Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia

Maher, Lisa; Jalaludin, Bin; Chant, Kerry; Jayasuriya, Rohan; Sladden, Tim; Kaldor, John; Sargent, Penny

doi:10.1111/j.1360-0443.2006.01543.x

Cited by 201 publications

(160 citation statements)

References 30 publications

Supporting

Mentioning

144

Contrasting

Order By: Relevance

“…This observation is consistent with studies of HCV incidence among young IDUs over shorter time periods, both locally and internationally. 9,[19][20][21][22] While there was no detectable increase in prevalence among the older cohorts during the decade of study, we observed that successively older cohorts had a successively higher prevalence of HCV. This pattern may represent decreasing incidence rates within cohorts over time, with a progressive increase in HCV prevalence towards a common plateau of approximately 90%.…”

Section: Discussioncontrasting

confidence: 60%

“…This would for the most part explain the incremental increases in HCV prevalence across duration of injection groups both among survey respondents who reported, and did not report, recent sharing of needles and syringes in our study. It is also possible that some cases of infection occurred via use of other contaminated drug preparation equipment 9,23 rather than sharing of needles and syringes at some point in time since injection initiation; however, we were unable to account for this in our analysis. While it is likely that the prevalence of sharing of needles and syringes was underreported in our study due to the highly stigmatized nature of the behavior and the perceived need to provide socially desirable responses in the survey context, 24 it is unlikely that the direction of the trends observed would have been affected by underreporting over time.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 In contrast, hepatitis C virus (HCV) prevalence and incidence in various clinic-and community-based IDU populations throughout Australia, mostly in major cities and regional urban centers, have remained high. [6][7][8][9][10] Routine surveillance data have the potential to increase our understanding of HCV transmission trends and consequently inform an improved public health response in the context of a well-established epidemic. To date, there has been limited published data internationally on trends in HCV infection and related risk factors in IDU populations over significant time periods, with studies examining trends in prevalent HCV infection being limited to IDUs recruited via drug treatment facilities 11 or comparison of different data sources over time.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hepatitis C Virus Acquisition among Injecting Drug Users: A Cohort Analysis of a National Repeated Cross-sectional Survey of Needle and Syringe Program Attendees in Australia, 1995–2004

2008

Self Cite

View full text Add to dashboard Cite

High hepatitis C virus (HCV) prevalence has been documented among many injecting drug user (IDU) populations worldwide; however, there is limited published data on trends in incidence of infection in these epidemics over time. To address this, we used a novel method of analyzing data collected via repeat, cross-sectional sero-surveys by injection initiation cohorts to investigate trends in HCV seropositivity among a population of needle and syringe program (NSP) attendees in Australia between 1995 and 2004, and thereby infer annual incidence trends. Injection initiation cohorts were defined by their time of entry into the IDU population. We also investigated the associations between HCV antibody seroprevalence and risk factor data, and trends in risk factor data over the decade. Approximately 20,000 NSP attendees participated in the study over the 10-year period. Within each injection initiation cohort, we found an increase in HCV prevalence over time, with prevalence appearing to reach saturation around 90%. There was little indication that the slopes of increase had changed with more recent initiation cohorts. While duration of injecting was most strongly associated with HCV seropositivity in this study, we also found that self-reported history of needle and syringe sharing and imprisonment were independently associated with higher HCV prevalence regardless of duration of injecting, with the exception of IDUs who have 15 or more years injecting experience. In this group, recent risk behavior had no relationship to prevalence. In summary, our findings suggest a persistent HCV epidemic despite significant harm reduction efforts in Australia since the mid-1980s, with HIV incidence effectively constant in successive initiation cohorts.

show abstract

Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hepatitis C Virus Acquisition among Injecting Drug Users: A Cohort Analysis of a National Repeated Cross-sectional Survey of Needle and Syringe Program Attendees in Australia, 1995–2004

2008

Self Cite

View full text Add to dashboard Cite

show abstract

“…Of these, unpublished data were obtained from seven cohort studies in Montreal, Canada; 33 Baltimore, USA; 34 San Francisco, USA; 35 London, UK; 36 and Sydney and Melbourne, Australia. 37,38 The full text of 141 papers was reviewed. A total of 19 papers were included, and 120 papers were excluded for the following reasons: no HCV infection incidence data (n = 55); no measure of intervention exposure (n = 34); contain no primary data (n = 20); the sample was not PWID (n = 1); all the sample were recruited from the intervention (n = 9); and the article could not be obtained in its original language (Japanese) (n = 1).…”

