signs of success national nesi data? · dr alison munro (uws) professor david goldberg (hps*) dr...
TRANSCRIPT
Needle Exchange Surveillance
Initiative
Signs of success – latest
national NESI data?
Alison Munro (University of the
West of Scotland)
Professor Avril Taylor – Chief Investigator (UWS)
Dr Alison Munro (UWS) Professor David Goldberg (HPS*)
Dr Sharon Hutchinson (HPS) Ms Norah Palmateer (HPS)
* Health Protection Scotland
Study partners
Today’s presentation
• Policy context
• NESI study - aim, objectives and methods
• Sample characteristics
• Drug use and risk taking behaviours
• Uptake of services (HCV testing, methadone
and sterile injecting equipment)
• HCV Incidence and prevalence
• Signs of success?
NESI: Policy context
Actions to develop and
improve services:
• Prevention
• Diagnosis
• Treatment
Evidence/Issues (mid 2000s)
• 1,500 PWID in Scotland infected annually
• Re-use/sharing of injection equipment still highly prevalent
• Widespread variations in provision of injection equipment
Actions
• National guidelines for injection equipment provision
• Injection equipment services improved in accordance with guidelines
Performance Indicator
• Prevalence & Incidence of HCV among PWID (NESI study)
Hepatitis C Action Plan: prevention
To evaluate and better target interventions aimed at reducing the spread of HCV among PWID (People
Who Inject Drugs)
NESI: AIM
• To determine prevalence of HCV and of injecting risk behaviours over time among PWID in Scotland
• To measure prevalence of HCV among recent initiates to injecting and to monitor changes in prevalence in this group over time
• To measure the uptake of harm reduction initiatives
(methadone; HBV vaccination & HCV testing; uptake of injecting equipment paraphernalia)
• To estimate the prevalence of acute HVC infection among PWID and monitor changes in prevalence of acute HCV over time
NESI: Objectives
• Cross-sectional voluntary anonymous survey
• PWID recruited at services in mainland
Scotland providing injecting equipment and
other harm reduction services
• Interviewer led 5 -10 min questionnaire
• DBS taken & tested for HCV (Ab and PCR)
NESI: Methods
NESI questionnaire
•Age, gender, homelessness
etc
•Methadone and other drug
treatment
•Injecting history, frequency of
injecting
•Injecting risk behaviours e.g.
N/S re-use and sharing, other
injecting equipment sharing
•HCV testing and treatment
•Use of injecting equipment
provision (IEP) services and
uptake of sterile equipment
NESI:2008/2009, 2010 & 2011
2008/09 2010 2011
Number of participants 2563 3100 2146
Number mainland NHS Boards 11 11 11
Number of sites 103 135 128
PWID (last 6 months) 80% 78% 83%
NESI sample characteristics
2008/09 2010
Gender – male 72% 72%
Age (mean) 33.4 yrs 34.5 yrs
Age first injected 22.7 yrs 22.9 yrs
Time since onset injecting
(mean) 10.2 years 11.1 years
Drug use, injecting and injecting risk
2008/2009 2010
Frequency of injecting (daily or more) 63% 54%
Drugs injected:
•Heroin 96% 96%
•Cocaine 16% 9%
•Crack 6% 2%
Injected with a used N/S last month 9% 6% Injected with used injecting equipment in last
month 36% 29%
HCV testing and prescribed methadone
2008/09 2010
Ever tested HCV 74% 77%
Tested in last 12 months 35% 38%
Receiving methadone (6 months prior to
interview) 72% 80%
% respondents reporting receipt of
‘sufficient’ sterile injecting equipment
75
14
22
4
79 74
57
3
0
10
20
30
40
50
60
70
80
90
N/S filters spoons water
2008/09 2010
Uptake of sterile injecting
equipment (ISD, 2012)
0
500000
1000000
1500000
2000000
2500000
3000000
3500000
4000000
4500000
5000000
2008/09 2009/10 2010/11
N/S
Filters
Spoons/Cookers
Water
HCV prevalence and
incidence
HCV Prevalence and incidence
53 57
52
0
10
20
30
40
50
60
70
80
90
100
2008/09 2010 2011
HCV Prevalence
HCV Prevalence (%) (2011 figure is provisional)
13.3
9.5
6.4
0
2
4
6
8
10
12
14
16
18
20
2008/09 2010 2011
HCV Incidence
HCV Incidence (rate) (2011 data is provisional)
Emerging evidence
• Uptake of ‘sufficient’ volume of other injecting equipment
significantly associated with lower risk of sharing
equipment (Aspinall et al. In press).
• Analysis of pooled UK data (including NESI) shows
evidence that uptake of OST and high coverage of n/s
provision can substantially reduce the risk of HCV
transmission among PWID (Turner et al, 2011).
• Further analysis of NESI data beginning to show that
receiving methadone and acquiring/using new/sterile N/S
significantly decreases the chances of becoming infected
with HCV.
Summary - signs of success?
• NESI providing valuable data
• Impact of IEP guidelines is positive
• Increasing uptake of harm reduction
services
• HCV incidence presently decreasing
• Emerging evidence that IEP is impacting
on HCV incidence – internationally
important evidence
• No room for complacency
References
• Aspinall, E et al. (in press) Uptake of paraphernalia from injecting
equipment provision services and its association with sharing of
paraphernalia among injecting drug users in Scotland. Drug and Alcohol
Dependence.
• ISD (2012) Injecting equipment provision in Scotland survey 2010/11.
http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-
Misuse/Publications/2012-07-31/2012-07-31-Injecting-Equipment-
Report.pdf
• Taylor, K (et al. (2011) The impact of needle and syringe provision and
opiate substitution therapy on the incidence of hepatitis C virus in injecting
drug users: pooling of UK evidence. Addiction, 106, 1978-88
• University West of Scotland et al. (2012) Needle Exchange Surveillance
Initiative (NESI): prevalence of HCV and injecting risk behaviours among
people who inject drugs attending injecting equipment provision services in
Scotland, 2008/2009 & 2010.
Coming soon....