Syringe Exchange and Risk of Infection with Hepatitis B and C Viruses

Hagan, Holly; McGough, James P.; Thiede, Hanne; Weiss, Noel S.; Hopkins, Sharon G.; Alexander, E. Russell

doi:10.1093/oxfordjournals.aje.a009792

Cited by 222 publications

(169 citation statements)

References 6 publications

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“…10 In each setting, a random-number sampling algorithm was used to select candidates for recruitment.…”

Section: Methodsmentioning

confidence: 99%

“…5 In 2004, among acute cases reported nationally to CDC with risk factor data, 16% reported recent use of injection drugs, 6 which is approximately the same percentage as in the four sentinel counties. 7 In populations of IDUs, prevalence of HBV infection has ranged from 22 to 68% [8][9][10][11] and incidence rates of 10 and 31% per year have been reported. 8,10 Hepatitis C virus causes an estimated 8,000 to 10,000 deaths per year.…”

Section: Introductionmentioning

confidence: 99%

“…7 In populations of IDUs, prevalence of HBV infection has ranged from 22 to 68% [8][9][10][11] and incidence rates of 10 and 31% per year have been reported. 8,10 Hepatitis C virus causes an estimated 8,000 to 10,000 deaths per year. 4 The estimated number of new infections was 20,000 in 2005.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Trends in Hepatitis B Virus, Hepatitis C Virus, and Human Immunodeficiency Virus Prevalence, Risk Behaviors, and Preventive Measures among Seattle Injection Drug Users Aged 18–30 Years, 1994–2004

et al. 2007

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Injection drug users (IDUs) are at risk for infection with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Information on time trends in prevalence of these viruses among IDUs and in behaviors influencing their transmission can help define the status of these epidemics and of public health efforts to control them. We conducted a secondary data analysis combining crosssectional data from IDUs aged 18-30 years enrolled in four Seattle-area studies from 1994 to 2004. Participants in all four studies were tested for antibody to HIV (anti-HIV), hepatitis B core antigen (anti-HBc), and HCV (anti-HCV), and completed behavioral risk assessments. Logistic regression was used to investigate trends in prevalence over time after controlling for sociodemographic, drug use, and sexual behavior variables. Between 1994 and 2004, anti-HBc prevalence declined from 43 to 15% (p G 0.001), anti-HCV prevalence fell from 68 to 32% (p G 0.001) and anti-HIV prevalence remained constant at 2-3%. Declines in anti-HBc and anti-HCV prevalence were observed within the individual studies, although not all these declines were statistically significant. The declines in anti-HBc and anti-HCV prevalence remained significant after control for confounding. Although we did not observe coincident declines in injection equipment sharing practices, there were increases in self-reported needle-exchange use, condom use, and hepatitis B vaccination. We conclude that there has been a substantial and sustained reduction in prevalence rates for HBV and HCV infection among young Seattle IDUs, while HIV rates have remained low and stable.

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“…10 In each setting, a random-number sampling algorithm was used to select candidates for recruitment.…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Trends in Hepatitis B Virus, Hepatitis C Virus, and Human Immunodeficiency Virus Prevalence, Risk Behaviors, and Preventive Measures among Seattle Injection Drug Users Aged 18–30 Years, 1994–2004

et al. 2007

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“…In the absence of a vaccine to prevent HCV infection, effective prevention programs must rely on changing behavior. Most programs such as counseling and testing 13,14 or structural interventions such as syringe exchange and methadone maintenance programs [15][16][17] have focused on primary prevention for those at risk. However, their efficacy in addressing secondary prevention by curbing the spread of HCV from infected IDUs to others has been inconclusive.…”

Section: Introductionmentioning

confidence: 99%

Design and Feasibility of a Randomized Behavioral Intervention to Reduce Distributive Injection Risk and Improve Health-Care Access Among hepatitisC virus Positive Injection Drug Users: The Study to Reduce Intravenous Exposures (STRIVE)

