norah palmateer, sharon hutchinson, avril taylor, elizabeth allen, syed ahmed and david goldberg

Trends in injecting risk behaviour and HCV prevalence among

injecting drug users in Glasgow, 1999-2007

Norah Palmateer, Sharon Hutchinson, Avril Taylor, Elizabeth Allen, Syed Ahmed and David Goldberg

SDF Seminar, 27th March 2009

Overview

• Why Glasgow• Historical HCV data• Current trends in injecting and

HCV (1999-2007)

Greater Glasgow (1%)

Prevalence of current injecting drug use in Scotland (2003)

(Hay et al., 2005)

Prevalence of HCV among current IDUs in Scotland (1999-

2000)

0

10

20

30

40

50

60

70

Arg

yll &

Cly

de

Ayr

shir

e &

Arr

an

Bor

der

s

Dum

frie

s &

Gal

low

ay

Fif

e

For

th V

alle

y

Gra

mpi

an

Gre

ater

Gla

sgow

Hig

hla

nd

Lana

rksh

ire

Loth

ian

Ork

ney

Isle

s

Shet

land

Isl

es

Tay

side

Wes

tern

Isl

es

Health Board

Prev

alen

ce H

CV a

ntib

ody

+ve

curr

ent

IDU

s (%

) Scotland ----------

HCV prevalence among recent onset IDUs (aged <25 years) who had a named HIV test

in Scotland

19901990 19921992 19941994 19961996 19981998 20002000

00

2020

4040

6060

8080

100100

Year testedYear tested

GlasgowGlasgow

LothianLothian

TaysideTayside

GrampianGrampian

Pre

vale

nce

(%

)P

reva

len

ce (

%)

Incidence of HCV Incidence of HCV amongamong IDUs in IDUs in GlasgowGlasgow

RegionRegion MethodMethod SampleSample YearsYears NN HCV incidence HCV incidence per 100 p-yrsper 100 p-yrs

(95% CI)(95% CI)

Greater Greater Glasgow Glasgow (GG)(GG)

UATUAT IDUs with IDUs with 2 2 named HIV testsnamed HIV tests 1993-981993-98 3131 28 28 (16-51)(16-51)

VATVATCommunityCommunity-wide -wide surveyssurveys

Current IDUs, Current IDUs, who had started who had started injecting in the injecting in the previous 5 yrsprevious 5 yrs

1990-931990-93

1994-961994-96

19991999

550550

173173

283283

2828 (25-31) (25-31)

2121 (17-26) (17-26)

25 25 (21-30)(21-30)

Current trends, 1999-2007• Data

– Size of population at risk– Prevalence of injecting risk behaviour– Prevalence of HCV infection

• Data sources– Drug treatment agency reports– Community-wide surveys – Capture-recapture studies– Surveillance programme (unlinked anonymous)

Size of injecting population

0

2000

4000

6000

8000

2000 2003

7,200

(6,100-8,600)

4,900

(4,400-5,500)

(Hay et al., 2005)

Risk behaviours – injecting at least daily (last 6 months)

0

20

40

60

80

100

(Community-wide surveys)

Risk behaviours – sharing needles/syringes (previous

month)

0

20

40

60

80

100

1999 2000 2001 2002 2003 2004 2005 2006 2007

Shared n/s

(Drug Misuse Statistics Scotland, ISD)

Risk behaviours – sharing needles/syringes and other injecting paraphernalia (previous

month)

0

20

40

60

80

100

1999 2000 2001 2002 2003 2004 2005 2006 2007

Shared n/s Shared paraphernalia

(Drug Misuse Statistics Scotland, ISD)

HCV prevalence among IDUs aged <25, Glasgow

0

20

40

60

80

100

(n=181) (n=162) (n=41)

(n=36)

IDUs aged <25 (UAT)IDUs injecting 5 yrs or less (community surveys)

Incidence of HCV Incidence of HCV amongamong IDUs in IDUs in GlasgowGlasgow

RegionRegion MethodMethod SampleSample YearsYears NN HCV incidence HCV incidence per 100 p-yrsper 100 p-yrs

(95% CI)(95% CI)

Greater Greater Glasgow Glasgow (GG)(GG)

UATUAT IDUs with IDUs with 2 2 named HIV testsnamed HIV tests 1993-981993-98 3131 28 28 (16-51)(16-51)

VATVATCommunityCommunity-wide -wide surveyssurveys

Current IDUs, Current IDUs, who had started who had started injecting in the injecting in the previous 5 yrsprevious 5 yrs

1990-931990-93

1994-961994-96

19991999

2001-022001-02

2004-052004-05

550550

173173

283283

385385

251251

2828 (25-31) (25-31)

2121 (17-26) (17-26)

2525 (21-30) (21-30)

29 29 (26-33) (26-33)

2929 (25-34) (25-34)

Numbers of HCV-infected current IDU aged <25, Glasgow

YearNo. current

IDU aged <25

HCV Prevalence

among <25s

No. HCV-infected current IDU aged <25 p

2000 2300 (1836-2797)

41 (34-48)

943 (698-1208)

<0.01

2003 1031 (851-1198)

42 (34-50)

433 (328-540)

Summary and limitations

• Collated data to present an overall picture• Limitations

– HCV incidence estimates– Self-reported injecting risk behaviour

• Some evidence that the frequency of injection has declined

• Unclear evidence relating to injecting risk• No evidence that the rate of new HCV infections

in declining…but evidence for a decline in the absolute number of HCV infections

What next…

• Hepatitis C Action Plan– Major investment in HCV prevention

services…will this have an impact?• Continued monitoring

– Needle Exchange Surveillance Initiative (NESI) • HCV prevalence/incidence• Injecting risk behaviour

– Unlinked Anonymous HCV testing • HCV prevalence