Factors Associated with Entry into Healthcare Pathways for Hepatitis C among People who Inject Psychoactive Drugs in the United Kingdom (UK)

Author: Hope VD, Njoroge J, Glass R, Tanner C, Parry JV, Ncube F

Theme: Epidemiology & Public Health Research Year: 2016


Hope VD1,2, Njoroge J1, Glass R1, Tanner C1, Parry JV1,2, Ncube F1.

National Infection Service, Public Health England, UK

Centre for Research on Drugs & Health Behavior, London School of Hygiene & Tropical Medicine, UK

Introduction: People who inject drugs (PWID) typically have high levels of hepatitis C virus (HCV) infection. Most will develop chronic infection with a risk of cirrhosis and liver cancer. The development of very effective antivirals means that diagnosis and entry into a care pathway is increasingly important to reducing HCV morbidity and transmission.

Methods: A voluntary unlinked-anonymous survey obtained dried-blood spot samples and questionnaires from PWID across the UK (except Scotland). Factors associated with care pathway uptake – seeing a specialist doctor/nurse and medication – among those HCV antibody (anti-HCV) positive who reported having been diagnosed (self-reports). Data from first participations during 2013-14 was used.

Results: During 2013-14, 2,038 anti-HCV positive participants had injected during the preceding year (median age 38 years; 25% women; 7% not UK born). Overall, 44% were aware of their HCV status; 10% had never had a test. Of those aware, 62% reported seeing a doctor/nurse about their HCV (28% of those anti-HCV positive), and of these, 27% reported receiving medication (7% of those anti-HCV positive). In multivariable analyses, seeing a doctor/nurse was positively associated with being born outside the UK (adjusted odds ratio [AOR]=1.86, 95%CI 1.021-3.39), receptive sharing (AOR=1.64, 95%CI 1.13-2.38) and seeing a general practitioner (AOR=1.42, 95%CI 1.06-1.89); and negatively associated with transactional sex (AOR=0.50, 95%CI 0.29-0.85), and injecting crack (AOR=0.67, 95%CI 0.46-0.99) or cocaine (AOR=0.66, 95%CI 0.49-0.89). Receiving medication was positively associated with recruitment in the English Midlands (AOR=1.92, 95%CI 1.19-3.07) or Wales/Northern Ireland (AOR=2.08, 95%CI 1.14-3.80) and negatively associated a recent overdose (AOR=0.52, 95%CI 0.30-0.90).

Conclusion: Many HCV infections among PWID remain undiagnosed; however, many of those diagnosed have accessed specialist healthcare workers. Those with greatest drug use related risks (indicated by crack injection and overdosing) may be less likely to have accessed HCV related healthcare, indicating a need for targeted interventions.

Disclosure of Interest Statement: This work was core funded by Public Health England. No pharmaceutical or other grants were received in the development or implementation of this study. No conflicts of interest.

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