Signs of success latest national NESI data?

Transcription

1 Needle Exchange Surveillance Initiative Signs of success latest national NESI data? Alison Munro (University of the West of Scotland)

2 Study partners Professor Avril Taylor Chief Investigator (UWS) Dr Alison Munro (UWS) Professor David Goldberg (HPS*) Dr Sharon Hutchinson (HPS) Ms Norah Palmateer (HPS) * Health Protection Scotland

3 Today s presentation Policy context NESI study - aim, objectives and methods Sample characteristics Drug use and risk taking behaviours Uptake of services (HCV testing, methadone and sterile injecting equipment) HCV Incidence and prevalence Signs of success?

4 NESI: Policy context Actions to develop and improve services: Prevention Diagnosis Treatment

5 Hepatitis C Action Plan: prevention Evidence/Issues (mid 2000s) 1,500 PWID in Scotland infected annually Re-use/sharing of injection equipment still highly prevalent Widespread variations in provision of injection equipment Actions National guidelines for injection equipment provision Injection equipment services improved in accordance with guidelines Performance Indicator Prevalence & Incidence of HCV among PWID (NESI study)

6 NESI: AIM To evaluate and better target interventions aimed at reducing the spread of HCV among PWID (People Who Inject Drugs)

7 NESI: Objectives To determine prevalence of HCV and of injecting risk behaviours over time among PWID in Scotland To measure prevalence of HCV among recent initiates to injecting and to monitor changes in prevalence in this group over time To measure the uptake of harm reduction initiatives (methadone; HBV vaccination & HCV testing; uptake of injecting equipment paraphernalia) To estimate the prevalence of acute HVC infection among PWID and monitor changes in prevalence of acute HCV over time

8 NESI: Methods Cross-sectional voluntary anonymous survey PWID recruited at services in mainland Scotland providing injecting equipment and other harm reduction services Interviewer led 5-10 min questionnaire DBS taken & tested for HCV (Ab and PCR)

9 NESI questionnaire Age, gender, homelessness etc Methadone and other drug treatment Injecting history, frequency of injecting Injecting risk behaviours e.g. N/S re-use and sharing, other injecting equipment sharing HCV testing and treatment Use of injecting equipment provision (IEP) services and uptake of sterile equipment

10 NESI:2008/2009, 2010 & / Number of participants Number mainland NHS Boards Number of sites PWID (last 6 months) 80% 78% 83%

11 NESI sample characteristics 2008/ Gender male 72% 72% Age (mean) 33.4 yrs 34.5 yrs Age first injected 22.7 yrs 22.9 yrs Time since onset injecting (mean) 10.2 years 11.1 years

12 Drug use, injecting and injecting risk 2008/ Frequency of injecting (daily or more) 63% 54% Drugs injected: Heroin 96% 96% Cocaine 16% 9% Crack 6% 2% Injected with a used N/S last month 9% 6% Injected with used injecting equipment in last month 36% 29%

13 HCV testing and prescribed methadone 2008/ Ever tested HCV 74% 77% Tested in last 12 months 35% 38% Receiving methadone (6 months prior to interview) 72% 80%

14 % respondents reporting receipt of sufficient sterile injecting equipment N/S filters spoons water 2008/

15 Uptake of sterile injecting equipment (ISD, 2012) / / /11 N/S Filters Spoons/Co okers Water

16 HCV Prevalence and incidence HCV prevalence and incidence

17 HCV Prevalence (%) (2011 figure is provisional) / HCV Prevalence

18 HCV Incidence (rate) (2011 data is provisional) / HCV Incidence

19 Emerging evidence Uptake of sufficient volume of other injecting equipment significantly associated with lower risk of sharing equipment (Aspinall et al. In press). Analysis of pooled UK data (including NESI) shows evidence that uptake of OST and high coverage of n/s provision can substantially reduce the risk of HCV transmission among PWID (Turner et al, 2011). Further analysis of NESI data beginning to show that receiving methadone and acquiring/using new/sterile N/S significantly decreases the chances of becoming infected with HCV.

20 Summary - signs of success? NESI providing valuable data Impact of IEP guidelines is positive Increasing uptake of harm reduction services HCV incidence presently decreasing Emerging evidence that IEP is impacting on HCV incidence internationally important evidence No room for complacency

21 References Aspinall, E et al. (in press) Uptake of paraphernalia from injecting equipment provision services and its association with sharing of paraphernalia among injecting drug users in Scotland. Drug and Alcohol Dependence. ISD (2012) Injecting equipment provision in Scotland survey 2010/11. Misuse/Publications/ / Injecting-Equipment- Report.pdf Taylor, K (et al. (2011) 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. Addiction, 106, University West of Scotland et al. (2012) Needle Exchange Surveillance Initiative (NESI): prevalence of HCV and injecting risk behaviours among people who inject drugs attending injecting equipment provision services in Scotland, 2008/2009 & 2010.

22 Coming soon...