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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.
Together studies recently conducted across the UK suggest that consistent participation in methadone maintenance treatment plus adequate access to fresh injecting equipment has prevented many hepatitis C infections, supporting calls for needle exchange to be expanded and methadone treatment sustained.
A review reporting on the results of six trials from the UK, USA and Australia finds that – at least on their own – interventions such as counselling and peer-educator training have not prevented injecting drug users becoming infected with hepatitis C.
A combination of needle exchange, methadone maintenance and a shift away from injecting meant that between 2008 and 2012, 1000 fewer Scottish injectors had to face chronic infection with the potentially deadly hepatitis C virus.
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