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  • Injection of new psychoactive substance snow blow associated with recently acquired HIV infections among homeless people who inject drugs in Dublin, Ireland, 2015

    Posted on October 9th, 2015 TimB No comments

    In February 2015, the Department of Public Health (DPH), Health Service Executive (HSE) in Dublin, Ireland, identified an unexpected increase in cases of acute HIV infection among people who inject drugs (PWID); three cases were diagnosed p24 antigen-positive in January and February 2015, compared with two cases diagnosed during the whole year in 2014 [1]. Drug treatment clinicians had also identified increased use of a new psychoactive substance (NPS) alpha-pyrrolidinovalerophenone (?-PVP), known as snow blow, which was being used by ‘chaotic’ PWID, and which they suspected might be linked to the increase [2]. Clinicians defined the chaotic group as homeless PWID who, if on opioid substitution treatment (OST), required daily attendance at their treatment programme, due to continued use of a variety of other illicit substances in an intensive or chaotic way. We undertook an epidemiological investigation to identify the likely source of this increase.

     

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  • Rapid Decline in HCV Incidence among People Who Inject Drugs Associated with National Scale-Up in Coverage of a Combination of Harm Reduction Interventions

    Posted on August 21st, 2014 TimB No comments

    Government policy has precipitated recent changes in the provision of harm reduction interventions –injecting equipment provision (IEP) and opiate substitution therapy (OST) – for people who inject drugs (PWID) in Scotland.

    We sought to examine the potential impact of these changes on hepatitis C virus (HCV) transmission among PWID. We used a framework to triangulate different types of evidence: ‘group-level/ecological’ and ‘individual-level’. Evidence was primarily generated from bio-behavioural cross-sectional surveys of PWID, undertaken during 2008-2012. Individuals in the window period (1–2 months) where the virus is present, but antibodies have not yet been formed, were considered to have recent infection. The survey data were supplemented with service data on the provision of injecting equipment and OST. Ecological analyses examined changes in intervention provision, self reported intervention uptake, self-reported risk behaviour and HCV incidence; individual-level analyses investigated relationships within the pooled survey data. Nearly 8,000 PWID were recruited in the surveys. We observed a decline in HCV incidence, per 100 person-years, from 13.6 (95% CI: 8.1–20.1) in 2008–09 to 7.3 (3.0–12.9) in 2011–12; a period during which increases in the coverage of OST and IEP, and decreases in the frequency of injecting and sharing of injecting equipment, were observed. Individual-level evidence demonstrated that combined high coverage of needles/syringes and OST were associated with reduced risk of recent HCV in analyses that were unweighted (AOR 0.29, 95%CI 0.11–0.74) and weighted for frequency of injecting (AORw 0.05, 95%CI 0.01–0.18).

    We estimate the combination of harm reduction interventions may have averted 1400 new HCV infections during 2008–2012.

    This is the first study to demonstrate that impressive reductions in HCV incidence can be achieved among PWID over a relatively short time period through high coverage of a combination of interventions.

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  • Up to 50,000 people in Ireland are estimated to be infected with hepatitis C

    Posted on July 28th, 2014 TimB No comments

    Up to 50,000 people in Ireland are estimated to be infected with hepatitis C, however many of these have not been diagnosed and therefore remain untreated.

    The HSE is today urging anyone who may be at risk of hepatitis C to seek help and get tested as it is estimated that between 20,000 and 50,000 people in Ireland are chronically infected with hepatitis C, more than half whom are not aware of the infection.

    Effective testing and treatment are available, according to consultant hepatologist, Dr Stephen Stewart, speaking on behalf of the HSE National Hepatitis C Implementation Group, to mark World Hepatitis Day 2014, which takes place today.

    “About 1,000 new cases are notified each year and Irish health services will come under further pressure in the future if we don’t actively work to prevent new cases occurring and diagnose and treat the cases that have already occurred.

    “Hepatitis C is often called ‘the silent pandemic’, because many patients are infected without knowing it and may only present in the very late stages when cirrhosis has already been established..

