Housing Instability among People Who Inject Drugs: Results from the Australian Needle and Syringe Program Survey

Topp, Libby; Iversen, Jenny; Baldry, Eileen; Maher, Lisa

doi:10.1007/s11524-012-9730-6

Cited by 61 publications

(57 citation statements)

References 77 publications

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“…Although studies have shown OST and needle and syringe programmes are highly effective at reducing an individual’s risk of acquiring HCV (in combination up to 80%(32, 33)), it is unclear whether all the elevated risk post-release could be prevented, even with intensive prevention efforts upon prison release. Indeed, it is likely that other structural factors may also need to be addressed, including high levels of homelessness following release(8, 23, 34), to fully prevent this period of elevated risk. However, our results suggest that efforts to reduce this risk, which may include linking PWID to harm reduction services and providing housing support on release from prison, could greatly reduce both HCV incidence and prevalence.…”

Section: Discussionmentioning

confidence: 99%

“…Further research and syntheses of available evidence are required to better define this risk. The reasons for the increased risk post-release are likely to be multi-factorial, associated with injecting risk environment and individual behaviors; for example, relapse may be unplanned and not involve sterile equipment, and post-release PWID may be more likely to have unstable housing(8, 23, 34) or be unemployed(6). Additionally, they may experience changes in social networks and inadequate family and financial support(42, 43).…”

Section: Discussionmentioning

confidence: 99%

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Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland

Martin²,

et al. 2017

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Background and AimsPeople who inject drugs (PWID) experience high incarceration rates, and previous incarceration is associated with elevated hepatitis C virus (HCV) transmission risk. In Scotland, national survey data indicate lower HCV incidence in prison than the community (4.3 versus 7.3 per 100 person‐years), but a 2.3‐fold elevated transmission risk among recently released (< 6 months) PWID. We evaluated the contribution of incarceration to HCV transmission among PWID and the impact of prison‐related prevention interventions, including scaling‐up direct‐acting antivirals (DAAs) in prison.DesignDynamic mathematical modelling of incarceration and HCV transmission, using approximate Bayesian computation for model calibration.SettingScotland, UK.ParticipantsA simulated population of PWID.MeasurementsPopulation‐attributable fraction (PAF) of incarceration to HCV transmission among PWID. Decrease in HCV incidence and chronic prevalence due to current levels of prison opiate substitution therapy (OST; 57% coverage) and HCV treatment, as well as scaling‐up DAAs in prison and/or preventing the elevated risk associated with prison release.FindingsIncarceration contributes 27.7% [PAF; 95% credible interval (CrI) –3.1 to 51.1%] of HCV transmission among PWID in Scotland. During the next 15 years, current HCV treatment rates (10.4/6.8 per 1000 incarcerated/community PWID annually), with existing prison OST, could reduce incidence and chronic prevalence among all PWID by a relative 10.7% (95% CrI = 8.4–13.3%) and 9.7% (95% CrI = 7.7–12.1%), respectively. Conversely, without prison OST, HCV incidence and chronic prevalence would decrease by 3.1% (95% CrI = –28.5 to 18.0%) and 4.7% (95% CrI = –11.3 to 14.5%). Additionally, preventing the heightened risk among recently released PWID could reduce incidence and chronic prevalence by 45.0% (95% CrI = 19.7–57.5%) and 33.3% (95% CrI = 15.6–43.6%) or scaling‐up prison HCV treatments to 80% of chronic PWID prison entrants with sufficient sentences (>16 weeks) could reduce incidence and prevalence by 45.6% (95% CrI = 38.0–51.3%) and 45.5% (95% CrI = 39.3–51.0%), respectively.ConclusionsIncarceration and the elevated transmission risk following prison release can contribute significantly to hepatitis C virus transmission among people who inject drugs. Scaling‐up hepatitis C virus treatment in prison can provide important prevention benefits.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland

