5. J. Sieroslawski - Program Prevention of HCV infections

5. J. Sieroslawski - Program Prevention of HCV infections

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
www.hcv.pzh.gov.pl
Instytut
Psychiatrii
I Neurologii
w Warszawie
Uniwersytet
Medyczny
w Lublinie
Główny
Inspektorat
Sanitarny
Main partner:
Narodowy Instytut Zdrowia
Publicznego – Państwowy
Zakład Higieny w Warszawie
Partners:
Instytut
Psychiatrii
I Neurologii
w Warszawie
www.hcv.pzh.gov.pl
Uniwersytet
Medyczny
w Lublinie
Główny
Inspektorat
Sanitarny
Janusz Sierosławski
Institute of Psychiatry and Neurology
PROJECT 2
Developing evidence based HCV prevention
program for injecting drug users (IDUs) and
assessing needs for prevention in this
population
Annual expert meeting on Drug-related deaths (DRD)
and Drug-related infectious diseases (DRID)
Lisbon, 15–17 October 2014
www.hcv.pzh.gov.pl
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
www.hcv.pzh.gov.pl
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
www.hcv.pzh.gov.pl
HCV antibodies and injecting drug use
Lifetime injecting and noninjecting drug use (numbers)
1000
900
800
700
600
500
400
300
200
100
0
HCV antibodies among IDUs and
non IDUs (percentages)
70
853
60
50
General
population
- about 1%
64.6
40
30
360
20
10
6.5
0
Non IDUs
www.hcv.pzh.gov.pl
IDUs
Non IDUs
IDUs
Statistically significant p 0,01
HCV antibodies among IDUs
Lifetime use of needles or
syringes used by others
HCV antibodies and use of
used needles or syringes
90
78.8
80
40.4
70
60
50
64,6
Total IDUs
43.5
40
30
20
59.6
No
Yes
10
0
Never used
www.hcv.pzh.gov.pl
Used
Statistically significant p 0,01
Risk of HCV antibodies among IDUs –
logistic regression model
Variables
(reference category)
Age
Odds
CI
CI Variables not included
ratio lower higher in the model:
1.130 1.103 1.158
Sharing needles or syringes
4.393 3.112 6.202
(no)
Imprisonment
(no)
Education
(secondary and higher)
www.hcv.pzh.gov.pl
1.458 1.010 2.104
• Gender
• Homelessness
• Number of years
since first injection
• Interaction between
age and number of
years since first
injection
Model fitting:
1.937 1.314 2.854
• 76,8% correctly
classified
• R2 Nagelkerke = 0,39
Conclusions
• 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
www.hcv.pzh.gov.pl
Project webpage (English):
http://www.hcv.pzh.gov.pl/en/Page/project-2-1
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
www.hcv.pzh.gov.pl
Instytut
Psychiatrii
I Neurologii
w Warszawie
Uniwersytet
Medyczny
w Lublinie
Główny
Inspektorat
Sanitarny