    “A minority– estimated at 20-30% -develop cirrhosis of the liver, which typically appears two or three decades after infection. Those patients also suffer a higher risk of developing hepatocellular carcinoma (HCC), the most common type of primary liver cancer. The healthcare costs of these ‘end-stage conditions’ of hepatitis C can be substantial. They are the leading cause of liver transplants worldwide, including in Europe, the US and Japan.

    “Anyone who may have put themselves at risk of hepatitis C, either through current activities or due to a past lifestyle should visit their GP and get tested.   While the majority of hepatitis C infections are related to injecting drug use, hepatitis C can also be acquired by any blood to blood contact,” said Dr Stewart. “Diagnostic tests are now relatively simple and the treatments are getting better and better with time”.

    The HSE has produced a number of campaign materials including posters and videos urging people to ‘seek help, get tested’

    The posters are available at www.hse.ie/hepc and to download the National Hepatitis C Strategy 2011-2014

    World Hepatitis Day is an annual event, endorsed by the World Health Organization.  Each year it provides international focus for patient groups and people living with hepatitis B and C and provides an opportunity for interested groups to raise awareness and influence real change in disease prevention and access to testing and treatment.

     

  • Report on Hepatitis C Notifications Quarter 3 2013 – Health Protection Surveillance Centre

    Posted on May 2nd, 2014 TimB No comments

    There were 225 notifications of hepatitis C in quarter 3 2013. This corresponds to a crude notification rate of 4.9 per 100,000 population. This is slightly higher than the 187 cases notified in Q2, but similar to Q1 (n=248). Hepatitis C notifications decreased significantly in 2012 (18%) and in 2013 to date (18%).

    Information on most likely risk factor was available for 58% (n=131) of cases in Q3. Seventy percent (n=91) of these were injecting drug users

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  • Health officials issue guidance for providers in diagnosing Anthrax in Injecting Drug Users

    Posted on October 6th, 2013 TimB No comments

    The aim of this guidance is to assist clinicians in Ireland in clinical and microbiological assessment of suspected cases of infection with B. anthracis in IDUs. Due to the nature of the infection in heroin users, clinicians should consider the following as possible presentations of anthrax and discuss the case immediately with their local microbiologist.

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  • HIV and Injecting Drug Use

    Posted on July 10th, 2013 TimB No comments

    A significant increase in the number of gay men injecting drugs and people injecting Image and Performance-Enhancing Drugs could lead to increasing levels of HIV, warns the National AIDS Trust today (6 July 2013).

    NAT report ‘HIV and Injecting Drug Use’, based on the evidence of a number of experts in drugs and blood-borne viruses, found these newer injecting practices risk undermining the successfully low rates of HIV amongst injecting drug users (1.2%)

    New injecting trends amongst gay men

    The report found gay men are increasing using newer drugs, such as crystal meth, mephedrone and GHB/GBL, often sharing needles and using drugs in the context of risky sexual behaviour.

    At one key service in London, 85% of gay men now report using one or more of these three drugs compared only 3% in 2005.

    Yusef Azad, Director of Policy and Campaigns at NAT, said: “We are currently failing gay men who have problems with drug use and safer sex.  There are few services which understand their specific needs and these services are massively overstretched.  We need drugs and sexual health services work together to meet the needs of gay men, reduce problematic drug use and reduce HIV and hepatitis C transmissions linked to drug use.”

    Other new drugs being injected – steroids and tanning agents

    The report also highlights the rise in injecting of what are known as Image and Performance Enhancing Drugs (IPEDs) such as steroids or tanning agents.

    This poses a significant HIV risk as these newer injectors may not understand safe injecting practices. There is evidence of elevated HIV and hepatitis rates amongst steroid injectors.

    Yusef Azad Director of Policy and Campaigns at NAT, said: “NAT’s 2010 survey of public knowledge and attitudes to HIV found only 45% of the general public knew HIV can be transmitted through sharing injecting equipment.  If newer communities are starting to inject drugs, there is an urgent task to ensure health promotion and harm reduction messages reach these groups.  Otherwise there will be new transmissions of HIV and hepatitis B and C.”

