Seroprevalence of HIV, hepatitis b, and hepatitis c among opioid drug users on methadone treatment in the netherlands

Abstract

BackgroundInjecting drug users (IDU) remain an important population at risk for blood-borne infections such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). In the Netherlands, a program is being implemented to offer annual voluntary screening for these infections to opioid drug users (ODUs) screened in methadone care. At two care sites where the program is now operating, our study aimed to estimate the seroprevalence among ODUs screened for HIV, HBV and HCV; to evaluate HBV vaccination coverage; and to assess the feasibility of monitoring seroprevalence trends by using routine annual screening data.MethodsOpioid drug users on methadone treatment are routinely offered voluntary screening for infectious diseases such as HIV, HBV and HCV. Data on uptake and outcome of anti-HIV, anti-HBc, and anti-HCV screening among ODUs receiving methadone were obtained from two regions: Amsterdam from 2004 to 2008 and Heerlen from 2003 to 2009.FindingsAnnual screening uptake for HIV, HBV and HCV varied from 34 to 69%, depending on disease and screening site. Of users screened, 2.5% were HIV-positive in Amsterdam and 11% in Heerlen; 26% were HCV-positive in Amsterdam and 61% in Heerlen. Of those screened for HBV, evidence of current or previous infection (anti-HBc) was found among 33% in Amsterdam and 48% in Heerlen. In Amsterdam, 92% were fully vaccinated for HBV versus 45% in Heerlen.ConclusionAnnual screening for infectious diseases in all ODUs in methadone care is not fully implemented in the Netherlands. On average, more than half of the ODUs in methadone care in Heerlen and Amsterdam were screened for HIV, HBV and HCV. In addition, screening data indicate that HBV vaccination uptake was rather high. While the HIV prevalence among these ODUs was relatively low compared to other drug-using populations, the high HCV prevalence among this group underscores the need to expand annual screening and interventions to monitor HIV, HBV and HCV in the opioid drug-using population.

Uptake of HIV, Hepatitis B and Hepatitis C testing among injection drug users in Thailand

“…The findings highlighted that a significant proportion of drug users had not received HBV screening. 20 Another study conducted in Switzerland found that nearly all methadone recipients had been tested for HIV (99%) or HCV (91%) 21 Several studies in India and Thailand have explored HIV and HCV uptake and its associated factors among IDUs recruited through peer-referral and targeted outreach. 22,23 These studies are focused on a single screening that may have overlooked the importance of co-infections.…”

Are the testing needs of key European populations affected by hepatitis B and hepatitis C being addressed? A scoping review of testing studies in Europe

“…At the same time, some categories in which the median proportion tested was 100% also included studies that reported relatively low levels of testing. For example, 33.6% of study participants in a study of people who use drugs were tested for HBV (39), and 13.0% of study participants in a study of asymptomatic patients in genitourinary medicine clinics were tested for HCV (59). However, we believe that our review findings around testing uptake are of limited value in assessing testing uptake levels in these populations because few studies had the specific purpose of examining HBV and HCV testing uptake.…”

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“…This phenomenon has been linked to ongoing "at-risk" practices and has to be taken as an indication of the attitudes of non-compliance with preventive measures [54]. As with HIV, there is already considerations of a screening of HCV in adults [55] and IDU [56].…”