Program Prevention of HCV infections

Transcription

1 Program Prevention of HCV infections The main objective of the Program is to provide a basis for planning a longterm strategy for preventing HCV and combating hepatitis C in Poland. PROGRAM SUPPORTED BY A GRANT FROM SWITZERLAND TROUGH THE SWISS CONTRIBUTION TO THE ENLARGEMENT EUROPEAN UNION AND BY MINISTRY OF HEALTH OF REPUBLIC OF POLAND Narodowy Instytut Zdrowia Publicznego Państwowy Zakład Higieny w Warszawie Instytut Psychiatrii I Neurologii w Warszawie Uniwersytet Medyczny w Lublinie Główny Inspektorat Sanitarny

2 Main partner: Narodowy Instytut Zdrowia Publicznego Państwowy Zakład Higieny w Warszawie Partners: Instytut Psychiatrii I Neurologii w Warszawie Uniwersytet Medyczny w Lublinie Główny Inspektorat Sanitarny

3 Janusz Sierosławski Institute of Psychiatry and Neurology Estimation of prevalence of HCV among IDUs in Poland and identification of risk factors Addiction Conference Lisbon, September 2015

4 Introduction Objectives of the project to cover IDUs population by evidence based HCV prevention measures to increase institutional capacity to response HCV problem among IDUs Outputs of the project Model HCV prevention program targeting IDUs Proposals for National HCV Prevention and Control Strategy HCV prevalence study: initial assessment for developing HCV prevention program baseline for evaluation of prevention program First preliminary results as a subject of presentation

5 Method Population under study drug users using regularly illicit substances and experience problems Inclusion criteria: daily or almost daily drug use during at least 1 month in the last 3 years, or lifetime injecting drug use Snowball sampling in 15 localization around Poland Testing saliva samples (anti HCV antibodies) and collecting standardized interviews Sample size 1219 (average per localization 81) Data collected in March June 2014

6 HCV antibodies and injecting drug use Lifetime injecting and noninjecting drug use (numbers) HCV antibodies among IDUs and non IDUs (percentages) General populatio n about 1% Statistically significant p 0,01

7 HCV antibodies among IDUs Lifetime use of needles or syringes used by others HCV antibodies and use of used needles or syringes Statistically significant p 0,01

8 Risk of HCV antibodies among IDUs logistic regression model Variables (reference category) Odds ratio CI lower CI higher Variables not included in the model: Age Gender Homelessness Number of years Sharing needles or syringes (no) Imprisonment (no) Education (secondary and higher) since first injection Interaction between age and number of years since first injection Model fitting: 76,8% correctly classified R 2 Nagelkerke = 0,39

9 Risk of use of used needles or syringes in last 30 days logistic regression model Variables (reference category) Odds ratio CI lower CI higher Homelessness (no) 2,359 1,435 3,879 Risky places of injections (no) 1,986 1,133 3,483 Injection every day (once a week or less frequently) Injection 2 6 times per week (once a week or less frequently) 3,430 1,746 6,737 1,694 0,852 3,367 Tested HCV+ (no tested) 0,656 0,387 1,109 Tested HCV (no tested) 0,299 0,131 0,685 N = 424 Variables not included in the model: Gender Age Education Number of years since first injection Imprisonment experiences Model fitting: 78,1% correctly classified R 2 Nagelkerke = 0,19

10 Conclusions 1 Prevalence of HCV antibodies among problem drug users without any injecting experiences six times higher than in the general population prevention program should be addressed also to non injecting drug users Prevalence of HCV antibodies among lifetime IDUs ten times higher than among other problem drug users Rick factors for HCV antibodies among IDUs: Increasing age Needles or syringes sharing Low education Experience in imprisonment Prevention measures should be different for different groups of problem drug users

11 Conclusions 2 The study results suggest that use of used injecting equipment is related to two environmental factors : Homelessness Injecting in risky places Response should include intervention focused not only on injectors but also on environment Injection rooms should be the best offer for homeless and IDUs who inject in risky places

12 Project webpage (English): PROGRAM SUPPORTED BY A GRANT FROM SWITZERLAND TROUGH THE SWISS CONTRIBUTION TO THE ENLARGEMENT EUROPEAN UNION AND BY MINISTRY OF HEALTH OF REPUBLIC OF POLAND Narodowy Instytut Zdrowia Publicznego Państwowy Zakład Higieny w Warszawie Instytut Psychiatrii I Neurologii w Warszawie Uniwersytet Medyczny w Lublinie Główny Inspektorat Sanitarny