Transcript Presentation - Canadian Public Health Association

A Profile of People Who Inject
Drugs in London, Ontario
Report on the Public Health Agency of Canada
I-Track Survey, Phase 3
Canadian Public Health Association
May 28, 2014
Authors:
Hilary Caldarelli BSc MPH
Alison Locker BSc MSc
Bryna Warshawsky MDCM MHSc CCFP FRCPC
Overview
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Background
Methods
Selected results
Limitations
Summary and local next steps
Acknowledgements
BACKGROUND
The Middlesex-London Region
• Population 439,151 (2011 Census)
– City of London: 366,151
– Remainder of Middlesex County: 73,000
• SW Ontario along the Windsor-Quebec
City corridor
– Approximately 2 hour drive from Windsor
and Toronto
What is the I-Track Survey?
• Survey of people who inject drugs
developed and led by Public Health Agency
of Canada (PHAC)
– Behavioural and biological surveillance
• Occurs regularly at sentinel sites
– Middlesex-London Health Unit participated for
first time in 2012, during Phase 3 (2010-2012)
Why is I-Track Important?
• Injection drug use is an important risk factor
in acquiring hepatitis C and HIV
• People who use injection drugs are a
vulnerable population
• Middlesex-London had a significantly higher
incidence of hepatitis C compared to Ontario
– 2010: 53.4 per 100,000 population vs. 33.1 per
100,000 in ON
METHODS
How were I-Track Survey
Participants Interviewed?
• The Health Unit partnered with Regional
HIV/AIDS Connection (RHAC)
• Face to face interview
– Participants recruited and interviewed through
RHAC needle and syringe exchange program
(NEP) in January to February 2012
– Approximately 80 questions in 6 topic areas
Who Was Eligible to Participate?
• Had injected drugs in the past 6 months
• ≥ 16 years of age
• Able to provide informed consent
• Able to speak English or French
• Had not already participated in Phase 3 of
the I-Track survey
SELECTED I-TRACK SURVEY
RESULTS
LONDON, 2012
Demographics
Sex and Age
Participants
Male
Female
Age (mean)
London
204
73.5%
26.5%
36
National
2,687
68.2%
31.8%
39
Demographics (cont’d)
Characteristic
< $1,000 / month income
Unstable housing
Incarcerated in past
6 months
London
43.8%
56.9%
20.1%
National
54.1%
38.7%
11.5%
• Unstable housing and recent incarceration
higher in London sample than national sample
Selected Drugs Injected in Past 6 Months
Drug
London
National
Percent (rank) Percent (rank)
Non-prescribed
morphine
75.5% (1)
47.0% (3)
Hydromorphone
(Dilaudid)
75.5% (1)
47.2% (2)
Oxycontin / Oxycodone
69.1% (3)
37.7% (4)
Methamphetamine
68.1% (4)
Not available
Ritalin
66.2% (5)
Not available
Cocaine
58.3% (6)
64.3% (1)
Crack
49.0% (7)
24.8% (6)
Heroin
17.2% (8)
26.7% (5)
Injection Risk Behaviours
Behaviour in past six
months
Borrowed needles
Borrowed any other injection
equipment (e.g. water,
cookers)
Lent needles to others
Lent any other injection
equipment
London
National
19.6%
42.9%
15.5%
34.5%
26.6%
43.6%
15.5%
33.1%
• Borrowing and lending needles and
equipment higher in London sample than
national sample
Hepatitis C and HIV Prevalence
Hepatitis C
HIV
Unaware HIV positive
London
79.1%
5.5%
60% (6/10)
National
68.0%
10.9%
21.4%
• London sample has higher hepatitis C prevalence
rates, but lower HIV prevalence rates compared
to the national sample
Hepatitis C and HIV Prevalence Rates in I-Track
vs. General Canadian Population
LIMITATIONS, SUMMARY AND
LOCAL NEXT STEPS
Limitations
• Non-random convenience sample
– Hard to reach population
• Self-reported
– Leveraged existing relationships between
interviewers and participants to minimize
social desirability bias
• Other potential biases
– Recall, selection
Summary
• Active local population of people who
inject drugs with a high prevalence of
hepatitis C and HIV
• Opioid drugs were most commonly
injected
• Higher prevalence of injection risk
behaviours compared to national
sample
Local Next Steps
• Overview of local withdrawal management
services and needle disposal and recovery
– Assess NEP services in County area
• Additional reporting on impacts of drug use
in Middlesex-London
• Collaborate with municipal and community
partners to develop a comprehensive
community drug strategy
Acknowledgements
• Survey participants
• Regional HIV/AIDS Connection (RHAC)
• Public Health Agency of Canada (PHAC)
Thank you!
A Profile of People Who Inject
Drugs in London, Ontario
Report on the Public Health Agency of Canada
I-Track Survey, Phase 3
Canadian Public Health Association
May 28, 2014
Authors:
Hilary Caldarelli, BSc MPH
Alison Locker, BSc MSc
Bryna Warshawsky, MDCM MHSc CCFP FRCPC