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

• Published in: Addiction (Abingdon, England) Vol. 106; no. 11; pp. 1978 - 1988
• Main Authors: Turner, Katy M. E., Hutchinson, Sharon, Vickerman, Peter, Hope, Vivian, Craine, Noel, Palmateer, Norah, May, Margaret, Taylor, Avril, De Angelis, Daniela, Cameron, Sheila, Parry, John, Lyons, Margaret, Goldberg, David, Allen, Elizabeth, Hickman, Matthew
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-11-2011; Blackwell
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Biological and medical sciences; Blood Diseases; Disease control; Disease Transmission, Infectious - prevention & control; Drug Abuse; Drug addiction; Drug use; Drug users; Epidemiologic Methods; Evidence; Female; Glasgow, Scotland; Harm Reduction; HCV; Hepatitis; Hepatitis C; Hepatitis C - epidemiology; Hepatitis C - prevention & control; Hepatitis C - transmission; Hepatitis C virus; Homelessness; Humans; Intervention; Male; Medical care; Medical sciences; Medical treatment; Meta-analysis; methadone; Methadone - therapeutic use; Miscellaneous; Narcotics - therapeutic use; needle and syringe programmes; Needle exchange programs; Needle Sharing - adverse effects; Needle Sharing - statistics & numerical data; Opiate Substitution Treatment; Opiates; Outcome Assessment (Health Care); Population; Prevention and actions; primary prevention; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression analysis; Risk; Sick Role; Substance abuse treatment; Substance Abuse, Intravenous - epidemiology; Substance Abuse, Intravenous - rehabilitation; Surveys; Systematic review; United Kingdom; United Kingdom - epidemiology; United Kingdom; Europe; United Kingdom > UK; British Isles, England, Avon, Bristol; British Isles, Wales; British Isles, England, Greater London, London; British Isles, Scotland, Glasgow; Human; Drug addiction; Replacement therapy; Intravenous administration; Illicit drug; Opiates; Methadone; Narcotic analgesic; needle and syringe programmes; Incidence; Virus; Prevention; Addiction; Needle; Syringe; primary prevention; opiate substitution treatment; HCV; Flaviviridae; Hepatitis C virus; Hepacivirus; Public health
• ISSN: 0965-2140; 1360-0443
• DOI: 10.1111/j.1360-0443.2011.03515.x

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.