Rapid decline in HCV incidence among people who inject drugs associated with national scale-up in coverage of a combination of harm reduction interventions
In 2008 the Scottish Government launched phase two of its hepatitis C action plan. One of its three main aims was to prevent the virus spreading between people who inject drugs. The main driver for change was the release of national guidelines which recommended providing enough new sets of sterile injecting equipment for one to be used for every injection. To help implement those guidelines, £3 million per year was awarded to the Scottish health service. At the same time, the Scottish Government’s drug and alcohol strategy sought to improve treatment services for patients dependent on opiates.
Funded by the Scottish Government, the featured study examined the impact of these changes on the transmission of hepatitis C among injectors. Specifically, the aim was to determine whether trends in the proportion of injectors newly infected with the virus between 2008 and 2012 could be linked to the adequacy of provision of sterile injecting equipment and of methadone maintenance treatment. Data on new infections, use of needle exchanges and methadone treatment, and on infection risk behaviour, came from three national surveys undertaken in 2008–2009, 2010, and 2012 of past or current injectors contacted via needle exchanges (often also sites for methadone treatment) and other equipment supply services. Around two thirds of the drug users asked to complete the survey did so, resulting in samples respectively totalling 2629, 3168 and 2154. Typically respondents were men in their thirties who had been injecting for just over 10 years. Around a quarter had recently been homeless most had at some time been imprisoned.
Official national statistics provided data on the total numbers of methadone prescriptions and injecting equipment distributed, including needles/syringes, filters, sterile water, and spoons to use in preparing drugs for injection. It was assumed that as these services became more available, injectors would be more adequately supplied with injecting equipment and more would enter methadone treatment. As a result, they would less often risk infection by sharing equipment, aided by methadone treatment reducing the number of times they injected. The end result would be fewer becoming infected with hepatitis C. Analyses of these links took in to account the injector’s age and sex, whether homeless, whether they injected stimulants, had injected in the past six months, how long they had been injecting, whether they had been imprisoned, and whether they had drank to excess in the past 12 months. An initial analysis treated each injector as equal; a second gave greater weight to more frequent injectors.
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