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

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• 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. • A previous positive result for hepatitis C did not appear to result in a change in sharing behaviour (Section 4.4). However, those who had presented for previous tests were more likely to be reformed sharers (i.e. not currently sharing). This may be because counselling received at the time of the test was successful in reducing subsequent risk behaviour regardless of the actual results of the test. However, it may relate to those asking for a test already having decided to protect their health. Further work should examine in more detail the links between hepatitis C testing and the identified reduction in sharing behaviour. • Sharing injecting equipment is more likely to occur in smaller groups of fellow users (Figure 4), possibly because the user feels safe among friends or with a partner. The high prevalence of hepatitis C in drug users in the North West means sharing with anyone carries a high risk of hepatitis C infection. Information about the risks of sharing should stress this includes close friends and sexual partners. Health information should also help users address the problems around refusing to share with a partner. H EPATITIS C IN INJECTING DRUG USERS IN THE N ORTH W EST 39
R EFERENCES Allory Y, Charlotte F, Benhamou Y, Opolon P, Le Charpentier Y, Poynard T (2000) Impact of human immunodeficiency virus infection on the histological features of chronic hepatitis C: a case-control study. Human Pathology 31: 69-74. van Beek I, Dwyer R, Dore GJ, Luo K, Kaldor JM (1998) Infection with HIV and hepatitis C virus among injecting drug users in a prevention setting: retrospective cohort study. British Medical Journal 317: 433-437. Bellis MA, Weild AR, Beeching NJ, Mutton KJ, Syed Q (1997) Prevalence of HIV and injecting drug use in men entering a Liverpool Prison. British Medical Journal 315: 30-31 Best D, Noble A, Finch E, Gossop M, Sidwell C, Strang J (1999) Accuracy of perceptions of hepatitis B and C status: cross sectional investigation of opiate addicts in treatment. British Medical Journal 319: 290-291. Birtles R, Bellis MA (2000) Drug services in Merseyside and Cheshire 1999: prevalence and outcomes. Liverpool John Moores University. Birtles R, Bellis MA, Millar T, Domnall M (1998) Drug misuse and the criminal justice system in the North West of England 1996. North West Drug Misuse occasional paper, issue number 1/98, University of Liverpool and University of Manchester. Birtles R, Bellis MA, Millar T, Domnall M (1999) Drug misuse in the North West of England 1998. Liverpool John Moores University and Manchester University. Bodsworth NJ, Cunningham P, Kaldor J, Donovan B (1996) Hepatitis C virus infection in a large cohort of homosexually active men: independent associations between HIV-1 infection and injecting drug use but not sexual behaviour. Genitourinary Medicine 72: 118-122. Brackmann SA, Gerritzen A, Oldenburg J, Brackmann HH, Schneweis KE (1993) Search for intrafamilial transmission of hepatitis C virus in haemophiliac patients. Blood 81: 1077-1082. Broers B, Junet C, Bourquin M, Déglon J-J, Perrin L, Hirschel B (1998) Prevalence and incidence rate of HIV, hepatitis B and C among drug users on methadone maintenance treatment in Geneva between 1988 and 1995. AIDS 12: 2059-2066. CDSC North West (1999) Policy Directory of the North West Communicable Disease and Environment Group (NWCDEG). Chapter 18, Hepatitis C. Coutinho (1998) HIV and hepatitis C among injecting drug users. British Medical Journal 317: 424-425. Crampin AC, Lamagni TL, Hope VD, Newham JA, Lewis KM, Parry JV, Gill ON. (1998) The risk of infection with HIV and hepatitis B in individuals who inject steroids in England and Wales. Epidemiology and Infection 121: 381-386. Crofts N, Hopper JL, Bowden DS, Breshkin AM, Milner R, Locarnini SA (1993) Hepatitis C virus infection among a cohort of Victorian injecting drug users. Medical Journal of Australia 159: 237-241. 40 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 and 4: S UMMARY Viruses such as HIV, hepat
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: 5.8 Conclusions and Recommendations
Page 43 and 44: Hepatitis Information Network (2000
Page 45 and 46: Tagger A, Donato F, Ribero ML, Chie

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