Screening injecting drug users for sexually transmitted infections and blood borne viruses using street outreach and self collected sampling

Abstract

Background: Injecting drug users (IDUs) are a marginalised population, who infrequently access health services for screening for sexually transmitted infections (STIs) and blood borne viruses (BBVs), and are at high risk of these infections. Objectives: To use street outreach and self collection of samples for STI screening, to establish the prevalence of BBVs and STIs, and to identify risk behaviours among a group of culturally diverse street based IDUs. Methods: This was a cross sectional study of 314 IDUs in the central business district of Melbourne, Australia, conducted over 3 years (1999)(2000)(2001)(2002). We used street outreach as the recruitment strategy with staff ''on foot'' in injecting and dealing locations, as well as self collected genital sampling to increase acceptance of screening for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis by polymerase chain reaction (PCR). Individuals were screened for hepatitis A, B, and C, syphilis and HIV, and given the option of a self collected or clinician collected blood sample to increase acceptance of screening for BBVs. Results: Street outreach was highly effective and self directed STI sampling was more acceptable than practitioner directed sampling (76% versus 9% acceptance, p,0.001). There was a high prevalence of hepatitis C (74%, 95% CI 69 to 79), STIs (8% (5 to 13)), and chlamydia (6% (3 to 10)), and past exposure to hepatitis A and B was common. High rates of recent sharing of injecting equipment, unprotected sex and casual sexual partners, together with low levels of awareness of current hepatitis C infection were identified. Conclusion: Street outreach and self collected genital samples facilitate screening for STIs and BBVs in IDUs and revealed a high prevalence of infections and risk behaviours.

Prevalence of Hepatitis C virus infections among the general population of Buner, Khyber Pakhtunkhwa, Pakistan

“…The Hepatitis C European Network for C-operative Research (HENCORE) group had reported the prevalence of 80% hepatitis C among intravenous drug users (IVDU) (Touzet et al, 2000). There was 36.6% positivity of hepatitis C in the intravenous drug users in Sydney, Australia and 74% hepatitis C positivity in the intravenous drug users in Melbourne, Australia (Bradshaw et al, 2005;Maher et al, 2004). In the recent study in London, England, the 428 intravenous drug users were under the age of 30 having 44% antibodies to hepatitis C compared to 4% with HIV, this is the incidence of 41.8 cases per 100 persons (Judd et al, 2004).…”

Seroprevalence of Hepatitis C and factors associated with this in crack users

“…The use of psycho-active substances can make drug addicts less aware of or concerned about STDs (15) . In one randomized study, the prevalence of HCV antibodies was significantly (p≤0.001)…”

Sexually Transmitted Infections and Sexual Practices among Injecting Drug Users in Harm Reduction Centers in Catalonia

“…Studies among IDUs generally show a moderate prevalence of STIs, similar to that observed in the general population [13,14] . For example, a recent study carried out in Baltimore among IDUs aged under 30 years showed the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae to be 4 and 1.2%, respectively, and the prevalence of those infections from a population-based study was 3.0 and 5.3%, respectively [15] .…”