The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence.

Abstract

AIMS:

To investigate whether opiate substitution therapy (OST) and needle and syringe programmes (NSP) can reduce hepatitis C virus (HCV) transmission among injecting drug users (IDUs).

DESIGN:

Meta-analysis and pooled analysis, with logistic regression allowing adjustment for gender, injecting duration, crack injecting and homelessness.

SETTING:

Six UK sites (Birmingham, Bristol, Glasgow, Leeds, London and Wales), community recruitment.

PARTICIPANTS:

A total of 2986 IDUs surveyed during 2001-09.

MEASUREMENT:

Questionnaire responses were used to define intervention categories for OST (on OST or not) and high NSP coverage (≥100% versus <100% needles per injection). The primary outcome was new HCV infection, measured as antibody seroconversion at follow-up or HCV antibody-negative/RNA-positive result in cross-sectional surveys.

FINDINGS:

Preliminary meta-analysis showed little evidence of heterogeneity between the studies on the effects of OST (I2=48%, P=0.09) and NSP (I2=0%, P=0.75), allowing data pooling. The analysis of both interventions included 919 subjects with 40 new HCV infections. Both receiving OST and high NSP coverage were associated with a reduction in new HCV infection [adjusted odds ratios (AORs)=0.41, 95% confidence interval (CI): 0.21-0.82 and 0.48, 95% CI: 0.25-0.93, respectively]. Full harm reduction (on OST plus high NSP coverage) reduced the odds of new HCV infection by nearly 80% (AOR=0.21, 95% CI: 0.08-0.52). Full harm reduction was associated with a reduction in self-reported needle sharing by 48% (AOR 0.52, 95% CI: 0.32-0.83) and mean injecting frequency by 20.8 injections per month (95% CI: -27.3 to -14.4).

CONCLUSIONS:

There is good evidence that uptake of opiate substitution therapy and high coverage of needle and syringe programmes can substantially reduce the risk of hepatitis C virus transmission among injecting drug users. Research is now required on whether the scaling-up of intervention exposure can reduce and limit hepatitis C virus prevalence in this population.

• Authors: Katy M E Turner, Sharon Hutchinson, Peter Vickerman, Vivian Hope, Noel Craine, Norah Palmateer, Margaret May, Avril Taylor, Daniela De Angelis, Sheila Cameron, John Parry, Margaret Lyons, David Goldberg, Elizabeth Allen, Matthew Hickman
• Journal: Addiction (Abingdon, England) (Addiction) Vol. 106 Issue 11 Pg. 1978-88 (Nov 2011) ISSN: 1360-0443 [Electronic] England
• PMID: 21615585 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
• Copyright: © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Chemical References

• Narcotics
• Methadone

Topics

• Adult
• Disease Transmission, Infectious (prevention & control)
• Epidemiologic Methods
• Female
• Harm Reduction
• Hepatitis C (epidemiology, prevention & control, transmission)
• Humans
• Male
• Methadone (therapeutic use)
• Narcotics (therapeutic use)
• Needle Sharing (adverse effects, statistics & numerical data)
• Needle-Exchange Programs
• Opiate Substitution Treatment
• Outcome Assessment, Health Care
• Substance Abuse, Intravenous (epidemiology, rehabilitation)
• United Kingdom (epidemiology)