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Prevention of Hepatitis C in Injecting Drug Users : the Impact of Screening for Hepatitis C and the

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Title: Prevention of Hepatitis C in Injecting Drug Users : the Impact of Screening for Hepatitis C and the


1
Prevention of Hepatitis C in Injecting Drug
Users the Impact of Screening for Hepatitis C
and the Effect of Treatment
  • Mohammed T Abou-Saleh,
  • WPA Section on Biological Psychiatry, St Georges
    Hospital Medical School, University of London ,UK

2
Scope
  • Epidemiology of Hepatitis C in drug users
  • Preventive strategies
  • Developing preventive counselling ( DH RCT)
  • Effect of treatment
  • Screening and testing (NTA Study)
  • Recommendations
  • Conclusions

3
Epidemiology of Hepatitis C in drug users
  • Prevalence of HCV in 66 studies in Europe 37-98
    ,England 80-86 ,Scotland 37-90
  • Rates of sharing injecting equipment 70-94
  • Hunter et al (2000) in 1241 IDUs sharing rate in
    past 4 weeks increased from 52 in response to a
    single question to 78 with multiple and detailed
    questions

4
Preventive strategies
  • Screening for Hepatitis C
  • Harm reduction needle exchange schemes
  • Demand reduction treatment of drug addictions
  • Early detection and Hepatitis C treatment

5
Developing preventive counselling
  • Stay Safe Therapy
  • the efficacy of enhanced counseling in the
    primary prevention of Hepatitis C among injecting
    drug users A randomised controlled trial
  • Simple Educational Counselling

6
Developing preventive counselling
  • Enhanced Prevention Counselling Stay Safe
    Therapy

7
Outcome Sero-conversion
  • At 12 months SST (10) SEC (25)
  • Incidence overall 18.5 per 100 person years

8
Outcome analysis
  • Addiction Severity Index, injecting (from 100
    to 20)
  • sharing IV equipment (from 62 to 16), ce
  • Hep C knowledge increased

9
Screening and testingfor Hepatitis C
  • Conventional blood testing
  • Saliva
  • Dried blood test
  • Previous study (with known positives and
    negatives) found 100 sensitivity and specificity
    of DBS test
  • More acceptable alternative to serum testing to
    many drug users
  • Useful with drug users with damaged veins, fear
    of needles, trouble keeping appointment with
    phlebotomist

10
Dried blood spot test
  • 6-fold increase in testing

11
National Treatment Agency Study
  • Objectives
  • To employ the DBS testing technique in Community
    Drug Teams (CDTs) in South West London, Needle
    Exchange and in prison by staff trained in the
    administration of the test.
  • To offer IDUs the option of obtaining a DBS
    sample themselves at their place of residence as
    an innovative way of delivering testing in the
    community.
  • To demonstrate an increase in rate of testing
    over more conventional methods, and also an
    increase in the availability of testing in
    alternative settings.

12
Methodology
Licensed User
Licensed User
  • 437 clients were tested
  • Levels of HCV testing were averaged for a 3 month
    period in 2003.
  • Referral pathways for all centres were
    established before testing commenced.

13
Results
  • The overall prevalence rate was found to be
    27.9, which varied from 14.8 in to 43.1
  • None of those who had never injected were found
    positive.
  • 35.8 had never been tested before.

14
Pathways to Care
15
Recommendations
  • The prevention of HCV in IDUs could be achieved
    by
  • Increasing the provision and capacity for HCV
    testing using the DBS. Optimally incorporated
    into the routine assessment with pre and post
    test counselling.
  • Providing needle exchange schemes
  • Providing prevention counselling to
    sero-negative IDUs to enable them to minimize the
    risk of contracting HCV optimally provided in
    treatment settings
  • Regular monitoring of HCV status with
    reinforcement of safe injecting and harm
    reduction approaches which could also identify
    incident infections where early treatment results
    in clearance of virus in more than 90 of cases.

16
CONCLUSIONS
  • Increasing the provision of testing for HCV in
    IDU's has important implications for the
    reduction in the rate of infection, in addition
    to the effects of treatment.
  • Our previous study using the DBS showed a lower
    incidence rate of HCV in treatment settings (18)
    (Abou-Saleh and John, 2003) compared with those
    not engaged in treatment (42) (Judd et al,
    2005).
  • Studies suggest that receiving a negative result
    can lead to or reinforce safe injecting practice
    (Craine et al., 2004, Wadd, 2001) and that
    knowledge of HCV status can reduce the risk of
    transmission (Best et al, 1999).
  • The impact of pre- and post-test counseling on
    change in risk behaviour is worthy of further
    investigation.
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