Usage of low dead space syringes and association with hepatitis C prevalence amongst people who inject drugs in the UK

Abstract

People who inject into their groin were less likely to use LDSS. Exclusive LDSS use was associated with lower prevalence of HCV amongst PWID that started injecting recently, suggesting LDSS use is protective against HCV.

Detachable low dead space syringes for the prevention of hepatitis C among people who inject drugs in Bristol, UK: an economic evaluation

“…Laboratory studies have shown that LDSS retain less viable HCV in the syringe in subsequent injections than HDSS [8,10], while modelling [11,12] has shown that smaller quantities of blood are transferred with LDSS than HDSS. Limited epidemiological studies also suggest lower HIV and HCV prevalence rates among PWID that use LDSS [13][14][15][16], although these studies have not measured incident infection and only one UK study adequately controlled for other factors that could affect infection risk [13].…”

Response to Commentary on Hancock et al. (2020): Low dead space syringes are just one component of an integrated package of care needed to tackle HCV and social exclusion among people who inject drugs

“…This research forms part of a multi-disciplinary body of evidence supporting the roll-out of LDSS. In addition, we have previously demonstrated that LDSS use is associated with reduced HCV risk in the United Kingdom, have shown why some PWID use LDSS and some do not [3] and critically shown that NSPs in general are a highly cost-effective way of reducing the spread of HCV among PWID [4].…”

Commentary on Hancock et al. (2020): Low dead space syringes are just one component of an integrated package of care needed to tackle HCV and social exclusion among people who inject drugs

“…It was encouraging to read Hancock et al's economic analysis of detachable low dead space syringes (LDSS), which concluded that the syringes are cost-saving and lead to additional quality-adjusted life years (QALY) in relation to hepatitis C (HCV) transmission and disease progression [1]. This is a useful addition to the growing body of evidence indicating the acceptability of LDSS among people who inject drugs (PWID) although, as Hancock et al acknowledge, further epidemiological evidence is needed to demonstrate their effectiveness in reducing HCV/HIV acquisition at a population level [2][3][4].…”

“…Women who inject drugs are at increased risk of HIV/HCV acquisition, violence and poorer mental health compared to their male counterparts, but they also face barriers to services related to stigma, concerns about confidentiality, loss of child custody and gendered power imbalances in injecting relationships [14][15][16]. People who inject crack cocaine are also at increased risk of HIV and HCV acquisition and are less likely to use LDSS [3,5,12]. Services need to adapt to reach these underserved populations, distributing injecting equipment via secondary distribution through peer-led outreach and in homeless hostels.…”

“…This is a useful addition to the growing body of evidence indicating the acceptability of LDSS among people who inject drugs (PWID) although, as Hancock et al . acknowledge, further epidemiological evidence is needed to demonstrate their effectiveness in reducing HCV/HIV acquisition at a population level.…”