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Injecting drug use and blood borne virus transmission in Wales: building the evidence base

Injecting drug use and blood borne virus transmission in Wales: building the evidence base. Project team. ICDS Dr Marion Lyons Dr Noel Craine Dr Mark Walker Josie Smith Zoe Couzens HPA Dr John Parry & Tamara Mcdonald Imperial College Dr Mathew Hickman Cardiff University Dr Barry Nix.

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Injecting drug use and blood borne virus transmission in Wales: building the evidence base

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  1. Injecting drug use and blood borne virus transmission in Wales: building the evidence base

  2. Project team ICDS Dr Marion Lyons Dr Noel Craine Dr Mark Walker Josie Smith Zoe Couzens HPA Dr John Parry & Tamara Mcdonald Imperial College Dr Mathew Hickman Cardiff University Dr Barry Nix

  3. Informing the blood borne virus strategy for Wales Future burden of disease? How effective are interventions to reduce transmission? What service developments are needed across Wales?

  4. Research into current prevention and service development in Wales qualitative study of needle and syringe exchange provision (collaboration Imperial College London and WIRED) - using grounded theory approach – addressing barriers to NSE uptake and availability South and West Wales - street recruited needs assessment provision of HBV and HCV services in primary and secondary health care settings across Wales

  5. Prevalence and incidence of HCV, HBV and HIV amongst IDUs South Wales HCV Incidence Study – prospective cohort study of injecting drug users • determine factors behind the patterns of incidence and prevalence • provide baseline data to monitor impact of intervention • inform estimates of future disease burden

  6. Sample sites and sample sizes North West Wales Salivary Survey (153) Merthyr (95) Abergavenny (11) Aberdare (9) Treorchy (17) Pontypridd / Rhydfelin (37) Caldicott (17) Swansea (97) Newport (134) Neath (31) Cardiff (200) Bridgend (51) Barry (15)

  7. Age profile of total sample of 717 n. of individuals age

  8. Sample characteristics male – 73%, female – 26% 54% of sample in substitution treatment (proportion varied across sample)

  9. Preliminary findings • anti-HCV - 26.8% (95% CI 24%-30%) • anti-HBc was 9.8% (95% CI 8%-12%) • both markers together - 7% • anti-HCV 6.1% (95% CI 2.1%-14.3%) amongst injectors who had been injecting for one year or less. • 539 HCV seronegatives for follow up • no significant difference in prevalence between males and females

  10. HCV and HBV - age prevalence curves for all sample (95%CI) prevalence age group

  11. Duration of injecting, anti-HCV and anti-HBc prevalence

  12. Anti-HCV prevalence by site ordered West to East (95%CI fitted) Swansea Cardiff prevalence % Mean anti-HCV prevalence – all South Wales sample (95%CI) Merthyr Tydfil sample site (West to East)

  13. Between site comparison – duration of injecting and HCV prevalence

  14. HCV testing and HCV positives 25% of dried blood spot positives knew they were positive from previous test 24% of dried blood spot positives reported a previous negative test result the remaining dried blood spot positives were either untested, didn't know result or didn't know if they had been tested

  15. HBV vaccination across sample mean

  16. HBV vaccination of IDUs • prisons 65% • GPs 15% • other drug services 8% • GUM 7% • other 5% 40% of anti-HBc positive individuals - vaccinated

  17. The next stage • follow up and re-sampling of cohort planned Dec / Jan • include HIV testing at follow-up • roll out of anonymous unlinked salivary monitoring program • look at the role of prisons

  18. How can we use this research to reduce transmission? early acquisition of infection regional variation – highlights potential for prevention baseline to assess impact of intervention large scale peer education program – needle and syringe sharing is common and needs to become rare

  19. HCV – age group prevalence for Cardiff, Swansea and Merthyr

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