Community Drug / Alcohol Pathways. Rachael Sadegh DAAT Co-ordinator

Transcription

1 Community Drug / Alcohol Pathways Rachael Sadegh DAAT Co-ordinator

2 Prevalence / Treatment in Tower Hamlets Estimated 3,561 Opiate / Crack users Estimated 773 Injecting drug Users Estimated 9,500 high risk drinkers Estimated 31,728 increasing risk drinkers Approx 1400 Opiate / Crack users in treatment annually Approx 650 drinkers in treatment annually

3 Figure 1: Trend in anti-hcv prevalence* among people who inject drugs in England: (PHE) *During 2009 to 2011 there was a phased change in the sample collected in the survey from an oral fluid to dried blood spot (DBS). The sensitivity of the anti-hcv tests on these two sample types is different. The sensitivity of the oral fluid test for anti-hcv is approximately 92%, (28) that on DBS samples is close to 100%. Data presented here have been adjusted for the sensitivity of the oral fluid test.

4 HIV, hepatitis B & hepatitis C prevalence and injection site infections; NUTS Region London: Year Sample type DBS DBS DBS DBS DBS Anti-HIV Prevalence 2.9% 3.9% 3.2% 4.0% 3.9% 3.8% 4.1% 4.3% 3.9% 3.7% 4.5% Number of samples anti-hiv positive Total number of samples collected Anti-HBc Prevalence 39% 40% 35% 45% 36% 28% 32% 33% 24% 28% 28% Proportion of samples anti-hbc positive 29% 30% 26% 34% 27% 21% 24% 28% 22% 24% 28% 28% Number of samples anti-hbc positive Total number of samples collected Anti-HCV Prevalence 60% 58% 62% 61% 65% 57% 59% 64% 48% 59% 59% Proportion of samples anti-hcv positive 55% 53% 57% 56% 60% 52% 54% 60% 61% 48% 59% 59% Number of samples anti-hcv positive Total number of samples collected Among those who had injected in preceding year Symptom of injection site infection 39% 44% 39% 43% 40% 37% 40% 38% Number reporting symptom Total number answering question * The sensitivity of the oral fluid test for anti-hcv is approximately 92%, and that for anti-hbc is approximately 75%. Anti-HIV Prevalence = (number of samples tested anti-hiv positive / total tested)x100. Anti-HBc Prevalence = [(number of oral fluids anti-hbc positive/0.75) + number of DBS anti-hbc positive] / (number of oral fluids + number of DBS)x100. Anti-HCV Prevalence = [(number of oral fluids anti-hcv positive/0.92) + number of DBS anti-hcv positive] / (number of oral fluids + number of DBS)x100. Self reports of a swelling containing pus (abscess), sore, or open wound at an injection site in preceding year. Data source: Unlinked Anonymous Monitoring Survey of HIV and Hepatitis in People Who Inject Drugs

5 * The sensitivity of the oral fluid test for anti-hcv is approximately 92%, and that for anti-hbc is approximately 75%. Sharing of needles and syringes in preceding four weeks. Sharing of needles and syringes, mixing containers, or filters among those who had last injected during the four weeks preceding participation in the survey. Note: the definition used here is different from that used in previous data sets. Data source: Unlinked Anonymous Monitoring Survey of HIV and Hepatitis in People Who Inject Drugs Hepatitis B vaccination uptake, uptake of testing for hepatitis C & HIV, injecting risks, and condom use; NUTS Region London: Year Sample type DBS DBS DBS DBS DBS Hepatitis B vaccine uptake 53% 54% 62% 62% 66% 66% 69% 73% 70% 73% 75% Number reporting hepatitis B vaccine uptake Total number answering question HCV VCT Uptake 72% 73% 80% 85% 85% 82% 87% 89% 82% 89% 87% Number reporting a VCT for HCV Total number answering question Proportion aware of HCV infection 56% 60% 63% 75% 69% 65% 67% 69% 59% 65% 60% Number aware of their HCV infection Total number answering question HIV VCT uptake 72% 68% 75% 83% 80% 80% 82% 87% 76% 85% 88% Number reporting a VCT for HIV Total number answering question Among those who had injected in preceding four weeks Level of direct sharing 32% 26% 28% 23% 25% 19% 17% 25% 22% 15% 15% Number reporting direct sharing Total number answering question Level of sharing (direct & indirect) 55% 54% 50% 48% 53% 40% 34% 42% 31% 35% 36% Number reporting sharing Total number answering question Among those with two or more (anal or vaginal) sexual partners in preceding year Proportion always using a condom 26% 25% 26% 23% 30% 38% 34% 26% 18% 32% 33% Number always using a condom Total number answering question

