Jenny Iversen

Uptake of hepatitis C treatment among people who inject drugs attending Needle and Syringe Programs in Australia, 1999–2011

The majority of new and existing cases of hepatitis C virus (HCV) infection occur among people who inject drugs (PWID). Despite safe and efficacious HCV antiviral therapy, uptake remains low in this population. This study examined trends in HCV treatment uptake among a large national sample of PWID attending Australian Needle and Syringe Programs between 1999 and 2011. Annual cross‐sectional sero‐surveys conducted among PWID since 1995 involve completion of a self‐administered questionnaire and provision of a dried blood spot for HCV antibody testing. Multivariate logistic regression identified variables independently associated with HCV treatment uptake among 9478 participants with both self‐reported and serologically confirmed prior HCV infection. Between 1999 and 2011, the proportion currently receiving treatment increased from 1.1% to 2.1% (P < 0.001), while the proportion having ever received treatment increased from 3.4% to 8.6% (P < 0.001). Men were significantly more likely than women to have undertaken HCV treatment (P = 0.002). Among men, independent predictors of HCV treatment uptake were homosexual identity and older age; among women, independent predictors included homosexual identity and an incarceration history. Despite increases in HCV treatment among Australian PWID between 1999 and 2011, uptake remains low. Strategies are required to increase the proportion of PWID assessed and treated for HCV infection to address the increasing burden of disease. Specific approaches that target women may also be warranted. Continued surveillance of HCV treatment uptake among PWID will be important to monitor the roll‐out of simple, safe and more effective HCV treatments expected to be available in the future.

The impact of needle and syringe programs on HIV and HCV transmissions in injecting drug users in Australia: a model-based analysis.

Objectives:We aim to estimate how changes in sterile syringe distribution through needle-syringe programs (NSPs) may affect HIV and hepatitis C virus (HCV) incidence among injecting drug users (IDUs) in Australia. Methods:We develop a novel mathematical model of HIV and HCV transmission among IDUs who share syringes. It is calibrated using biological and Australian epidemiological and behavioral data. Assuming NSP syringe distribution affects the number of times each syringe is used before disposal, we use the model to estimate the relationship between incidence and syringe distribution. Results:HIV is effectively controlled through NSP distribution of sterile syringes {with the effective reproduction ratio below 1 [0.66 median, interquartile range (0.63-0.70)] under current syringe distribution}. In contrast, HCV incidence is expected to remain high and its control is not feasible in the foreseeable future. The proportion of injections that are shared and the number of times each syringe is used before disposal are the driving factors of HCV incidence. The frequency in which each syringe is used can potentially be influenced by changes in syringe distribution. We estimate that if syringe distribution or coverage doubled, then annual incidence is likely to reduce by 50%. However, if it was decreased to one third of the current level, then ∼3 times the incidence could be expected. Conclusions:This research highlights the large benefits of NSPs, puts forward a quantitative relationship between incidence and syringe distribution, and indicates that increased coverage could result in significant reductions in viral transmissions among IDUs.

Estimating the cost-effectiveness of needle-syringe programs in Australia.

Objective:To evaluate the impact and cost-effectiveness of needle-syringe programs (NSPs) with respect to HIV and hepatitis C virus (HCV) infections among Australian injecting drug users (IDUs). Design/methods:A health economic analysis was conducted incorporating a mathematical model of HIV and HCV transmission among IDUs. An empirical relationship between syringe availability and receptive syringe sharing (RSS) was assessed. We compared the epidemiological outcomes and costs of NSP coverage (status quo RSS of 15–17%) with scenarios that had no NSPs (RSS of 25–50%). Outcomes included numbers of HIV and HCV infections averted, lifetime health sector costs, and cost per quality-adjusted life year (QALY) gained. Discounting was applied at 3% (sensitivity: 0%, 5%) per annum. Results:We estimated that NSPs reduced incidence of HIV by 34–70% (192–873 cases) and HCV by 15–43% (19 000–77 000 cases) during 2000–2010, leading to 20 000–66 000 QALYs gained. Economic analysis showed that NSP coverage saved A

Prevalence and predictors of injecting‐related injury and disease among clients of Australia's needle and syringe programs

70–220 million in healthcare costs during 2000–2010 and will save an additional A

Reduction in HCV Incidence Among Injection Drug Users Attending Needle and Syringe Programs in Australia: A Linkage Study

340–950 million in future healthcare costs. With NSPs costing A

HIV, HCV and health-related harms among women who inject drugs: Implications for prevention and treatment

245 million, the programs are very cost-effective at A

Are people who inject performance and image-enhancing drugs an increasing population of Needle and Syringe Program attendees?

416–8750 per QALY gained. Financial investment in NSPs over 2000–2010 is estimated to be entirely recovered in healthcare cost savings by 2032 with a total future return on investment of

Individual-level syringe coverage among Needle and Syringe Program attendees in Australia

1.3–5.5 for every

Is point of access to needles and syringes related to needle sharing? Comparing data collected from pharmacies and needle and syringe programs in south-east Sydney

1 invested. Conclusion:Australias early introduction and high coverage of NSPs has significantly reduced the prevalence of HIV and HCV among IDUs. NSPs are a cost-effective public health strategy and will result in substantial net cost savings in the future.

Gender differences in hepatitis C antibody prevalence and risk behaviours amongst people who inject drugs in Australia 1998-2008.

Objective: To identify lifetime prevalence and predictors of self‐reported injecting‐related injuries and diseases (IRID) and/or injecting‐related problems (IRP) among a national cross‐sectional sample of injecting drug users.