The impact of needle and syringe provision and opiate substitution therapy on the incidence of Hepatitis C virus in injecting drug users: pooling of UK evidence.


Turner, KM; Hutchinson, S; Vickerman, P; Hope, V; Craine, N; Palmateer, N; May, M; Taylor, A; De Angelis, D; Cameron, S; Parry, J; Lyons, M; Goldberg, D; Allen, E; Hickman, M; (2011) The impact of needle and syringe provision and opiate substitution therapy on the incidence of Hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction (Abingdon, England), 106 (11). pp. 1978-88. ISSN 0965-2140 DOI: https://doi.org/10.1111/j.1360-0443.2011.03515.x

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Abstract

AIMS: To investigate whether opiate substitution therapy (OST) and needle and syringe programmes (NSP) can reduce hepatitis C virus (HCV) transmission among injecting drug users (IDUs).<br/> DESIGN: Meta-analysis and pooled analysis, with logistic regression allowing adjustment for gender, injecting duration, crack injecting and homelessness.<br/> SETTING: Six UK sites (Birmingham, Bristol, Glasgow, Leeds, London and Wales), community recruitment.<br/> PARTICIPANTS: A total of 2986 IDUs surveyed during 2001-09.<br/> MEASUREMENT: Questionnaire responses were used to define intervention categories for OST (on OST or not) and high NSP coverage (?100% versus <100% needles per injection). The primary outcome was new HCV infection, measured as antibody seroconversion at follow-up or HCV antibody-negative/RNA-positive result in cross-sectional surveys.<br/> FINDINGS: Preliminary meta-analysis showed little evidence of heterogeneity between the studies on the effects of OST (I2=48%, P=0.09) and NSP (I2=0%, P=0.75), allowing data pooling. The analysis of both interventions included 919 subjects with 40 new HCV infections. Both receiving OST and high NSP coverage were associated with a reduction in new HCV infection [adjusted odds ratios (AORs)=0.41, 95% confidence interval (CI): 0.21-0.82 and 0.48, 95% CI: 0.25-0.93, respectively]. Full harm reduction (on OST plus high NSP coverage) reduced the odds of new HCV infection by nearly 80% (AOR=0.21, 95% CI: 0.08-0.52). Full harm reduction was associated with a reduction in self-reported needle sharing by 48% (AOR 0.52, 95% CI: 0.32-0.83) and mean injecting frequency by 20.8 injections per month (95% CI: -27.3 to -14.4).<br/> CONCLUSIONS: There is good evidence that uptake of opiate substitution therapy and high coverage of needle and syringe programmes can substantially reduce the risk of hepatitis C virus transmission among injecting drug users. Research is now required on whether the scaling-up of intervention exposure can reduce and limit hepatitis C virus prevalence in this population.<br/>

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Faculty of Public Health and Policy > Dept of Social and Environmental Health Research
Research Centre: Social and Mathematical Epidemiology (SaME)
SaME Modelling & Economics
PubMed ID: 21615585
Web of Science ID: 296046000019
URI: http://researchonline.lshtm.ac.uk/id/eprint/698

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