Section: Study Selectionmentioning

confidence: 99%

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

et al. 2017

Self Cite

View full text Add to dashboard Cite

Background There is limited evidence of the impact of needle and syringe programmes (NSPs) and opioid substitution therapy (OST) on hepatitis C virus (HCV) incidence among people who inject drugs (PWID), nor have there been any economic evaluations. Objective(s) To measure (1) the impact of NSP and OST, (2) changes in the extent of provision of both interventions, and (3) costs and cost-effectiveness of NSPs on HCV infection transmission. Design We conducted (1) a systematic review; (2) an analysis of existing data sets, including collating costs of NSPs; and (3) a dynamic deterministic model to estimate the impact of differing OST/NSP intervention coverage levels for reducing HCV infection prevalence, incidence and disease burden, and incremental cost-effectiveness ratios to measure the cost-effectiveness of current NSP provision versus no provision. Setting Cost-effectiveness analysis and impact modelling in three UK sites. The pooled analysis drew on data from the UK and Australia. The review was international. Participants PWID. Interventions NSP coverage (proportion of injections covered by clean needles) and OST. Outcome New cases of HCV infection. Results The review suggested that OST reduced the risk of HCV infection acquisition by 50% [rate ratio (RR) 0.50, 95% confidence interval (CI) 0.40 to 0.63]. Weaker evidence was found in areas of high (≥ 100%) NSP coverage (RR 0.77, 95% CI 0.38 to 1.54) internationally. There was moderate evidence for combined high coverage of NSPs and OST (RR 0.29, 95% CI 0.13 to 0.65). The pooled analysis showed that combined high coverage of NSPs and OST reduced the risk of HCV infection acquisition by 29–71% compared with those on minimal harm reduction (no OST, ≤ 100% NSP coverage). NSPs are likely to be cost-effective and are cost-saving in some settings. The impact modelling suggest that removing OST (current coverage 81%) and NSPs (coverage 54%) in one site would increase HCV infection incidence by 329% [95% credible interval (CrI) 110% to 953%] in 2031 and at least double (132% increase; 95% CrI 51% to 306%) the number of new infections over 15 years. Increasing NSP coverage to 80% has the largest impact in the site with the lowest current NSP coverage (35%), resulting in a 27% (95% CrI 7% to 43%) decrease in new infections and 41% (95% CrI 11% to 72%) decrease in incidence by 2031 compared with 2016. Addressing homelessness and reducing the harm associated with the injection of crack cocaine could avert approximately 60% of HCV infections over the next 15 years. Limitations Findings are limited by the misclassification of NSP coverage and the simplified intervention definition that fails to capture the integrated services that address other social and health needs as part of this. Conclusions There is moderate evidence of the effectiveness of OST and NSPs, especially in combination, on HCV infection acquisition risk. Policies to ensure that NSPs can be accessed alongside OST are needed. NSPs are cost-saving in some sites and cost-effective in others. NSPs and OST are likely to prevent considerable rates of HCV infection in the UK. Increasing NSP coverage will have most impact in settings with low coverage. Scaling up other interventions such as HCV infection treatment are needed to decrease epidemics to low levels in higher prevalence settings. Future work To understand the mechanisms through which NSPs and OST achieve their effect and the optimum contexts to support implementation. Funding The National Institute for Health Research Public Health Research programme.

show abstract

“…The majority of these inject illicit drugs [16][17][18][19][20][21][22][23][24][25][26][27][28][29] . In some societies it is still possible to contract HCV infection from the health care system as precautions to guarantee the safety of the blood supply and to ensure adequate sterilisation of re-used medical equipment are not and often cannot be implemented fully.…”

Section: Societal Attitudes To Those Most At Risk Of Acquiring Hcvmentioning

confidence: 99%

Controversies in and challenges to our understanding of hepatitis C

Batey¹

2007

WJG

View full text Add to dashboard Cite

Discovered in 1989, the hepatitis C virus (HCV) continues to cause significant morbidity and mortality world-wide despite a huge research commitment to defining and understanding the virus and the disease it causes. This paper discusses a number of areas where progress in the management of the HCV have not kept pace with the scientific understanding of the HCV. It is suggested that in the fields of HCV prevention and providing access to treatment, practice falls short of what could be achieved. The role of alcohol in the pathogenesis of HCV liver injury is discussed. Discrimination against those with HCV infection and particularly those in prison settings fails to match good clinical practice. The complicated processes of sharing information between specialty groups is also discussed in an attempt to optimise knowledge dissemination in this field.

show abstract

Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia

Cited by 201 publications

References 30 publications

Hepatitis C Virus Acquisition among Injecting Drug Users: A Cohort Analysis of a National Repeated Cross-sectional Survey of Needle and Syringe Program Attendees in Australia, 1995–2004

Hepatitis C Virus Acquisition among Injecting Drug Users: A Cohort Analysis of a National Repeated Cross-sectional Survey of Needle and Syringe Program Attendees in Australia, 1995–2004

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

Controversies in and challenges to our understanding of hepatitis C

Contact Info

Product

Resources

About