|Titre :||Can needle and syringe programmes and opiate substitution therapy achieve substantial reductions in hepatitis C virus prevalence? Model projections for different epidemic settings (2012)|
|Auteurs :||P. VICKERMAN ; N. MARTIN ; K. TURNER ; M. HICKMAN|
|Type de document :||Article : Périodique|
|Dans :||Addiction (Vol.107, n°11, November 2012)|
|Article en page(s) :||1984-1995|
|Note générale :||Commentary: Reducing hepatitis C virus among injection drug users through harm reduction programs. Smith-Spangler C.M., Asch S.M., p. 1996-1997.|
|Discipline :||MAL (Maladies infectieuses / Infectious diseases)|
Thésaurus TOXIBASEPROGRAMME ; ECHANGE DE SERINGUES ; TRAITEMENT DE MAINTENANCE ; SUBSTITUTION ; HEPATITE ; PREVALENCE ; REDUCTION DES RISQUES ; MODELE STATISTIQUE
Aims: To investigate the impact of scaling-up opiate substitution therapy (OST) and high coverage needle and syringe programmes (100%NSP - obtaining more sterile syringes than you inject) on HCV prevalence among injecting drug users (IDUs).
Design: Hepatitis C virus HCV transmission modelling using UK estimates for effect of OST and 100%NSP on individual risk of HCV infection.
Setting: Range of chronic HCV prevalent (20/40/60%) settings with no OST/100%NSP, and UK setting with 50% coverage of both OST and 100%NSP.
Participants: Injecting drug users.
Measurements: Decrease in HCV prevalence after 5-20 years due to scale-up of OST and 100%NSP to 20/40/60% coverage in no OST/100%NSP settings, or from 50% to 60/70/80% coverage in the UK setting.
Findings: For 40% chronic HCV prevalence, scaling-up OST and 100%NSP from 0% to 20% coverage reduces HCV prevalence by 13% after 10 years. This increases to a 24/33% relative reduction at 40/60% coverage. Marginally less impact occurs in higher prevalence settings over 10 years, but this becomes more pronounced over time. In the United Kingdom, without current coverage levels of OST and 100%NSP the chronic HCV prevalence could be 65% instead of 40%. However, increasing OST and 100%NSP coverage further is unlikely to reduce chronic prevalence to less than 30% over 10 years unless coverage becomes >=80%.
Conclusions: Scaling-up opiate substitution therapy and high coverage needle and syringe programmes can reduce hepatitis C prevalence among injecting drug users, but reductions can be modest and require long-term sustained intervention coverage. In high coverage settings, other interventions are needed to further decrease hepatitis C prevalence. In low coverage settings, sustained scale-up of both interventions is needed.
|Domaine :||Drogues illicites / Illicit drugs|
|Refs biblio. :||76|
|Affiliation :||London School of Hygiene and Tropical Medicine, London, UK|