Martin²,

et al. 2017

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“…Participants were categorized as having stable housing or unstable housing based on their responses to the question ‘what kind of place do you live in at the moment?’ Participants who reported options ‘own house/flat; rental house/flat’ were classified as having stable housing . Response options of ‘staying temporarily with friends; shelter/refuge; street/homeless; parent's place’ and any other specified including boarding house, hostel, crisis accommodation and ‘couch surfing’ were classified as unstable housing . Alcohol consumption was assessed using the AUDIT‐C, a 3‐item alcohol screen that can help to detect persons who are high‐risk alcohol drinkers or who have active alcohol use disorders .…”

Section: Methodsmentioning

confidence: 99%

Hepatitis C virus testing, liver disease assessment and treatment uptake among people who inject drugs pre‐ and post‐universal access to direct‐acting antiviral treatment in Australia: The LiveRLife study

Bajis

Grebely

Hajarizadeh

et al. 2019

Journal of Viral Hepatitis

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Gaps in hepatitis C virus (HCV) testing, diagnosis, liver disease assessment and treatment uptake among people who inject drugs (PWID) persist. We aimed to describe the cascade of HCV care among PWID in Australia, prior to and following unrestricted access to direct‐acting antiviral (DAA) treatment. Participants enrolled in an observational cohort study between 2014 and 2018 provided fingerstick whole‐blood samples for dried blood spot, Xpert HCV Viral Load and venepuncture samples. Participants underwent transient elastography and clinical assessment by a nurse or general practitioner. Among 839 participants (mean age 43 years), 66% were male (n = 550), 64% (n = 537) injected drugs in the previous month, and 67% (n = 560) reported currently receiving opioid substitution therapy. Overall, 45% (n = 380) had detectable HCV RNA, of whom 23% (n = 86) received HCV treatment within 12 months of enrolment. HCV treatment uptake increased from 2% in the pre‐DAA era to 38% in the DAA era. Significant liver fibrosis (F2‐F4) was more common in participants with HCV infection (38%) than those without (19%). Age 50 years or older (aOR, 2.88; 95% CI, 1.18‐7.04) and attending a clinical follow‐up with nurse (aOR, 3.19; 95% CI, 1.61‐6.32) or physician (aOR, 11.83; 95% CI, 4.89‐28.59) were associated with HCV treatment uptake. Recent injection drug use and unstable housing were not associated with HCV treatment uptake. HCV treatment uptake among PWID has increased markedly in the DAA era. Evaluation of innovative and simplified models of care is required to further enhance treatment uptake.

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“…In a recent Australian study, Topp et al . [21] examined the factors associated with housing instability among PWID recruited through needle and syringe programs across Australia and found that compared with stably housed participants, homeless participants were more likely to be male, younger, Indigenous, have a prison history, and report higher rates of public injecting and receptive sharing of injecting equipment. Each of these factors points to a sub‐population of PWID at extreme risk.…”

Section: Introductionmentioning

confidence: 99%

“…The few studies exploring associations of homelessness among PWID have been limited to data collected from people entering drug treatment [18] and those who had already been recruited for studies examining HIV prevalence or risk reduction interventions [19,20]. In a recent Australian study, Topp et al [21] examined the factors associated with housing instability among PWID recruited through needle and syringe programs across Australia and found that compared with stably housed participants, homeless participants were more likely to be male, younger, Indigenous, have a prison history, and report higher rates of public injecting and receptive sharing of injecting equipment. Each of these factors points to a sub-population of PWID at extreme risk.…”

Section: Introductionmentioning

confidence: 99%

Multiply disadvantaged: Health and service utilisation factors faced by homeless injecting drug consumers in Australia

et al. 2015

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Housing Instability among People Who Inject Drugs: Results from the Australian Needle and Syringe Program Survey

Cited by 61 publications

References 77 publications

Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland

Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland

Hepatitis C virus testing, liver disease assessment and treatment uptake among people who inject drugs pre‐ and post‐universal access to direct‐acting antiviral treatment in Australia: The LiveRLife study

Multiply disadvantaged: Health and service utilisation factors faced by homeless injecting drug consumers in Australia

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