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Drug Use and
Hepatitis C
Are we mindful of the
gaps?
Dave Liddell, SDF
Gaps
Scale of the problem – are there still
gaps in our knowledge?
Definitely Treatment gaps re current
and former injectors with HCV
Prevention issues – key gaps
Policy gaps
Total number of current
injectors in Scotland
 19000* drug injectors(2003 estimate) of whom 8000 HCV
positive
 19000 likely to be an underestimate as no needle exchange
data was used. And treatment data through SMR25 likely to
underestimate levels of injecting. Also prevalence figure
did not include psycho-stimulant injectors

*Source: Glasgow University Prevalence study 2003
HCV Testing, treatment and care
issues
In Phase 1 of the Action Plan the focus is on
raising awareness among professionals because
it is evident that there are not sufficient services
to cope with the need for treatment.
Therefore in Phase 1 a Needs assessment is to
be undertaken by October 2007
‘The Health Department will publish the findings
of an in-depth needs assessment undertaken in
relation to HCV testing, treatment, care and
support services’
Its vitally important that this needs assessment also looks
at the delivery mechanisms..
The Action Plan states..
‘Stakeholders from around Scotland have argued for new
community-based models of care for Hepatitis C-infected
individuals. It has been suggested that these new models
of care could take the form of outreach, nurse-led clinics in
primary care services, in prisons and / or in drug
treatment services.’
 Kennedy – HCV treatment outcomes just as good for
current injectors
 Sharon – small numbers currently getting anti-viral therapy
 Kennedy – co-location of services
Testing/contact tracing
 Clearly to date there has been a reluctance to
test or follow up former injectors due to scarce
treatment resources. But…
 Thought must be given now as to how a
campaign could be undertaken to get more
people who are current and former injectors into
treatment.
 25,000 former and 8000 current injectors infected
 Sharon – this is cost effective
Prevention of HCV – gaps?
Prevention of problem drug use
Early intervention with drug users to limit
progression to injecting
Improved access and availability of
needle exchanges
Swift access to quality treatment to
enable sustained move away from
injecting
Specific services for injectors
Service user experiences
Early intervention
 Re inventing wheels!
 Young people – detached youth work models
 Young drug users – detached youth work models
Early intervention with drug
injectors
Taking services to injectors. HCV Action Plan….
‘The Scottish Executive will ask NHS boards to consider
whether they have the full range of interventions in
place…..
These interventions should include: more outreach and
mobile needle exchange services; distributing a
wide range of paraphernalia (in addition to needles and
syringes) in needle exchanges; and labelling or colourcoding of injecting equipment to help drug users
identify their own.’
Services for drug users
 There remain major issues with drug treatment
services
 Retention rates are poor in a number of areas
 Low dose prescribing/punitive approaches
 Services delivered in silos
 Greater focus on abstinence could lead to
injectors being a forgotten population – focus
will be on those motivated to come off drugs
Specific services for
injectors
 Outreach Needle Exchange/home
delivery/secondary supply/peer projects
 Heroin prescribing services
 Services for Cocaine injectors
 Migrant populations
 Prison needle Exchange
Service user experiences
 Feedback on how best to deliver needle
exchanges
 Issues of delivery – eg in some areas there is an
issue for users re attending needle exchange as
part of a treatment service
 Dawn – 50% of specialist needle exchanges
attached to treatments services
Policy gaps
 Responses to drug problems and those to
HCV/blood borne viruses not sufficiently joined
up
Within the Scottish Executive
 Health – BBVs – Alcohol
 Justice – Drugs
Local level
 BBV Committees/ADATS
 CJAs, CHPs, CPPs etc
Policy gaps
 Potential for responses to be in conflict eg greater focus on
abstinence, increased relapse/return to injecting
 Planning structures: Need to be clearer lines of
responsibility. E.g. Whose responsibility is it to identify
levels of injecting and ensure services are available to
meet the needs of this population
 Under 16’s Needle Exchange
 Limits on sets of works(1987 strict 1 for 1 exchange max of
3)
 Return rates
Conclusion
 1000-2000 new infections among drug injectors
each year (Sharon suggested a 1000)
 Needle Exchange provision and HCV treatment
services biggest gaps
 Investment in needle exchanges very cost
effective –
 HIV and HCV treatment savings mean, according
to an Australian study that for every £1 invested
in needle exchange £50 will be saved in other
costs