9261 HEPATITIS C REPORT GALLEY - North West Public Health ...

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Hepatitis C in injecting drug users in the North West A Multi-Agency Study Penny A. Cook, Jim McVeigh, Apurva Patel, Qutub Syed, Ken Mutton and Mark A. Bellis Published by Public Health Sector School of Health and Human Sciences Liverpool John Moores University 70 Great Crosshall Street Liverpool L3 2AB Tel: +44 (0151) 231 4316 Fax: +44 (0151) 231 4320 e-mail: p.a.cook@livjm.ac.uk August 2000 ISBN 1-902051-19-X British Library Cataloguing in Publication Data A Catalogue record for this book is available from the British Library H EPATITIS C IN INJECTING DRUG USERS IN THE N ORTH W EST
S UMMARY Viruses such as HIV, hepatitis C and hepatitis B that are transmitted in the blood pose a major health threat for people who inject drugs. Hepatitis C is a particular cause for concern for several reasons. Firstly, its prevalence is extremely high among injecting drug users (IDUs) (reported levels range between 60 - 80%). Secondly, no vaccine is as yet available, and the rapid mutation rate of the virus makes the imminent development of one unlikely. Thirdly, treatment is often ineffective, with even the most advanced treatment available clearing the infection on only 40% of occasions. Finally, a high proportion of cases (around 80%) become chronically infected, and of these, around 20% go on to develop serious liver damage, such as cirrhosis or hepatic carcinomas. Because individuals can have many years of asymptomatic infection before presenting to health services with chronic disease, the scale of the problem is hard to assess. Moreover, in IDUs infection with multiple strains of hepatitis C or co-infection with hepatitis B or HIV is common, and this exacerbates damage to the liver. In the wake of the HIV crisis and the provision of needle exchange schemes, IDUs reduced the levels of high risk sharing behaviour. However, hepatitis C is much more efficiently transmitted in small amounts of blood, and infections occur via indirect sharing of other injecting paraphernalia. At present there is no national strategy for the screening and treatment of IDUs. Treatment requires a high level of compliance, and has unpleasant side effects such as depression. Since IDUs often display chaotic behaviour, they are generally not considered suitable for treatment. However, taking a hepatitis C test and the counselling that accompanies it may represent an opportunity for addressing risk behaviours and possibly stabilising drug use. Aims Reviewing current knowledge about hepatitis C epidemiology reveals a number of factors that are at present unmeasured but necessary to implement effective and economic policies for hepatitis C prevention and treatment. Key amongst these is the level of infection in wider drug injecting communities in the North West (not just those requesting a test or in treatment at specialist drug agencies). Equally however, additional data are needed on the risk behaviours associated with infection and information is required on whether and how individuals change such behaviour once aware of their hepatitis C serostatus. Consequently, a group of IDUs in the North West were recruited in order to: 1. compare the prevalence of hepatitis C among drug users accessing different types of service, and among drug users not accessing services 2 H EPATITIS C IN INJECTING DRUG USERS IN THE N ORTH W EST
Page 1: Hepatitis C in injecting drug users
Page 5 and 6: • Those who are infected with hep
Page 7 and 8: C ONTENTS Summary 2 Aims 2 Key Find
Page 9 and 10: 1. INTRODUCTION 1.1 Background Viru
Page 11 and 12: where sexual partners do get infect
Page 13 and 14: ehaviour at some stage in their dru
Page 15 and 16: likely to use a condom and less lik
Page 17 and 18: 2. AIMS AND O BJECTIVES Reviewing c
Page 19 and 20: 3.3 Testing Subjects gave blood and
Page 21 and 22: Table 1b: Basic results: behaviours
Page 23 and 24: Table 2: Hepatitis C and B status a
Page 25 and 26: Table 3: Effects of risk factors on
Page 27 and 28: Figure 3: Percentage of injecting d
Page 29 and 30: Table 5: Percentage (number) of sub
Page 31 and 32: 4.5 Predicting sharing behaviour Pe
Page 33 and 34: 4.6 Blood donation Of those who had
Page 35 and 36: 5.2 Co-infection between hepatitis
Page 37 and 38: sharers were significantly more lik
Page 39 and 40: 5.8 Conclusions and Recommendations
Page 41 and 42: R EFERENCES Allory Y, Charlotte F,
Page 43 and 44: Hepatitis Information Network (2000
Page 45 and 46: Tagger A, Donato F, Ribero ML, Chie

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