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, 27 th March 2009
Jan 15, 2016
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