Prevalence and correlates of hepatitis C infection among users of North America's first medically supervised safer injection facility
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)
- et al.
Opportunities for prevention: hepatitis C prevalence and incidence in a cohort of young injection drug users
Hepatology
(2002) - et al.
The professional acceptance of drug use: a closer look at drug consumption rooms in the Netherlands, Gemany, and Switzerland
Int J Drug Policy
(1999) - et al.
Rationale for evaluating North America's first medically supervised safer injecting facility
Lancet Infect Dis
(2004) - et al.
Hepatitis C virus infection and needle exchange use among young injection drug users in San Francisco
Hepatology
(2001) - et al.
Needle exchange and difficulty with needle access during an ongoing HIV epidemic
Int J Drug Policy
(2002) - et al.
Methadone maintenance and hepatitis C virus infection among injecting drug users
Addiction
(1997) - et al.
Updating the infection risk reduction hierarchy: preventing transition into injection
J Urban Health
(2004) - et al.
Hepatitis C virus infection among injection drug users: survival analysis of time to seroconversion
Epidemiology
(2004) - et al.
Factors associated with persistent high-risk syringe sharing in the presence of an established needle exchange programme
AIDS
(2002) - et al.
Drug consumption facilities: an update since 2000
Drug Alcohol Rev
(2003)
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