Increased Risk Of Hepatitis-C Virus And Skin And Soft Tissue Infection Among People Who Inject Novel Psychoactive Substances

Author: McAuley A, Yeung A, Taylor A, Hutchinson SJ, Goldberg DJ, Munro A

Theme: Epidemiology & Public Health Research Year: 2018

Background: Use of Novel Psychoactive Substances (NPS) is of increasing public health concern, but little is known about people who inject NPS and related harms. We aimed to examine the prevalence of NPS injecting in Scotland among People Who Inject Drugs (PWID) and the factors associated with it, and to assess the burden of hepatitis c virus (HCV) among people who inject NPS. Methods: Data from the Scottish Needle Exchange Surveillance Initiative (NESI) survey collected between 2008 and 2016 were analysed. Unadjusted and adjusted logistic regression was used to determine factors associated with NPS injecting and HCV infection. Results: The proportion of PWID taking part in the survey reporting that they had injected NPS in the previous six months increased from 0.2% in 2008-09 to 11% in 2015-16. Those who reported injecting NPS were considerably more likely to have taken part in recent surveys (2013-14: aOR 26.06, 95% CI 10.99-61.78; 2015-16: aOR 120.65, 95% CI 52.91–275.11) than in earlier studies, typically younger than other PWID (aOR 0.95, 95% CI 0.93-0.97), and more likely have had recent experience of homelessness (aOR 1.42, 95% CI 1.04–1.94)) or ever been in prison (aOR 1.60, 95% CI 1.16–2.22). When considering harms, people who inject NPS were significantly more likely to be HCV antibody positive (aOR 1.71, 95% CI 1.23-2.38). Increasing HCV antibody prevalence and high rates of incident HCV infection were evident in the locality with the greatest exposure to NPS injecting. Conclusion: People who inject NPS in Scotland are at increased risk of HCV despite high coverage of harm reduction interventions. NPS injecting potentially presents a threat to HCV elimination strategies. Prevention efforts should utilise both legislative and harm reduction approaches, with a particular focus on homeless and ex-prisoner populations who appear especially vulnerable to NPS injecting and related harms. Disclosure of Interest Statement: DJG has received personal fees from Gilead Sciences, Bristol-Myers Squibb and Abbvie, all unrelated to this study. All remaining authors have nothing to disclose.

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