Trends in injecting risk behaviour and HCV prevalence among
injecting drug users in Glasgow, 1999-2007
Norah Palmateer, Sharon Hutchinson, Avril Taylor, Elizabeth Allen, Syed Ahmed and David Goldberg
SDF Seminar, 27th March 2009
Overview
• Why Glasgow• Historical HCV data• Current trends in injecting and
HCV (1999-2007)
Greater Glasgow (1%)
Prevalence of current injecting drug use in Scotland (2003)
(Hay et al., 2005)
Prevalence of HCV among current IDUs in Scotland (1999-
2000)
0
10
20
30
40
50
60
70
Arg
yll &
Cly
de
Ayr
shir
e &
Arr
an
Bor
der
s
Dum
frie
s &
Gal
low
ay
Fif
e
For
th V
alle
y
Gra
mpi
an
Gre
ater
Gla
sgow
Hig
hla
nd
Lana
rksh
ire
Loth
ian
Ork
ney
Isle
s
Shet
land
Isl
es
Tay
side
Wes
tern
Isl
es
Health Board
Prev
alen
ce H
CV a
ntib
ody
+ve
curr
ent
IDU
s (%
) Scotland ----------
HCV prevalence among recent onset IDUs (aged <25 years) who had a named HIV test
in Scotland
19901990 19921992 19941994 19961996 19981998 20002000
00
2020
4040
6060
8080
100100
Year testedYear tested
GlasgowGlasgow
LothianLothian
TaysideTayside
GrampianGrampian
Pre
vale
nce
(%
)P
reva
len
ce (
%)
Incidence of HCV Incidence of HCV amongamong IDUs in IDUs in GlasgowGlasgow
RegionRegion MethodMethod SampleSample YearsYears NN HCV incidence HCV incidence per 100 p-yrsper 100 p-yrs
(95% CI)(95% CI)
Greater Greater Glasgow Glasgow (GG)(GG)
UATUAT IDUs with IDUs with 2 2 named HIV testsnamed HIV tests 1993-981993-98 3131 28 28 (16-51)(16-51)
VATVATCommunityCommunity-wide -wide surveyssurveys
Current IDUs, Current IDUs, who had started who had started injecting in the injecting in the previous 5 yrsprevious 5 yrs
1990-931990-93
1994-961994-96
19991999
550550
173173
283283
2828 (25-31) (25-31)
2121 (17-26) (17-26)
25 25 (21-30)(21-30)
Current trends, 1999-2007• Data
– Size of population at risk– Prevalence of injecting risk behaviour– Prevalence of HCV infection
• Data sources– Drug treatment agency reports– Community-wide surveys – Capture-recapture studies– Surveillance programme (unlinked anonymous)
Size of injecting population
0
2000
4000
6000
8000
2000 2003
7,200
(6,100-8,600)
4,900
(4,400-5,500)
(Hay et al., 2005)
Risk behaviours – injecting at least daily (last 6 months)
0
20
40
60
80
100
(Community-wide surveys)
Risk behaviours – sharing needles/syringes (previous
month)
0
20
40
60
80
100
1999 2000 2001 2002 2003 2004 2005 2006 2007
Shared n/s
(Drug Misuse Statistics Scotland, ISD)
Risk behaviours – sharing needles/syringes and other injecting paraphernalia (previous
month)
0
20
40
60
80
100
1999 2000 2001 2002 2003 2004 2005 2006 2007
Shared n/s Shared paraphernalia
(Drug Misuse Statistics Scotland, ISD)
HCV prevalence among IDUs aged <25, Glasgow
0
20
40
60
80
100
(n=181) (n=162) (n=41)
(n=36)
IDUs aged <25 (UAT)IDUs injecting 5 yrs or less (community surveys)
Incidence of HCV Incidence of HCV amongamong IDUs in IDUs in GlasgowGlasgow
RegionRegion MethodMethod SampleSample YearsYears NN HCV incidence HCV incidence per 100 p-yrsper 100 p-yrs
(95% CI)(95% CI)
Greater Greater Glasgow Glasgow (GG)(GG)
UATUAT IDUs with IDUs with 2 2 named HIV testsnamed HIV tests 1993-981993-98 3131 28 28 (16-51)(16-51)
VATVATCommunityCommunity-wide -wide surveyssurveys
Current IDUs, Current IDUs, who had started who had started injecting in the injecting in the previous 5 yrsprevious 5 yrs
1990-931990-93
1994-961994-96
19991999
2001-022001-02
2004-052004-05
550550
173173
283283
385385
251251
2828 (25-31) (25-31)
2121 (17-26) (17-26)
2525 (21-30) (21-30)
29 29 (26-33) (26-33)
2929 (25-34) (25-34)
Numbers of HCV-infected current IDU aged <25, Glasgow
YearNo. current
IDU aged <25
HCV Prevalence
among <25s
No. HCV-infected current IDU aged <25 p
2000 2300 (1836-2797)
41 (34-48)
943 (698-1208)
<0.01
2003 1031 (851-1198)
42 (34-50)
433 (328-540)
Summary and limitations
• Collated data to present an overall picture• Limitations
– HCV incidence estimates– Self-reported injecting risk behaviour
• Some evidence that the frequency of injection has declined
• Unclear evidence relating to injecting risk• No evidence that the rate of new HCV infections
in declining…but evidence for a decline in the absolute number of HCV infections
What next…
• Hepatitis C Action Plan– Major investment in HCV prevention
services…will this have an impact?• Continued monitoring
– Needle Exchange Surveillance Initiative (NESI) • HCV prevalence/incidence• Injecting risk behaviour
– Unlinked Anonymous HCV testing • HCV prevalence