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    Targeting Hepatitis C virus Treatment ~ Who should be treated to first?

    Background

    Due to the high cost of improved Hepatitis C virus treatment, in most cases, it is not feasible to offer treatment to all injection drug users at once. In order to optimize the benefits for the overall injection population, targeting HCV treatment appropriately is vital. Previously, treatment has been withheld from active injectors because of the risk that they may become re-infected and limit the benefits to themselves and the whole population.

    Approach

    The authors of this study look at the population-level benefits of treating one chronically HCV infected injection drug user in a population of high- and low- risk users. They then compared the benefits of treating one high or low risk user to develop an optimal treatment strategy.

    Findings

    • High-risk injectors share injecting equipment approximately 7 times more frequently than low-risk injectors.
    • When approximately 32% of injectors are infected with Hepatitis C, the preventative impact of treating high and low risk injectors is equivalent

    (1 high-risk injector = 1 low-risk injector).

    • When Hepatitis C Virus is rare, the benefits of preventing high-risk injectors spreading it to larger numbers outweighs the risk that they will become re-infected.
    • When the virus is already very common, fewer injectors can be infected, which reduces the spreading potential of high-risk users. At this point, it is better to focus efforts toward treating lower risk injectors who are less likely to become re-infected.

    Conclusion

    To enhance the preventative impact of hepatitis C virus treatment, interventions should be targeted based on how often the patient shares injecting equipment. When Hepatitis C virus is relatively uncommon among injectors, it is best to cure infected high-risk injectors. When the virus is relatively common, low-risk injectors should be targeted.

    De Vos, A.S., Prins, M., and Kretzschmar, M.E.E. (2015). Hepatitis C virus treatment as prevention among injecting drug users: who should we cure first? Addiction. Vol.110, pp. 975-983.

  2. Exploring Health Services Access to Non-active Injectors

    Background

    It is important for former injectors to maintain connections with syringe exchange programs (SEPs) in order to access general social and health services that will help them to maintain sobriety. This study looked at walking distance to needle exchange programs for both current and former people who inject drugs (PWID).

    Approach

    The study surveyed 137 people who inject drugs who presented for services at syringe exchange program (SEP) mobile distribution sites in Washington DC.

    Findings

    • Active and non-active injectors do not have equal access to syringe exchange program (SEP) services.
    • Those who are not actively injecting may have less motivation to travel to access services compared to when they were actively injecting and seeking sterile equipment.
    • Non-active injectors may also be seeking healthcare services elsewhere.
    • Challenges to enhancing access to SEP services include policies that restrict where needle exchange programs can legally operate (e.g. certain proximity to schools). Future work should explore enhancing access in areas of greatest need.

    Conclusion

    Providing comprehensive services for former/non-active substance users, a vulnerable population, is important for addressing their complex medical and social health care needs such as addiction treatment and support and housing.

    Allen, S., Ruiz, M., and O’Rourk, A. (2015).How far will they go?: assessing the travel distance of current and former drug users to access harm reduction services. Harm Reduction Journal. Vol. 12. Issue 3.