished estimates. [33][34][35]59,60 Only five studies published adjusted estimates, 33,42,44,47,48 restricting the sensitivity analysis that could be conducted.…”

Section: Effectiveness Of Needle/syringe Programmes and Opioid Substimentioning

confidence: 99%

“…Comparison groups consisted of non-attendance in the NSP 14,34,35,[41][42][43]48,50,54,60 or lower coverage of injections covered by a clean needle or syringe, 14,44,47,59 or a needle or syringe obtained from a safe source.…”

Section: Effectiveness Of Needle/syringe Programmes and Opioid Substimentioning

confidence: 99%

See 3 more Smart Citations

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: Study Selectionmentioning

confidence: 99%

Section: Type Of Interventionsmentioning

confidence: 99%

Section: Effectiveness Of Needle/syringe Programmes and Opioid Substimentioning

confidence: 99%

Section: Effectiveness Of Needle/syringe Programmes and Opioid Substimentioning

confidence: 99%

See 2 more Smart Citations

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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“…The behavioural and psychosocial components of the questionnaire were developed by adapting elements from the SurvUDI study questionnaire of IDUs in Quebec (Roy et al, 2007), the Montreal Street Youth Cohort (Roy et al, 1998), the Bloodborne Virus Transmission Risk Assessment Questionnaire used in Australia (Fry & Lintzeris, 2003), and the Diffusion of Benefits Through Syringe Exchange Program Project Questionnaire used in the United States (Grau, Bluthenthal, Marshall, Singer, & Heimer, 2005). Items pertaining to the model variables were developed through an iterative process involving several steps.…”

Section: Data Collectionmentioning

confidence: 99%

Low perceived benefits and self-efficacy are associated with hepatitis C virus (HCV) infection-related risk among injection drug users

Cox

Morissette³

et al. 2008

Social Science & Medicine

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Hepatitis C prevention counselling and education are intended to increase knowledge of disease, clarify perceptions about vulnerability to infection, and increase personal capacity for undertaking safer behaviours. This study examined the association of drug equipment sharing with psychosocial constructs of the AIDS Risk Reduction Model, specifically, knowledge and perceptions related to hepatitis C virus (HCV) among injection drug users (IDUs). Active IDUs were recruited between April 2004 and January 2005 from syringe exchange and methadone maintenance treatment programs in Montreal, Canada. A structured, interviewer-administered questionnaire elicited information on drug preparation and injection practices, self-reported hepatitis C testing and infection status, and AIDS Risk Reduction Model constructs. Separate logistic regression models were developed to examine variables in relation to: (1) the sharing of syringes, and (2) the sharing of drug preparation equipment (drug containers, filters, and water). Among the 321 participants, the mean age was 33 years, 70% were male, 80% were single, and 91% self-identified as Caucasian. In the multivariable analyses, psychosocial factors linked to syringe sharing were lower perceived benefits of safer injecting and greater difficulty to inject safely. As with syringe sharing, the sharing of drug preparation equipment was associated with lower perceived benefits of safer injecting but also with low self-efficacy to convince others to inject more safely. Interventions should aim to heighten awareness of the benefits of risk reduction and provide IDUs with the skills necessary to negotiate safer injecting with their peers.

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Survival Sex Work Involvement as a Primary Risk Factor for Hepatitis C Virus Acquisition in Drug-Using Youths in a Canadian Setting

Shannon¹,

Marshall²,

Li³

et al. 2010

Arch Pediatr Adolesc Med

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High hepatitis C virus prevalence and incidence among Canadian intravenous drug users

Cited by 80 publications

References 11 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

Low perceived benefits and self-efficacy are associated with hepatitis C virus (HCV) infection-related risk among injection drug users

Survival Sex Work Involvement as a Primary Risk Factor for Hepatitis C Virus Acquisition in Drug-Using Youths in a Canadian Setting

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