Syringe Exchange An Intervention that Works to Control the Spread of Hepatitis C and HIV Wayne Crabtree Administrator, Louisville Metro Department of Public Health and Wellness According to the CDC Kentucky has the nation's highest rate of acute hepatitis C with a rate of 5.1 cases in 2013 and 4.0 in 2014 per every 100,000 people compared to the national rate of 0.7. Cases of acute hepatitis C increased by 240% between 2009 and 2013 More than 56,000 Kentuckians may have chronic hepatitis C infection, according to the Cabinet for Health and Family Services. According to the CDC the primary cause of hepatitis C is sharing needles among people who inject drugs (PWID). A recent CDC study found that hepatitis C cases across four Appalachian states -- Kentucky, Tennessee, West Virginia, and Virginia -- more than tripled between 2006 and 2012. The study is the first from the CDC to link the rise in hepatitis C to an increase in injection drug use. 1
A syringe exchange is an evidence-based intervention to prevent the spread of hepatitis C, HIV and other blood borne diseases. Hepatitis C among PWIDs dropped nearly 40% in New York city after widespread implementation of syringe exchanges. A 2005 study found that HIV rates decreased by nearly 6% in cities that had syringe exchange programs compared to a national increase of nearly 6% per year. Definition A syringe exchange is: A public health intervention for people who inject drugs It provides new, sterile syringes and HIV prevention supplies. It also provides a means to dispose of used and potentially contaminated syringes Syringe exchanges have been proven to reduce the spread of HIV, hepatitis C and other blood-borne infections An evidence-based practice to connect people who inject drugs to: Counseling and treatment Testing for hepatitis C, HIV, and other infections Education about the harms associated with drug use and how to minimize them Safe disposal of contaminated equipment 2
There are syringe exchange programs in about 230 cities across America. Syringe exchange programs can lead people who inject drugs to seek testing, counseling and treatment. Syringe exchange programs bring PWID in contact with the health system where they can be tested for hepatitis C and HIV and, if positive, be treated. Syringe exchange programs can make drug treatment options known to addicted individuals. Studies show that program participants are five times more likely to enter drug treatment than those who do participate in syringe exchange programs. Syringe exchange programs do not lead to increased drug use in the cities that implement them. Many scientific studies, including a Surgeon General s report, show that syringe exchanges do not increase drug use when conducted with referrals to both drug treatment and hepatitis C and HIV testing, medical care and support services. 3
Syringe exchange programs reduce the number of contaminated needles in the streets and parks. Syringe exchange and disposal programs actually encourage individuals to bring back used syringes to trade them in at the syringe exchange site. A study published in the American Journal of Public Health showed that San Francisco s syringe exchange program reduced the risk from infectious syringes left by injection drug users. The study was based on a survey of more than 600 injection drug users and a visual inspection of 1,000 city blocks in areas heavily trafficked by drug users. Why Did Louisville Establish Its Syringe Exchange Program? Austin Indiana just 35 miles from Louisville had 181 new HIV cases as a result of needle sharing among people who inject drugs. About 86% of those infected with HIV in Austin also have hepatitis C. 4
In a city the size of Louisville that would proportionately mean more than 27,100 new hepatitis C and 31,600 new HIV cases. In a state the size of Kentucky that would proportionately mean 158,000 new hepatitis C cases and almost 184,000 new HIV cases. To prevent the spread of hepatitis C and HIV and to link people to the health system where they can get drug treatment, the Metro Council and the Board of Health approved the Louisville Metro Syringe Exchange Program We opened June 10, 2015. And so far it s working! 5
Program Goals 1. To prevent the spread of blood-borne diseases spread by needle sharing such as hepatitis C and HIV. 2. To link people who inject drugs to the health system where they can get treatment. The Louisville Metro Syringe Exchange provides: Free sterile syringes Sharps containers to safely return used syringes Hepatitis C testing Referral to Hepatitis C treatment HIV testing and prevention supplies Referral to HIV treatment Referrals for addiction treatment Education and counseling on STD prevention, wound treatment and syringe disposal Naloxone on-site and referrals for the take home use of naloxone A Certified Alcohol and Drug Counselor (CADC) provides staffing for the site in addition to a Health Educator. The Seven Counties Services, Inc., Jefferson Alcohol and Drug Abuse Center (JADAC) has assigned a full time addictions treatment case manager: Works with participants on drug treatment options Makes treatment referrals 6
We have contracted with Volunteers of America, Mid-States to provide community outreach. This month our main syringe site will move from an RV parked outside our Gray Street headquarters in downtown Louisville to refurbished space inside the building. This site is open six days a week. We have also opened two community sites that are each open one day a week. Participants in the Louisville Metro Syringe Exchange Program have come from every Zip Code in Jefferson County as well as from surrounding Zip Codes in Indiana and Kentucky 7
In fact, participants have come from throughout central Kentucky as well as from far eastern and far western Kentucky. We use the Needs Based Exchange Model. More and more syringes are being returned each week as participants come to trust the program. The ratio of sterile syringes distributed to used syringes returned has narrowed each week from a high of 8.3 to 1 in June, 2015 to 1.7 to 1 in June 2016. Returning clients are bringing back 74% of their syringes. The program is working! Through June 4, 2016 the Louisville Metro Syringe Exchange Program has: Had 3,603 participants with 1691(47%) returning participants. Tested 312 people for hepatitis C. Tested 138 people-hepatitis C preliminary + in LMSEP. Referred 202 people for hepatitis C treatment. Tested 371 people for HIV. Tested 2 people for HIV that were preliminary + in LMSEP. Referred 10 people for HIV treatment. Referred 215 people for drug treatment. Prevented the same sort of outbreak of hepatitis C and HIV that occurred in Austin Indiana. 8
Questions? Contact Info Wayne Crabtree Administrator Louisville Metro Department of Public Health and Wellness Email: Wayne.Crabtree@louisvilleky.gov Office: 502-574-8328 9