A review of the evidence for the effectiveness of primary prevention interventions for Hepatitis C among injecting drug users

FRANÇAIS :
Cette revue de la littérature a pour but de déterminer l'efficacité des actions de prévention primaire de l'hépatite C chez les usagers de drogues injectables. L'analyse des résultats des études recensées montre que les différents types d'interventions (programmes d'échange de seringues, programmes de maintenance à la méthadone, interventions comportementales, distributions d'eau de javel ou de matériel d'injection, salles d'injection contrôlée...) ont un impact limité et réduisent peu l'incidence du VHC chez les usagers de drogues par voie intraveineuse, contrairement à ce qu'on observe pour le VIH.
ENGLISH :
Background: Hepatitis C (HCV) prevalence is most common amongst injecting drug users where up to 98% of the population can be infected despite a low prevalence of HIV. This review considers the evidence for the effectiveness of primary prevention interventions to reduce incidence or prevalence of hepatitis C. Methods: Systematic review of the major electronic medical databases: Medline, EMBASE, PsycINFO, CINAHL and the Cochrane Library (Evidence Based Health). Either intervention or observational studies were included if they described an intervention targeting injecting drug using populations with the outcome to reduce either the prevalence or incidence of hepatitis C infection. Results: 18 papers were included in the final review from 1007 abstracts. Needle exchange programmes reduce the prevalence of HCV though prevalence remains high. Similarly the effectiveness of methadone maintenance treatment is only marginally effective at reducing HCV incidence. There is limited evidence evaluating either the effectiveness of behavioural interventions, bleach disinfectants, or drug consumption rooms. Conclusion: Primary prevention interventions have led to a reduction in HIV incidence, have been less effective at reducing HCV incidence. Global prevalence of HCV remains disturbingly high in injecting drug users. A robust response to the global health problem of HCV will require provision of new interventions. Behavioural interventions; distribution of bleach disinfectant; other injecting paraphernalia alongside sterile needle distribution; and evaluation of drug consumption rooms merit further expansion internationally and research activity to contribute to the emerging evidence base. Whilst the prevalence of HCV remains high, nevertheless many current interventions aimed at primary HCV prevention have been shown to be cost-effective due to their significant positive impact upon prevalence of HIV. (Review' s abstract)