Integrating multiple programme and policy approaches to hepatitis C prevention and care for injection drug users: A comprehensive approach

AIDS Institute, New York State Department of Health, Albany, NY 12237, United States. <>
The International journal on drug policy (Impact Factor: 3.19). 11/2007; 18(5):417-25. DOI: 10.1016/j.drugpo.2007.01.013
Source: PubMed


New York State is home to an estimated 230,000 individuals chronically infected with hepatitis C virus (HCV) and roughly 171,500 active injection drug users (IDUs). HCV/HIV co-infection is common and models of service delivery that effectively meet IDUs' needs are required. A HCV strategic plan has stressed integration.
HCV prevention and care are integrated within health and human service settings, including HIV/AIDS organisations and drug treatment programmes. Other measures that support comprehensive HCV services for IDUs include reimbursement, clinical guidelines, training and HCV prevention education. Community and provider collaborations inform programme and policy development.
IDUs access 5 million syringes annually through harm reduction/syringe exchange programmes (SEPs) and a statewide syringe access programme. Declines in HCV prevalence amongst IDUs in New York City coincided with improved syringe availability. New models of care successfully link IDUs at SEPs and in drug treatment to health care. Over 7000 Medicaid recipients with HCV/HIV co-infection had health care encounters related to their HCV in a 12-month period and 10,547 claims for HCV-related medications were paid. The success rate of transitional case management referrals to drug treatment is over 90%. Training and clinical guidelines promote provider knowledge about HCV and contribute to quality HCV care for IDUs. Chart reviews of 2570 patients with HIV in 2004 documented HCV status 97.4% of the time, overall, in various settings. New HCV surveillance systems are operational. Despite this progress, significant challenges remain.
A comprehensive, public health approach, using multiple strategies across systems and mobilizing multiple sectors, can enhance IDUs access to HCV prevention and care. A holisitic approach with integrated services, including for HCV-HIV co-infected IDUs is needed. Leadership, collaboration and resources are essential.

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    • "A. Olsen et al. / International Journal of Drug Policy 23 (2012) 312– 318 317 investigations and treatment, lack of knowledge about it, lack of follow-up with appointments, poverty, reluctance of physicians to treat PWID and issues of medical or psychiatric co-morbidity (Dalgard, 2005; Davis & Rodrigue, 2001; Grebely, deVlaming, Duncan, Viljoen, & Conway, 2008; Mehta et al., 2008; Swan et al., 2010; Treloar & Holt, 2008). Policy and practice could more effectively meet the needs of PWID by integrating testing and treatment within health and human service settings such as drug treatment (Birkhead et al., 2007) and peer support programs (Grebely et al., 2007; Winter et al., 2008), as well as community and provider collaborations to inform programme and policy development. Our data suggest that there are elements of 'choice' at play in the low treatment uptake amongst PWID. "
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    ABSTRACT: Background: It is assumed that people who inject drugs (PWID) care little about their health. This emerges from social and moral perceptions of PWID and is framed by research that focuses on their morbidity and mortality. Drawing on the narratives of Australian women who inject drugs, we examined the salience of health for our participants and the contexts that structure their descriptions of health and wellbeing. Methods: We conducted qualitative interviews with 83 women who inject drugs and live with hepatitis C virus (HCV) to explore their experiences of health and health care seeking. Findings: Although the interviews focused on HCV, women discussed their health within broader contexts of drug dependence, unstable housing, unemployment, financial strain, other health issues and relationships. Concern about HCV was less pronounced than concerns about other health problems and socio-economic circumstances. Broadening the focus of health beyond drug use alone, women's narratives strongly suggest that PWID can and do care about their health. Conclusions: Whilst research and policy often focus on health problems and barriers to health amongst PWID, the women in our sample maintained positive health beliefs and behaviours. Much like other members of society, their health priorities are contextualised by cultural, economic and political factors. This suggests that health interventions aimed at women who inject drugs could build upon the salience of a range of health priorities as well as integrating these with structural interventions designed to improve housing and economic status.
    Full-text · Article · Jun 2012 · The International journal on drug policy
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    • "However, given that an inability to access syringes through a pharmacy was correlated with using and giving away previously used syringes, these results are consistent with the longitudinal evidence to date, indicating that increased options for syringe access predict lower risk behaviors. For instance, Cleland et al. found that safe syringe disposal increased following New York’s expanded syringe demonstration program;15 Singer et al. reported that pharmacies were an important source of sterile syringes 4 years after policy changes that allowed sales in Connecticut,21 and results reported by Des Jarlais et al. suggested that a comprehensive public health approach, using multiple strategies across systems, could enhance the prevention of blood-borne pathogens.22 Taken together, these studies suggest that pharmacies can be an effective and sustainable mode of reducing injection-related HIV risk by augmenting syringe access established at programs such as SEPs. "
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    ABSTRACT: Increased options for syringe acquisition and disposal have been associated with reductions in high-risk behaviors. This study determined the extent of pharmacy uptake in accessing syringes among injection drug users (IDUs) and estimated associations between pharmacy uptake and safer injection/disposal practices. Two years after the implementation of California's Disease Prevention Demonstration Project, which removed restrictions to non-prescription syringe sales through pharmacies with local authorization, IDUs were recruited through street outreach in San Francisco and interviewed regarding recent syringe acquisition, use, and disposal. The sample of 105 persons included a high proportion of men (67%), people of color (49%), and homeless persons (71%). The most common syringe source was a syringe exchange program (SEP) (80%), with pharmacies being accessed by 39% of respondents. The most commonly cited source of disposal was a SEP (65%), with very few reports of pharmacy disposal (2%). Adjusted analysis showed that unsuccessful attempts to purchase syringes at a pharmacy increased the odds of both injecting with a used syringe and giving away a used syringe. Using a SEP decreased the odds of unsafe injection and disposal practices. Thus, 2 years after the initiation of the California Disease Prevention Demonstration Project, results from this small study suggest that SEPs still provide the majority of syringe distribution and disposal services to San Francisco IDUs; however, pharmacies now augment syringe access. In addition, unsafe injection behavior is reported more often among those who do not use these syringe sources. These results are consistent with prior studies in suggesting that increasing the availability of syringes through SEPs and pharmacies, and developing bridges between them, may further reduce syringe-related risk.
    Full-text · Article · Jul 2010 · Journal of Urban Health
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    ABSTRACT: 350 words maximum: Prevention and treatment of hepatitis C (HCV) among injecting drug users (IDUs) is a public health priority in many countries around the world. However, there has been limited research that explores cultural differences in IDUs' approaches to HCV prevention and treatment. In Australia, previous research indicates that Indo-Chinese IDUs (Cambodian, Lao and Vietnamese) are an important group to target in HCV-related public health interventions. This ethnographic study aimed to explore Indo-Chinese IDUs' explanatory models of HCV and their influence on HCV-related prevention and treatment-seeking. Data were used to inform the development of a brief intervention (BI) about HCV treatment and its availability at a tertiary liver clinic. A trial of the BI was then conducted, to identify barriers to treatment uptake experienced by this group. Participants' explanatory models of HCV were syncretic and diverse within and between cultural groups. However, the study found that participants' approaches to HCV prevention and treatment-seeking were predominantly influenced by a cultural context heavily shaped by the stigma associated with injecting drug use. In participants' local worlds, social, structural and institutional forces exacerbated their marginalization and often positioned mainstream public health advice regarding HCV prevention and treatment as irrelevant or out of reach. Participants' narratives of suffering, diminishing hope for the future and 'spoiled identity' revealed how health promotion messages could act as a form of symbolic violence when they do not reflect the everyday constraints experienced by affected communities.
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