Transcript Document

Injecting drug use and blood borne virus
transmission in Wales: building the evidence base
Project team
ICDS
Dr Marion Lyons
Dr Noel Craine
Dr Mark Walker
Josie Smith
Zoe Couzens
HPA
Dr John Parry & Tamara Mcdonald
Imperial College
Dr Mathew Hickman
Cardiff University
Dr Barry Nix
Informing the blood borne virus strategy for Wales
Future burden of disease?
How effective are interventions to reduce transmission?
What service developments are needed across Wales?
Research into current prevention and service
development in Wales
qualitative study of needle and syringe exchange provision
(collaboration Imperial College London and WIRED)
- using grounded theory approach
– addressing barriers to NSE uptake and availability
South and West Wales - street recruited needs assessment
provision of HBV and HCV services in primary and
secondary health care settings across Wales
Prevalence and incidence of HCV, HBV and
HIV amongst IDUs
South Wales HCV Incidence Study – prospective cohort
study of injecting drug users
– determine factors behind the patterns of incidence
and prevalence
– provide baseline data to monitor impact of
intervention
– inform estimates of future disease burden
Sample sites and sample sizes
North West Wales Salivary Survey (153)
Merthyr (95)
Abergavenny (11)
Aberdare (9)
Treorchy (17)
Pontypridd / Rhydfelin (37)
Caldicott (17)
Swansea (97)
Newport (134)
Neath (31)
Bridgend (51)
Barry (15)
Cardiff (200)
Age profile of total sample of 717
160
120
n. of
individuals
80
40
0
16
20
24
28
32
age
36
40
44
48
52
56
Sample characteristics
male – 73%, female – 26%
54% of sample in substitution treatment
(proportion varied across sample)
100.0
90.0
80.0
70.0
60.0
% receiving substitution treatment
50.0
40.0
30.0
20.0
10.0
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Preliminary findings
• anti-HCV - 26.8% (95% CI 24%-30%)
• anti-HBc was 9.8% (95% CI 8%-12%)
• both markers together - 7%
• anti-HCV 6.1% (95% CI 2.1%-14.3%) amongst
injectors who had been injecting for one year or less.
• 539 HCV seronegatives for follow up
• no significant difference in prevalence between males
and females
HCV and HBV - age prevalence curves for all sample
(95%CI)
prevalence
age group
Duration of injecting, anti-HCV and anti-HBc
prevalence
Anti-HCV prevalence by site ordered West to East
(95%CI fitted)
Swansea
Cardiff
prevalence %
Mean anti-HCV prevalence
– all South Wales sample
(95%CI)
Merthyr Tydfil
sample site (West to East)
Between site comparison – duration of injecting
and HCV prevalence
HCV testing and HCV positives
25% of dried blood spot positives knew they were
positive from previous test
24% of dried blood spot positives reported a previous
negative test result
the remaining dried blood spot positives were either
untested, didn't know result or didn't know if they had
been tested
f
Ne
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or
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Ab
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ga
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dif
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Ba
idg
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Sw
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HBV vaccination across sample
100.0
90.0
80.0
70.0
60.0
50.0
40.0
mean
30.0
20.0
10.0
0.0
HBV vaccination of IDUs
• prisons 65%
• GPs 15%
• other drug services 8%
• GUM 7%
• other 5%
40% of anti-HBc positive individuals - vaccinated
The next stage
• follow up and re-sampling of cohort planned Dec / Jan
• include HIV testing at follow-up
• roll out of anonymous unlinked salivary monitoring
program
• look at the role of prisons
How can we use this research to reduce transmission?
early acquisition of infection
regional variation – highlights potential for prevention
baseline to assess impact of intervention
large scale peer education program – needle and
syringe sharing is common and needs to become rare
HCV – age group prevalence for Cardiff, Swansea
and Merthyr