1 / 10

Anneke de Vos 1 , Jannie van der Helm 2 , Amy Matser 2 , Maria Prins 2,3 , Mirjam Kretzschmar 1,4

Decline in incidence of HIV and Hepatitis C virus infection among injecting drug users in Amsterdam; evidence for harm reduction?. Anneke de Vos 1 , Jannie van der Helm 2 , Amy Matser 2 , Maria Prins 2,3 , Mirjam Kretzschmar 1,4.

shiro
Download Presentation

Anneke de Vos 1 , Jannie van der Helm 2 , Amy Matser 2 , Maria Prins 2,3 , Mirjam Kretzschmar 1,4

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Decline in incidence of HIV and Hepatitis C virus infection among injecting drug users in Amsterdam; evidence for harm reduction? Anneke de Vos1, Jannie van der Helm2, Amy Matser2, Maria Prins2,3, Mirjam Kretzschmar1,4 1. Julius Center, University Medical Centre Utrecht, Utrecht, The Netherlands. 2. Public Health Service, Amsterdam, the Netherlands 3. Academic Medical Center, University of Amsterdam (CINIMA), Amsterdam, the Netherlands 4. Centre for Infectious Disease Control, RIVM, Bilthoven, The Netherlands.

  2. Amsterdam IDU • Cohort studies since 1985 (ACS) • HIV & HCV: very strong incidence decline • HIV: strong prevalence decline • introduction ~1980, peak ~1990 • Harm reduction from 1981 • opiate substitution (methadone) • needle exchange facilities

  3. Amsterdam IDU • Changing demography • fewer new injectors • →aging population • Natural epidemic progression: • incidence ↔ prevalence • HIV-mortality ↔ population structure Matser et al. 2012

  4. Can we explain disease time-trends by demographic dynamics, assuming no effects of harm reduction? Method: individual based simulation modeling Study description

  5. Low risk Start injecting HCV+ Stop injecting Relapse injecting Recruitment ACS Stop injecting Death Modeled individuals • Injecting status • constant stop- and relapse-rates • ACS participation status • recruitment of current injectors • HIV & HCV status • Mortality-rate by: • age • time since HIV infection • HIV treatment (from 1997) • Risk behavior: high or low • No harm reduction

  6. Results

  7. Results explained • Decline in HIV & HCV incidence • fewer ever-IDU still injecting • fits ACS data • due to a constant stop-rate + fewer new IDU • high-risk infected sooner → low-risk left at risk • HIV prevalence decline • high-risk IDU die faster → lowered population risk

  8. Lowered risk? Introduction of cART Results improved? • cART introduction more gradual • better fit HIV prevalence decline • Harm reduction; risk decline by calendar-time • can explain slight HCV prevalence decline • similar results for risk decline with age! • strong effects on risk consistent but not necessary

  9. Summary & conclusion • Main trends in HIV and HCV among Amsterdam IDU could be explained by demographic changes • Effects of harm reduction could not be disentangled from other causes Studies on the effects of harm reduction intervention should consider natural epidemic progression and demographics

  10. Conducted within UCID – Utrecht Center for Infection Dynamics We thank RoelCoutinho We are grateful to the Amsterdam Cohort Studies Thank you Funded by:

More Related