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

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List of tables Table 1 Basic results 19 Table 2 Hepatitis C and B status as determined during this study 22 and recall of testing history in relation to contact type Table 3 Effects of risk factors on the prevalence of hepatitis C and 24 hepatitis B infection Table 4 Percentage of individuals sharing injecting equipment 27 (ever and in the previous four weeks) by current serostatus and test history Table 5 Percentage (number) of subjects using and injecting 28 each type of drug List of figures Figure 1 Percentage of injecting drug users with hepatitis C and B 23 infection against number of times individuals have been in prison Figure 2 Percentage of drug users infected with hepatitis C and B 25 against length of history of injecting drug use Figure 3 Percentage of injecting drug users with hepatitis C and B 26 infection against number of different drugs injected during lifetime Figure 4 Percentage of injecting drug users sharing injecting 30 equipment stratified by size of the group of fellow drug takers present when last injecting Figure 5 The percentage of injecting drug users sharing any 31 form of injecting equipment in the previous four weeks (needles, syringes or other paraphernalia), categorised by time since first injected H EPATITIS C IN INJECTING DRUG USERS IN THE N ORTH W EST 7
1. INTRODUCTION 1.1 Background Viruses such as the human immunodeficiency virus (HIV), hepatitis C and hepatitis B that are transmitted through blood pose a major health threat particularly for people who inject drugs. Amongst these viruses, hepatitis C represents a growing concern for several reasons. Firstly, previous studies in the UK and Ireland suggest that its prevalence is extremely high among injecting drug users (IDUs) (between 60% and 90%: Smythe et al.1998; Goldberg et al. 1998; Lamden et al. 1998; Best et al. 1999). Secondly, unlike for hepatitis A and B, no vaccine is as yet available, and the rapid mutation rate of the hepatitis C virus makes the imminent development of one unlikely (Liang et al. 2000). Thirdly, 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 carcinoma (Theodore & Fried 2000). Finally, current treatment is often ineffective, with even the most advanced treatment available clearing the infection on only 40% of occasions (Liang et al. 2000). Key objectives in the Government's ten year drug strategy Tackling Drugs to Build a Better Britain (1998) include increasing the number of users entering treatment programmes, reducing the number of young people using drugs and reducing the levels of injecting and sharing of equipment. If these targets are met, the number of new hepatitis C infections would decrease. However, currently there are large numbers of users in the North West who share equipment who are either infected with hepatitis C or at risk of infection (see Section 1.4). The exact scale of the problem is difficult to assess as individuals typically have many years of asymptomatic infection before presenting to health services with chronic disease. What is clear though, is that the high prevalence among IDUs currently accessing drug treatment services suggests considerable future health care costs in treating the expected associated rise in liver failure and associated morbidity (Leal et al. 1999), as well as the health and social costs of prolonged morbidity and disability to those infected with hepatitis C (Dolan 1997). 1.2 Transmission Hepatitis C is primarily transmitted through blood. Prior to screening of blood donations, recipients of blood transfusions or blood products were at risk of infection. As a result, an estimated 4000 haemophiliacs in the UK have been infected through blood products (The Haemophilia Society 1999) and the total number of people infected through blood or blood product transfusion and organ donation is estimated to be around 7500 (Syed & Snee 1997; CDSC North West 1999). The risk of infection through this route dropped dramatically with the introduction of effective heat treatment in 1986 (1987 in Scotland) (The Haemophilia Society 1999). The risk then dropped further with the introduction of hepatitis C antibody screening in 1991. The group now at the highest risk is IDUs. 8 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: C ONTENTS Summary 2 Aims 2 Key Find
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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