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SERIES OF ARTICLES 2004 PDF file 2750Kb
Hepatitis C and needle exchange
Major series asking what remains a key question - can needle exchanges step up to the challenge of the highly transmissible hepatitis C virus? Features city case studies and forensic examination of the British record.
REVIEW ABSTRACT 2009 HTM file
The primary prevention of hepatitis C among injecting drug users
To curb hepatitis C, UK government advisers call for substantial expansion of needle exchange provision so that a new set of equipment is available for every injection and for methadone programmes to provide access to injecting equipment and vice versa.
STUDY 2005 PDF file 154Kb
Hepatitis C therapy cost-effective for injectors
Two new analyses agree that despite relapse to drug use and imperfect adherence to a demanding medical regime, anti-viral therapy for hepatitis C infection in drug injectors cost-effectively prolongs and improves life.
OFFCUT 2005 PDF file 151Kb
Hepatitis C is spreading more rapidly than was thought
From the early 2000s in Britain there was clear evidence from research and routine monitoring that drug policy was failing to contain hepatitis C infection among injectors, and worrying signs of a trend upwards in HIV infection.
STUDY 2005 PDF file 115Kb
Simple interventions cut hepatitis C risk
In Australia a detailed assessment of an injector's risk of becoming infected with hepatitis C was followed by substantial risk reductions not improved on by individualised advice.
US figures show that testing needle exchange users for hepatitis B and at the same time starting a short course of vaccinations (the UK model) saves lives and thousands of health service dollars, but UK exchanges have lagged behind in offering these services.
Despite the challenges, review confirms that hepatitis C infection can be prevented among injectors, but it takes multi-component strategies with elements such as substitute prescribing to reduce or eliminate drug injection, treatment of infection, and enabling safe injection practices by providing sterile injecting equipment and behaviour-change counselling.
Authors who worked on Scotland's hepatitis C plan conclude that limitations in the research mean the best that can be said is that attending needle exchanges which provide injecting paraphernalia may be associated with reduced sharing of this equipment.
Trends in hepatitis C infection among recent initiates to drug injecting in England between 2004 (when a national action plan was launched) and 2008 indicate the importance of reinvigorating and improving the coverage of harm reduction measures such as needle exchange and substitute prescribing.
Among the messages of this simulation model for the UK and other countries is the resilience of hepatitis C in the face of considerable investment in methadone and needle exchange services, that these have nevertheless helped and need to be maintained and if possible expanded, but also that further measures are required to substantially curtail the virus.
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