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

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2. establish the extent of co-infection of hepatitis C and hepatitis B 3. elucidate risk factors for hepatitis C infection 4. explore the effect of knowledge of previous hepatitis test results on behaviour 5. identify factors that predict sharing of equipment 6. establish a cohort for follow up and establish feasibility of monitoring hepatitis C infection among drug using populations using saliva samples (results not covered in this report). Key Findings and Recommendations This study has identified the following key findings and recommendations: • Among the 341 injecting drug users in this study, the prevalence of hepatitis C was 53.1% (181 people), hepatitis B 26.6% (89 people) and 19.0% (65 people) were co-infected with hepatitis C and B (Section 4.1). Although the study was relatively small, different areas of study recruitment provided different levels of hepatitis C infection, with those presenting to drugs services requesting a test or those in treatment with community drugs teams having the highest prevalence. Those who had been for a hepatitis C test before this study were 1.68 times more likely to be hepatitis C positive in this study, again suggesting that people presenting for tests are more likely to be hepatitis C positive (Section 4.4). Models of health impact of hepatitis C should consider potential variations in prevalence rates between settings and recognise that most studies to date have assessed those most at risk of infection. • We crudely estimate that there are around 30,200 drug users currently in contact with services in the North West. Using estimates of the proportion of these injecting drugs, and applying the hepatitis C prevalence of 53% found in this study, we estimate that there are 12,800 people currently chronically infected with hepatitis C. Of these, 2,600 will go on to develop serious liver damage (cirrhosis or hepatic carcinoma) (Section 5.1). This figure does not include the hidden population of drug users, previous or new users entering the drug-using population. Health Authorities should anticipate the increase in treatment costs associated with treating this high number of patients with liver damage over the next twenty years. H EPATITIS C IN INJECTING DRUG USERS IN THE N ORTH W EST 3
• Those who are infected with hepatitis C are four times more likely to also be infected with hepatitis B (Section 4.1). Co-infection increases the risk of progression to serious disease. Current hepatitis B vaccination programmes should attempt to protect people early in their drug injecting career before exposure to hepatitis C. • Having ever visited prison, and the number of prison stays, were both strong predictors of hepatitis C infection (Figure 1). Prison represents a potential injecting and non-injecting risk for hepatitis C. For example sharing of personal items such as razors may lead to infection, and those few study participants infected but not identified as injectors were more likely to have been in prison. More awareness of these other, albeit low risk, activities is needed generally but in particular in prisons. • Chaotic behaviours such as polydrug use (Figure 3), use of less commonly misused drugs (Section 4.3) and a longer history of injecting (Figure 2) all predicted hepatitis C infection. Harm reduction measures can be targeted at such high risk groups and predictors identified in this study can be used as indicators as to which populations or individuals are at most risk of infection or most likely to be infected. • Significant levels of sharing were revealed. Almost 40% had shared some form of injecting equipment over the previous four weeks, and 7% had shared needles (Table 4). Consistent with more chaotic behaviour, sharing injecting equipment is more likely to occur in those with polydrug use (Section 4.5). Also, sharing injecting equipment is most common in new injectors (those who have been injecting for up to five years) (Figure 5). Work is urgently needed to reach young vulnerable groups of drug users who have recently begun injecting or may progress to injecting drugs. Such work requires education on the risks of injecting to reduce high risk behaviours or ideally prevent them even before they begin. 4 H EPATITIS C IN INJECTING DRUG USERS IN THE N ORTH W EST
Page 1 and 2: Hepatitis C in injecting drug users
Page 3: S UMMARY Viruses such as HIV, hepat
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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