Elsevier

Public Health

Volume 119, Issue 12, December 2005, Pages 1111-1115
Public Health

Prevalence and correlates of hepatitis C infection among users of North America's first medically supervised safer injection facility

https://doi.org/10.1016/j.puhe.2005.05.006Get rights and content

Summary

Background

North America's first medically supervised safer injection facility (SIF) for illicit drug users was opened in Vancouver, Canada on 22 September 2003. We examined the prevalence and correlates of hepatitis C (HCV) infection among a representative cohort of SIF users.

Methods

Users of the Vancouver SIF were selected at random and asked to enrol in the Scientific Evaluation of Supervised Injecting (SEOSI) cohort. At baseline, venous blood samples were collected and an interviewer-administered questionnaire was performed. Participants who were HCV-positive were compared with HCV-negative subjects using bivariate and logistic regression analyses.

Results

Between 1 December 2003 and 30 July 2004, 691 participants were enrolled into the SEOSI cohort, among whom 605 (87.6%) were HCV-positive at baseline. Factors independently associated with HCV infection in logistic regression analyses included: involvement with the sex trade [adjusted odds ratio (AOR) 3.7, 95% confidence interval (CI) 2.1–6.1], history of borrowing syringes (AOR 1.8, 95%CI 1.1–2.9), and history of incarceration (AOR 2.6, 95%CI 1.5–4.4). Daily heroin use was protective against HCV infection (AOR 0.6, 95%CI 0.3–0.9).

Conclusion

The SIF has attracted injection drug users with a high burden of HCV infection and a substantial proportion of uninfected individuals. Although cross-sectional, this study provides some insight into historical risks for HCV infection among this population, and prospective follow-up of this cohort will be useful to determine if use of the SIF is associated with reduced risk behaviour and HCV incidence.

Introduction

A growing dialogue has recently emerged regarding the potential of conventional public health efforts to stem the spread of hepatitis C (HCV) among injection drug users (IDUs).1 While it is evident that greater attention should be focused on the prevention of injection,2 there remains an urgent need for novel interventions for the prevention of blood-borne disease transmission among active IDUs. For instance, while HCV may spread rapidly among IDUs,3 recent studies have indicated that there is a measurable period over which interventions may be effective for preventing the spread of HCV,4 but that current approaches to prevention have several shortcomings.5

In several European cities and, more recently, in Sydney, Australia, safer injection facilities (SIFs), where IDUs can inject pre-obtained illicit drugs, have been implemented in an effort to reduce the public health impacts of injection drug use including blood-borne disease transmission.6 Within SIFs, IDUs are typically provided with sterile injecting equipment, emergency care in the event of overdose, primary care services and referral to addiction treatment.7, 8 While several process reports and qualitative examinations of SIFs exist, there are few epidemiological investigations of HCV infection levels among representative cohorts of SIF users in the scientific literature.9, 10, 11, 12

On 22 September 2003, North America's first government-sanctioned SIF pilot study was opened in Vancouver, Canada.12 Although impacts of the SIF on certain outcomes, such as blood-borne infection incidence, will require several years to assess, it is now possible to examine the prevalence of HCV infection among users of the SIF. Therefore, the present study was conducted to examine the prevalence and correlates of HCV infection among users of the Vancouver SIF.

Section snippets

Methods

The Vancouver SIF, known as InSite, is centrally located in Vancouver's Downtown Eastside (DTES), which is the most impoverished urban neighbourhood in Canada and home to well-documented overdose and infectious disease epidemics among the estimated 5000 IDUs that reside there.13, 14 The Scientific Evaluation of Supervised Injecting (SEOSI) cohort has been described in detail previously.15 Briefly, the SEOSI cohort is based on a representative sample of InSite users. The sample was derived

Results

Between 1 December 2003 and 30 July 2004, 904 participants were randomly invited to enrol into the SEOSI study, among whom 735 (81.3%) had decided to attend the external research site to learn about participation in the SIF evaluation by 30 July 2004. Overall, five IDUs were deemed by research staff to be unfit to provide informed consent and were not enrolled, and 15 decided not to enrol into the study after learning about what cohort participation would require. Therefore, 713 individuals

Discussion

In the present study, we found that the prevalence of HCV among users was 88% and that factors associated with HCV infection among this population included involvement in the sex trade, history of borrowing syringes, and history of incarceration, whereas daily heroin use was protective against HCV infection.

Given what is known about the transmission rates of HCV infection among IDUs,1, 16 historical rates of HCV infection in this community,3 and that the majority of SEOSI participants in the

Acknowledgements

The authors wish to thank the staff of the InSite SIF and Vancouver Coastal Health (Chris Buchner, Heather Hay, David Marsh). We also thank Bonnie Devlin, Aaron Eddie, Evelyn King, Peter Vann, Dave Isham, Steve Gaspar, Steve Kain, Carl Bognar, Elisa Lloyd-Smith and Suzy Coulter for their research and administrative assistance. The SIF evaluation has been made possible through a financial contribution from Health Canada, although the views expressed herein do not represent the official policies

References (21)

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