Needle Exchange Surveillance

Initiative

Signs of success – latest

national NESI data?

Alison Munro (University of the

West of Scotland)

Professor Avril Taylor – Chief Investigator (UWS)

Dr Alison Munro (UWS) Professor David Goldberg (HPS*)

Dr Sharon Hutchinson (HPS) Ms Norah Palmateer (HPS)

* Health Protection Scotland

Study partners

Today’s presentation

• Policy context

• NESI study - aim, objectives and methods

• Sample characteristics

• Drug use and risk taking behaviours

• Uptake of services (HCV testing, methadone

and sterile injecting equipment)

• HCV Incidence and prevalence

• Signs of success?

NESI: Policy context

Actions to develop and

improve services:

• Prevention

• Diagnosis

• Treatment

Evidence/Issues (mid 2000s)

• 1,500 PWID in Scotland infected annually

• Re-use/sharing of injection equipment still highly prevalent

• Widespread variations in provision of injection equipment

Actions

• National guidelines for injection equipment provision

• Injection equipment services improved in accordance with guidelines

Performance Indicator

• Prevalence & Incidence of HCV among PWID (NESI study)

Hepatitis C Action Plan: prevention

To evaluate and better target interventions aimed at reducing the spread of HCV among PWID (People

Who Inject Drugs)

NESI: AIM

• To determine prevalence of HCV and of injecting risk behaviours over time among PWID in Scotland

• To measure prevalence of HCV among recent initiates to injecting and to monitor changes in prevalence in this group over time

• To measure the uptake of harm reduction initiatives

(methadone; HBV vaccination & HCV testing; uptake of injecting equipment paraphernalia)

• To estimate the prevalence of acute HVC infection among PWID and monitor changes in prevalence of acute HCV over time

NESI: Objectives

• Cross-sectional voluntary anonymous survey

• PWID recruited at services in mainland

Scotland providing injecting equipment and

other harm reduction services

• Interviewer led 5 -10 min questionnaire

• DBS taken & tested for HCV (Ab and PCR)

NESI: Methods

NESI questionnaire

•Age, gender, homelessness

etc

•Methadone and other drug

treatment

•Injecting history, frequency of

injecting

•Injecting risk behaviours e.g.

N/S re-use and sharing, other

injecting equipment sharing

•HCV testing and treatment

•Use of injecting equipment

provision (IEP) services and

uptake of sterile equipment

NESI:2008/2009, 2010 & 2011

2008/09 2010 2011

Number of participants 2563 3100 2146

Number mainland NHS Boards 11 11 11

Number of sites 103 135 128

PWID (last 6 months) 80% 78% 83%

NESI sample characteristics

2008/09 2010

Gender – male 72% 72%

Age (mean) 33.4 yrs 34.5 yrs

Age first injected 22.7 yrs 22.9 yrs

Time since onset injecting

(mean) 10.2 years 11.1 years

Drug use, injecting and injecting risk

2008/2009 2010

Frequency of injecting (daily or more) 63% 54%

Drugs injected:

•Heroin 96% 96%

•Cocaine 16% 9%

•Crack 6% 2%

Injected with a used N/S last month 9% 6% Injected with used injecting equipment in last

month 36% 29%

HCV testing and prescribed methadone

2008/09 2010

Ever tested HCV 74% 77%

Tested in last 12 months 35% 38%

Receiving methadone (6 months prior to

interview) 72% 80%

% respondents reporting receipt of

‘sufficient’ sterile injecting equipment

75

14

22

4

79 74

57

3

0

10

20

30

40

50

60

70

80

90

N/S filters spoons water

2008/09 2010

Uptake of sterile injecting

equipment (ISD, 2012)

0

500000

1000000

1500000

2000000

2500000

3000000

3500000

4000000

4500000

5000000

2008/09 2009/10 2010/11

N/S

Filters

Spoons/Cookers

Water

HCV prevalence and

incidence

HCV Prevalence and incidence

53 57

52

0

10

20

30

40

50

60

70

80

90

100

2008/09 2010 2011

HCV Prevalence

HCV Prevalence (%) (2011 figure is provisional)

13.3

9.5

6.4

0

2

4

6

8

10

12

14

16

18

20

2008/09 2010 2011

HCV Incidence

HCV Incidence (rate) (2011 data is provisional)

Emerging evidence

• Uptake of ‘sufficient’ volume of other injecting equipment

significantly associated with lower risk of sharing

equipment (Aspinall et al. In press).

• Analysis of pooled UK data (including NESI) shows

evidence that uptake of OST and high coverage of n/s

provision can substantially reduce the risk of HCV

transmission among PWID (Turner et al, 2011).

• Further analysis of NESI data beginning to show that

receiving methadone and acquiring/using new/sterile N/S

significantly decreases the chances of becoming infected

with HCV.

Summary - signs of success?

• NESI providing valuable data

• Impact of IEP guidelines is positive

• Increasing uptake of harm reduction

services

• HCV incidence presently decreasing

• Emerging evidence that IEP is impacting

on HCV incidence – internationally

important evidence

• No room for complacency

References

• Aspinall, E et al. (in press) Uptake of paraphernalia from injecting

equipment provision services and its association with sharing of

paraphernalia among injecting drug users in Scotland. Drug and Alcohol

Dependence.

• ISD (2012) Injecting equipment provision in Scotland survey 2010/11.

http://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-

Misuse/Publications/2012-07-31/2012-07-31-Injecting-Equipment-

Report.pdf

• Taylor, K (et al. (2011) The impact of needle and syringe provision and

opiate substitution therapy on the incidence of hepatitis C virus in injecting

drug users: pooling of UK evidence. Addiction, 106, 1978-88

• University West of Scotland et al. (2012) Needle Exchange Surveillance

Initiative (NESI): prevalence of HCV and injecting risk behaviours among

people who inject drugs attending injecting equipment provision services in

Scotland, 2008/2009 & 2010.

Coming soon....