Incidence of HIV, hepatitis C and hepatitis B viruses among injection drug users in southwestern China: a 3-year follow-up study

Ruan, Yuhua; Qin, Guangming; Yin, Li; Chen, Kanglin; Qian, Han-Zhu; Hao, Chun; Liang, Shu; Zhu, Jian; Xing, Hui; Hong, Kui; Shao, Yiming

doi:10.1097/01.aids.0000304695.54884.4f

Cited by 63 publications

(59 citation statements)

References 17 publications

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“…51,56,57 The one study measuring the impact of OST used for detoxification was not associated with reduced HCV infection risk acquisition (RR 1.45, 95% CI 0.79 to 2.66). 55 High dosage with OST was associated with a reduction of HCV infection acquisition (RR 0.52, 95% CI 0.29 to 0.94) but low dosage was not (RR 0.85, 95% CI 0.44 to 1.65) (Figure 4).…”

Section: Referencementioning

confidence: 98%

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21 published studies 14,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] and seven unpublished studies [33][34][35][36][37]59,60 comprising 1827 HCV incident infections and 8789.7 person-years of follow-up.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

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of the included studies reported the impact of OST, 14,20,39,40,[45][46][47]49,[51][52][53]55,57,58 including seven unpublished estimates.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Seventeen studies reported the impact of NSPs, 14,20,[41][42][43][44]47,48,50,54,56,58 including five unpublished sources, [33][34][35]59,60 and four reported combined measures of NSPs with OST, 14,33,44,47 including one unpublished data source.…”

Section: Type Of Interventionsmentioning

confidence: 99%

“…51,56,57 One study did not define the time frame and was coded as past experience of OST. 56 Three studies published unadjusted estimates of interrupted OST use.…”

Section: History Of Opioid Substitution Therapymentioning

confidence: 99%

“…Three studies reported past exposure to OST, 51,56,57 three reported interrupted OST use, 40,46,53 one measured OST use for detoxification, 55 and two measured high dosage (≥ 60 mg) or low dosage (1-59 mg) of methadone for daily use.…”

Section: Effectiveness Of Needle/syringe Programmes and Opioid Substimentioning

confidence: 99%

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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: Referencementioning

confidence: 98%

Section: Study Selectionmentioning

confidence: 99%

Section: Type Of Interventionsmentioning

confidence: 99%

“…51,56,57 One study did not define the time frame and was coded as past experience of OST. 56 Three studies published unadjusted estimates of interrupted OST use.…”

Section: History Of Opioid Substitution Therapymentioning

confidence: 99%

Section: Effectiveness Of Needle/syringe Programmes and Opioid Substimentioning

confidence: 99%

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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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Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs

Platt

Minozzi²,

Reed

et al. 2017

Cochrane Database of Systematic Reviews

195

188

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BackgroundNeedle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugsNeedle syringe programmes (NSP) and opioid substitution therapy (OST) are the primary interventions to reduce hepatitis C (HCV) transmission in people who inject drugs. There is good evidence for the effectiveness of NSP and OST in reducing injecting risk behaviour and increasing evidence for the effectiveness of OST and NSP in reducing HIV acquisition risk, but the evidence on the effectiveness of NSP and OST for preventing HCV acquisition is weak.ObjectivesTo assess the effects of needle syringe programmes and opioid substitution therapy, alone or in combination, for preventing acquisition of HCV in people who inject drugs.Search methodsWe searched the Cochrane Drug and Alcohol Register, CENTRAL, the Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment Database (HTA), the NHS Economic Evaluation Database (NHSEED), MEDLINE, Embase, PsycINFO, Global Health, CINAHL, and the Web of Science up to 16 November 2015. We updated this search in March 2017, but we have not incorporated these results into the review yet. Where observational studies did not report any outcome measure, we asked authors to provide unpublished data. We searched publications of key international agencies and conference abstracts. We reviewed reference lists of all included articles and topic-related systematic reviews for eligible papers.Selection criteriaWe included prospective and retrospective cohort studies, cross-sectional surveys, case-control studies and randomised controlled trials that measured exposure to NSP and/or OST against no intervention or a reduced exposure and reported HCV incidence as an outcome in people who inject drugs. We defined interventions as current OST (within previous 6 months), lifetime use of OST and high NSP coverage (regular attendance at an NSP or all injections covered by a new needle/syringe) or low NSP coverage (irregular attendance at an NSP or less than 100% of injections covered by a new needle/syringe) compared with no intervention or reduced exposure.Data collection and analysisWe followed the standard Cochrane methodological procedures incorporating new methods for classifying risk of bias for observational studies. We described study methods against the following 'Risk of bias' domains: confounding, selection bias, measurement of interventions, departures from intervention, missing data, measurement of outcomes, selection of reported results; and we assigned a judgment (low, moderate, serious, critical, unclear) for each criterion.Main resultsWe identified 28 studies (21 published, 7 unpublished): 13 from North America, 5 from the UK, 4 from continental Europe, 5 from Australia and 1 from China, comprising 1817 incident HCV infections and 8806.95 person-years of follow-up. HCV incidence ranged from 0.09 cases to 42 cases per 100 person-years across the studies. We judged only two studi...

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Two decades of hepatitis B infections among drug users in Amsterdam: Are they still a high‐risk group?

Houdt

Berg

Stolte

et al. 2009

Journal of Medical Virology

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In general, little is known about the incidence of hepatitis B virus (HBV) among drug users, especially among non-injecting drug users. Therefore, changes in incidence, risk factors, and circulating genotypes over time were determined among drug users in Amsterdam over an 18-year period (1985-2002). Sera of 1,268 drug users, both injecting and non-injecting, were screened for anti-HBc. HBV genotypes of the anti-HBc seroconverters were determined. Poisson regression was used to test for temporal trends in incidence and to identify risk factors for seroconversion. Of the 598 participants who were anti-HBc negative at entry, 83 seroconverted for anti-HBc. The incidence of HBV declined from 5.9/100 Person Years up to 1993 to 0/100 Person Years in 2002. Of the drug users infected acutely, both injecting and non-injecting, 88% were infected with the same genotype D, serotype ayw3 strain. Multivariate analyses revealed current injecting, age, and calendar year of visit as independent risk factors. The decline in the incidence of HBV among drug users in Amsterdam is probably caused by a decline in injecting behavior. Injecting and non-injecting drug users were infected with the same strain, indicating that drug users infect one another, regardless of their risk behavior. After 2000, no injecting drug users with an acute HBV infection were reported to the Public Health Service Amsterdam and the specific genotype D strain had disappeared. These findings suggest that drug users may no longer be a high-risk group for HBV infection in Amsterdam. However, trends in drug use need to be monitored.

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Incidence of HIV, hepatitis C and hepatitis B viruses among injection drug users in southwestern China: a 3-year follow-up study

Cited by 63 publications

References 17 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

Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs

Two decades of hepatitis B infections among drug users in Amsterdam: Are they still a high‐risk group?

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