6 Proportion anti-hbc positive and HBV vaccine uptake (%) Trends in Hepatitis B prevalence and vaccine uptake # among PWID in EW&NI: 1990/ % HBV HBV vaccine uptake HBV EW & NI 80% 60% 40% 20% 0% Survey Year Source: Survey data tables PHE, 2014 # Self reports, those receiving one or more vaccine doses.

7 Sentinel surveillance testing by service type Tower Hamlets Samples submitted to BLT March February 2010 Total tests 29,267, total antibody +ve 1,277, estimated RNA +ve 950 type Number tested Number positive (%) GP (2%) GUM (3%) Occupational health A&E (6%) Obs and Gynae (3%) Specialist Drug (30%) Renal medicine (2%) Specialist liver services General medical/surgical (5%) (11%)

8 Prevention / Treatment for drug users Stop injecting OST/ detoxification / psychosocial interventions Needle exchange / safer injecting advice Low dead space needles Coloured equipment Foil Alongside OST Hepatitis B vaccination Frequent Hepatitis C screening user focussed HCV treatment

9 Prevention / treatment for drinkers Identification and Brief Advice Stop / reduce drinking Brief advice Psychosocial interventions Detoxification (community / residential) Anti-craving medications Nalmefene Address diet / parenteral vitamin supplementation LFTs / Ultrasound / CT

10 LB Tower Hamlets: Current Provision Referral sources GP Self Drug Probat ion CARAT CJS Oth er DIP Dellow Day Centre Somali SM Link Project RLH drug / alcohol nurses Treatment Health E1 Shared Care ISIS CDT SAU Community Alcohol Team Island Day Nafas Day and Abstinence Support network DIP Changes Nacro Interven tion and Link Harbour Centre Panel Other T4 Spot Purchase

11 Needle Exchange / Safer Injecting advice Referral sources GP Self Drug Probat ion CARAT CJS Oth er DIP Dellow Day Centre Somali SM Link Project RLH drug / alcohol nurses Treatment Health E1 Shared Care ISIS CDT SAU Community Alcohol Team + 4 pharmacies, Ambrose King Centre Island Day Nafas Day and Abstinence Support network DIP Changes Nacro Interven tion and Link Harbour Centre Panel Other T4 Spot Purchase

12 HBV Vaccination / HCV screening Referral sources GP Self Drug Probat ion CARAT CJS Other DIP Dellow Day Centre Somali SM Link Project RLH drug / alcohol nurses Treatment Health E1 Shared Care ISIS CDT SAU Community Alcohol Team Island Day Nafas Day and Abstinence Support network DIP Changes Nacro Interven tion and Link Harbour Centre Panel Other T4 Spot Purchase

13 BBV Headlines individuals accessing service per quarter via treatment services 291 individuals registered with Chronic HCV infection Approx new individuals tested for HCV each quarter Approx 10 new HCV cases each quarter 76-97% of treatment service caseload seen by BBV nurses HBV vaccination rates and HCV screening rates way above London average Award winning HCV treatment service

14 LB Tower Hamlets: Approved treatment system option Referral sources GP Self Probation CARAT CJS Other Other DIP Lot 1 Lead Referral RLH Drug and Alcohol service RLH Specialis t Midwife Treatment Lot 2 Lead Drugs and Alcohol Lot 3 Lead Support Health E1 Homeless Medical Centre Panel