Kapadia

Latka

Hagan³

et al. 2007

J Urban Health

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Hepatitis C virus (HCV) is hyperendemic among injection drug users (IDUs). However, few scientifically proven interventions to prevent secondary transmission of HCV from infected IDUs to others exist. This report describes the design, feasibility, and baseline characteristics of participants enrolled in the Study to Reduce Intravenous Exposure (STRIVE). STRIVE was a multisite, randomized-control trial to test a behavioral intervention developed to reduce distribution of used injection equipment (needles, cookers, cottons, and rinse water) and increase health-care utilization among antibody HCV (anti-HCV) positive IDUs. STRIVE enrolled anti-HCV positive IDU in Baltimore, New York City, and Seattle; participants completed behavioral assessments and venipuncture for HIV, HCV-RNA, and liver function tests (LFTs) and were randomized to attend either a six-session, small-group, peer-mentoring intervention workshop or a timematched, attention-control condition. Follow-up visits were conducted at 3 and 6 months. At baseline, of the 630 HCV-positive IDUs enrolled (mean age of 26 years, 60% white, 76% male), 55% reported distributive needle sharing, whereas 74, 69, and 69% reported sharing cookers, cottons, and rinse water, respectively. Health-care access was low, with 41% reporting an emergency room as their main source of medical care. Among those enrolled, 66% (418/630) were randomized: 53% (222/418) and 47% (196/418) to the intervention and control conditions, respectively. Follow-up rates were 70 and 73% for the 3-and 6-month visits, respectively. As distributive sharing of used injection equipment was common while reports of receiving HCV care were low, these findings indicate an urgent need for HCV-related interventions with IDUs and demonstrate the acceptability and feasibility to do so.Kapadia is with the Guttmacher Institute,

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“…Most studies that have evaluated syringe exchange programs (SEPs) have found that they have reduced the risk of infection with HIV, HBV, and HCV among IDUs. [1][2][3][4][5][6][7][8][9][10] However, the legalization of SEP and other syringe distribution programs (e.g., pharmacy sales) is not universal in the USA, [11][12][13] and the programs are often restricted in reaching IDUs because of laws limiting their operation and other factors, such as geographic location 14 and police harassment. 15,16 In New York State, except for a very limited pilot program run by the New York City (NYC) Department of Health between 1988 and 1990, SEPs have been legal since 1992 when the New York State Department of Health (NYSDOH) provided a special waiver from the syringe possession laws to allow for the limited operation of SEPs in the state.…”

Section: Introductionmentioning

confidence: 99%

Greater Drug Injecting Risk for HIV, HBV, and HCV Infection in a City Where Syringe Exchange and Pharmacy Syringe Distribution are Illegal

et al. 2008

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Comparing drug-injecting risk between cities that differ in the legality of sterile syringe distribution for injection drug use provides a natural experiment to assess the efficacy of legalizing sterile syringe distribution as a structural intervention to prevent human immunodeficiency virus (HIV) and other parenterally transmitted infections among injection drug users (IDUs). This study compares the parenteral risk for HIV and hepatitis B (HBV) and C (HCV) infection among IDUs in Newark, NJ, USA, where syringe distribution programs were illegal during the period when data were collected, and New York City (NYC) where they were legal. IDUs were nontreatment recruited, 2004-2006, serotested, and interviewed about syringe sources and injecting risk behaviors (prior 30 days). In multivariate logistic regression, adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for city differences are estimated controlling for potential city confounders. IDUs in Newark (n=214) vs. NYC (n=312) were more likely to test seropositive for HIV (26% vs. 5%; AOR=3.2; 95% CI=1.6, 6.1), antibody to the HBV core antigen (70% vs. 27%; AOR=4.4; 95% CI=2.8, 6.9), and antibody to HCV (82% vs. 53%; AOR=3.0; 95% CI=1.8, 4.9), were less likely to obtain syringes from syringe exchange programs or pharmacies (AOR=0.004; 95% CI=0.001, 0.01), and were more likely to obtain syringes from street sellers (AOR=74.0; 95% CI=29.9, 183.2), to inject with another IDU's used syringe (AOR=2.3; 95% CI=1.1, 5.0), to reuse syringes (AOR=2.99; 95% CI=1.63, 5.50), and to not always inject once only with a new, sterile syringe that had been sealed in a wrapper (AOR=5.4; 95% CI=2.9, 10.3). In localities where sterile syringe distribution is illegal, IDUs are more likely to obtain syringes from unsafe sources and to engage in injecting risk behaviors. Legalizing and rapidly implementing sterile syringe distribution programs are critical for reducing parenterally transmitted HIV, HBV, and HCV among IDUs.

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Syringe Exchange and Risk of Infection with Hepatitis B and C Viruses

Cited by 222 publications

References 6 publications

Trends in Hepatitis B Virus, Hepatitis C Virus, and Human Immunodeficiency Virus Prevalence, Risk Behaviors, and Preventive Measures among Seattle Injection Drug Users Aged 18–30 Years, 1994–2004

Trends in Hepatitis B Virus, Hepatitis C Virus, and Human Immunodeficiency Virus Prevalence, Risk Behaviors, and Preventive Measures among Seattle Injection Drug Users Aged 18–30 Years, 1994–2004

Design and Feasibility of a Randomized Behavioral Intervention to Reduce Distributive Injection Risk and Improve Health-Care Access Among hepatitisC virus Positive Injection Drug Users: The Study to Reduce Intravenous Exposures (STRIVE)

Greater Drug Injecting Risk for HIV, HBV, and HCV Infection in a City Where Syringe Exchange and Pharmacy Syringe Distribution are Illegal

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