    The report also criticised worrying comments made by the Government last year about maintaining people on OST (Opioid Substitution Therapy) – a key element in harm reduction.  It also called on the Government to tackle the high death rates amongst injecting drug users. People who inject drugs and who also have HIV have a death rate twenty times higher than the rest of the population.

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  • Perceptions of drug users regarding Hepatitis C screening and care: a qualitative study

    Posted on June 21st, 2013 TimB No comments

    Illicit drug users have a high prevalence of HCV and represent the majority of newly infected persons in the U.S. Despite the availability of effective HCV treatment, few drug users have been evaluated or treated for HCV. Racial and ethnic minorities have a higher incidence and prevalence of HCV and higher HCV-related mortality. Factors contributing to poor engagement in care are incompletely understood. The study concludes  Drug users perceived a paucity of settings for self-initiated HCV testing and poor provider patient communication at test sites and during medical encounters. Notably, drug users reported having an unclear understanding about the meaning of a positive HCV test, the health implications of HCV infection, the importance of clinical evaluations and monitoring, and of treatment options for HCV. Efforts to improve the delivery of clinical messages about HCV infection for drug users at test settings and clinical encounters are needed.

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  • Strategies to Address HCV Infection Among Young People who use drugs

    Posted on June 7th, 2013 TimB No comments

    The consultation participants recommended several key public health actions including:

    • Create community-led education and messaging strategies on hepatitis C risks, injection transmission risks (e.g., sharing drug preparation equipment in addition to sharing drug injection equipment), and HCV testing resources.
    • Improve and increase infrastructure for HCV surveillance and data collection.
    • Create age-appropriate (e.g., young adult) substance use and hepatitis C interventions and prevention strategies that are evidence based and effective.
    • Expand both community-based and basic science research activities to better understand how to effectively address the emerging crisis of hepatitis C infection among young IDUs.

    Discussions about this issue are ongoing among the participants and other federal and non-federal partners as we collaborate on ways to stem the tide of new HCV infections among young PWID and connect those already living with HCV to care and treatment for their infection and underlying drug use. With heightened awareness of this evolving epidemic and the attention and engagement of partners from across all sectors of society– including the voices of young people– we can make a positive difference in the lives of these young men and women.

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  • Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors

    Posted on May 8th, 2013 TimB No comments

    Evidence documents successful hepatitis C virus (HCV) treatment outcomes for people who inject drugs (PWID) and interest in HCV treatment among this population. Maximising HCV treatment for PWID can be an effective HCV preventative measure. Yet HCV treatment among PWID remains suboptimal. This review seeks to map social factors mediating HCV treatment access.

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  • Prevalence of, and risk factors for, human immunodeficiency virus, hepatitis B and hepatitis C infections among men who inject image and performance enhancing drugs in England & Wales.

    Posted on April 23rd, 2013 TimB No comments

    Dr Vivian Hope of Public Health England told the British HIV Association conference yesterday that injection of image- and performance-enhancing drugs is rising in England and Wales. Moreover, his research suggests that men may be acquiring bloodborne viruses through this route – 1.5% had antibodies to HIV, 8.8% had antibodies to hepatitis B and 5.5% to hepatitis C.

    Dr Hope said that across the world, only three previous studies have been conducted on HIV prevalence among people who inject drugs which are taken to enhance body image, physical strength or performance. One of these three was conducted in the UK in the mid-1990s and did not find any HIV infections in those surveyed.

    There are reports of increased numbers of people injecting these drugs who present to needle and syringe exchanges. However, not all syringe exchanges have the skills and experience to meet their needs. The injecting process is different to that of opiates ­– these drugs are normally delivered in a sealed vial, and are not usually injected into a vein, but into a muscle or beneath the skin.

    Moreover, the social profile of injectors of image- and performance-enhancing drugs is different to that of opiate injectors – younger, more likely to be employed, less likely to have had problems with the criminal justice system.

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