Impact of Current and Scaled Up Levels of Needle and Syringe Programmes and Opiate Substitution Therapy in Three UK Settings

Author: Ward Z, Platt L, Sweeney S, Hope V, Maher L, Hutchinson S, Palmateer N, Smith J, Craine N, Taylor A, Martin N, Dillon J, Hickman M, Vickerman P

Theme: Epidemiology & Public Health Research Year: 2016


Ward Z1, Platt L2, Sweeney S2, Hope V3, Maher L4, Hutchinson S5, Palmateer N5,Smith J6, Craine N6, Taylor A7, Martin N8, Dillon J, Hickman M1, Vickerman P1

University of Bristol, Bristol, UK1, London School of Hygiene and Tropical Medicine, London, UK2, Public Health England, UK3, University of New South Wales, Sydney, Australia4, Glasgow Caledonian University, Glasgow, UK5, Public Health Wales, Cardiff, UK6, University of the West of Scotland, Paisley, UK7, University of California, San Diego, USA8, University of Dundee, Dundee, UK9

Background: Most HCV infections in the UK are acquired through injecting drug use. This study investigated the impact of current and scaled-up coverage of needle and syringe programmes (NSP) and opiate substitution therapy (OST) among people who inject drugs (PWID) in 3 UK settings with differing chronic prevalence: Bristol (45%), Walsall (24%) and Dundee (38%).

Methods: A HCV transmission model was parameterised and calibrated with UK estimates for effect of OST and/or high coverage NSP on HCV acquisition risk and detailed data from each setting. The model estimated the increase in incident infections and prevalence from 2016 to 2031 if current interventions were removed or NSP were scaled-up to 80% coverage.

Results: Removing OST (current coverage 81%) and NSP (coverage 54%) in Bristol would at least double (113% increase 95%CrI 48-335%) the number of new infections over 15-years. In Dundee, which has the highest current NSP coverage (60%), removing NSP would result in a 47% (95%CrI 12-183%) increase in new infections whereas also removing OST (coverage 70%) would result in a 116% (95%CrI 42-431%) increase. In Walsall removing both interventions increases new infections by 214% (95%CrI 72-508%). Increasing NSP coverage to 80% has the largest impact in Walsall, which has the lowest current NSP coverage (35%), resulting in 23% (95%CrI 7-39%) decrease in new infections over 15-years, whereas it drops by 11% and 14% in Bristol and Dundee, respectively. Increasing NSP coverage to 80% results in small (3.5-4.5% absolute drop) drop in prevalence over 15 years in all settings.

Conclusions: Despite variations in coverage, NSP and OST are likely preventing considerable HCV infections in the UK. Increasing NSP coverage will have most impact in settings with low coverage. Scaling up other interventions such as HCV treatment are needed to decrease epidemics to low levels in higher prevalence settings.

Disclosure of Interest: Nothing to disclose

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