Syringe Exchange: Indicators of Need & Success March 2015

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Cynthia Copeland
5 years ago
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1 Syringe Exchange: Indicators of Need & Success March 2015 The recent outbreak of HIV in southern Indiana among injection drug users brings attention to the lack of a strong public health system in these communities. Syringe exchange programs (SEPs) are part of a comprehensive public health response to HIV and Hepatitis C. 1 Key indicators of need for SEPs include reported Hepatitis C, and injection drug use. CDC indicates that between 50-90% of people with HCV are coinfected with HIV. SEPs are cost Hepatitis C & Heroin Use: Surrogate Indicators Hepatitis C virus (HCV) has increased in Indiana since There have been 15,709 reported cases of acute and chronic HCV from Urban and rural communities are affected. Communities with state prisons may have additional public health system needs due to the number of HCV cases among prison populations. Heroin: From there was a significant increase in reported heroin use among Hoosiers (most recent trend data available). Of those admitted for substance abuse treatment, 9% reported heroin as their primary drug in This is significantly higher than in 2007 (2.9%). 3 Youth: In 2011, 2.9% of Indiana youth (9-12 th grades) reported using heroin at least once. 4 Nationally, there is evidence of an increase of HCV among young, heroin-injecting drug users who first used oral prescription opioid drugs. 5 effective, because they reduce Hepatitis C and HIV among injection drug users. Evidence-based programs link SEPs tightly with HIV testing, antiretroviral treatment and substance abuse treatment. Dr. Beth Meyerson, Rural Center for AIDS/STD Prevention, Indiana University School of Public Health- Bloomington Public Health System: Necessary for SEP Success Preventive health services such as HIV screening, HIV treatment and substance abuse treatment are critical components to SEPs. System investment is necessary. Prior to the outbreak, southern Indiana counties had limited access to HIV testing, HIV treatment and affordable substance abuse treatment (see inset). The closest infectious disease treatment clinic is in Louisville, KY. AIDS Resource Group, Evansville (testing & case management) Positive Link IU Health-Bloomington (testing & case management) Matthew 25, Evansville (testing) HIV Testing, Case Management and Treatment Resources in Region Posey Gibson Vanderburgh Knox Pike Warrick Bartholomew County Health Department (testing) Daviess Greene Martin Dubois Spencer Perry Monroe Brown Bartholomew Lawrence Orange Crawford Jackson Washington Harrison Floyd Scott Decatur County Health Department (testing) Jennings Clark Decatur Jefferson Franklin Ripley Dearborn Ohio Switzerland Clark County Health Department, Jeffersonville (testing & case management) Infectious Disease Clinic, Louisville Page 1 of 5

2 Acute and Chronic Hepatitis C in Indiana Counties An analysis of publicly available reported cases of acute and chronic HCV by county for 2011, 2012 and 2013 suggests the following: (see attached table) Both rural and urban communities are affected by HCV. Those in quartile 4 merit attention to their public health systems to assure early HCV and HIV screening; and linkage to HIV, HCV and substance abuse treatment. Counties with state prisons that report HCV cases likely have unique public health system needs to assure coordinated services. Rates of HCV (cases per 100,000 indicate more about the impact of HCV in communities than case counts do, and they allow comparison between and among communities. Scott County, the center of the current HIV outbreak, ranks among the top 3 counties for rates of acute and chronic hepatitis C. Wayne, Fayette and Henry counties, also in quartile 4, experienced a rapid increase of acute HCV among young injection drug users in early in Methodology The state of Indiana publishes combined reported cases for acute and chronic HCV by year for each county. While HCV case rates are usually calculated for acute HCV, both types are associated with HIV. Thus, rates for the combined acute and chronic reported cases were calculated per 100,000 population to allow for county comparison. Recommendations Separate analyses of county level reported acute and chronic Hepatitis C is recommended to allow comparison with the nationally published acute HCV annual rates. Identification of current HCV screening and reporting systems will be necessary to understand public health system capacity and preparedness. References: 1. Centers for Disease Control and Prevention. Syringe Exchange Programs United States Morbidity and Mortality Weekly Report (45); Indiana State Department of Health. Chronic and Acute Hepatitis C rates by county (Maps) 2011, 2012, Center for Health Policy, IUPUI. The Consumption and Consequences of Alcohol, Tobacco and Drugs in Indiana: A State Epidemiologic Profile Indiana Youth Risk Behavior Surveillance System (YRBSS), Klevens RM, Hu DJ, Jiles R, Holmberg SD. Evolving epidemiology of hepatitis C virus in the United States. Clin Infect Dis 2012;55(S1):S Gross BM, Emergence of Acute Hepatitis C in Young Injection Drug Users. Presentation at the 2013 Hepatitis Technical Assistance Meeting hosted by the National Alliance of State and Territorial AIDS Directors. Page 2 of 5

3 and Rates of Acute and Chronic Hepatitis C by Indiana County rate Quartile 1 Benton Newton Ohio Warren Whitley Wells Hamilton Steuben Noble* White Adams Posey Kosciusko Carroll Johnson* Huntington LaGrange Dubois Marshall Elkhart DeKalb St. Joseph* Porter Quartile 2 Pike Hancock Fountain Jasper Bartholomew Daviess Vermillion Knox Tippecanoe Orange Gibson Spencer Page 3 of 5

4 and Rates of Acute and Chronic Hepatitis C by Indiana County rate Quartile 2 (continued) Fulton Pulaski Clay Allen* Sullivan Cass* Decatur Owen Boone Harrison Crawford Quartile 3 Wabash* Franklin Warrick Lake Starke Monroe Greene Shelby Rush Perry* Floyd Ripley Morgan Jefferson* Washington Switzerland Howard Tipton Grant Clinton Lawrence Marion* Montgomery Page 4 of 5

5 and Rates of Acute and Chronic Hepatitis C by Indiana County rate Quartile 4 Madison* LaPorte* Brown Union Clark* Martin Miami* Jackson Vanderburgh Dearborn Randolph Jay Putnam* Delaware Henry* Jennings Vigo Wayne Blackford Fayette Scott Hendricks* Parke* Indiana *Includes cases reported from Indiana Department of Corrections facilities in these counties **Annual rates for counties with suppressed cases (less than <5) were not calculated ***Hepatitis C case counts published by the state of Indiana include combined reported acute and chronic hepatitis C cases Page 5 of 5

Governor s Commission for a Drug-Free Indiana. Commission s Purpose. Local Coordinating Councils 10/18/2013

Governor s Commission for a Drug-Free Indiana Presented By: Indiana Criminal Justice Institute Substance Abuse Services Division Commission s Purpose Strengthen Local Coordinating Councils (LCCs) and assist