There is considerable evidence that needle/syringe exchange provision has helped to control HIV t... more There is considerable evidence that needle/syringe exchange provision has helped to control HIV transmission among injecting drug users (IDUs) [1]. However, the indications are that current interventions may be reducing, but are not controlling, the spread of hepatitis C infection (HCV) [2].
The lead author* affirms that he had full access to all of the data in the study and had final re... more The lead author* affirms that he had full access to all of the data in the study and had final responsibility for the decision to submit for publication.
Background Novel Psychoactive Substance (NPS) use has increased in recent years and generated sig... more Background Novel Psychoactive Substance (NPS) use has increased in recent years and generated significant concern within public health. People who inject drugs (PWID) are at increased risk of blood borne viruses, in particular Hepatitis C virus (HCV). However, little is known about the extent of NPS injecting at a national level and its association with HCV. This study provides one of the first epidemiological analyses of the association between NPS injecting and HCV among a population level sample of PWID. Methods Five cross sectional surveys of almost 13,000 PWID attending services providing injecting equipment across Scotland between 2008 and 2016 were analysed. Logistic regression was used to determine associations between NPS injecting and HCV. Results The proportion of PWID reporting that they had injected NPS in the previous six months increased from 0.2% in 2008-09 to 11.0% in 2015-16. Those who reported injecting NPS were considerably more likely to be resident in the Lothian NHS Board area at the time of the study (AOR 5.6 (95% CI 4.1-7.5)) and to have had recent experience of homelessness (AOR 1.4 (95% CI 1.0-1.9)). People who injected NPS were also significantly more likely to be HCV positive (AOR 1.7 (95% CI 1.2-2.4)). In Lothian, HCV prevalence rose from around 30% between 2008 and 2012 to 41% and then 48% in 2013-14 and 2015-16 respectively. Increases in prevalent HCV infection in Lothian may be partly attributed to increases in NPS injecting. Conclusion In Scotland, people who had injected Novel Psychoactive Substances were at increased risk of hepatitis C virus. Novel Psychoactive Substance injecting poses a threat to HCV elimination strategies.
While it is increasingly recognized that recovery from dependent use of heroin or alcohol is poss... more While it is increasingly recognized that recovery from dependent use of heroin or alcohol is possible, little is known about the long-term process of recovery. A study in Glasgow, Scotland used interviews and self-completed questionnaires to investigate the recovery journeys of former problematic users of heroin or alcohol. Qualitative data showed that recovery was understood as including but transcending freedom from dependence, and that most participants saw their own recovery as an ongoing process rather than a time-limited milestone. Motivating factors were usually negative personal experiences—with former heroin users more likely to cite “the lifestyle” and former alcohol users their behavior and health problems - and more positively around issues of personal identity. Social factors were often cited as key in sustaining recovery, especially peer support. An understanding of the views and perceptions of those who have experienced recovery from dependent use of alcohol or heroin...
Introduction In 2004, Scotland's Health Minister stated that the hepatitis C virus (HCV) “is ... more Introduction In 2004, Scotland's Health Minister stated that the hepatitis C virus (HCV) “is one of the most serious and significant public health risks of our generation” Methods To appreciate the prevention and care challenges posed by HCV in Scotland, we reviewed all country-specific data on i) the prevalence of infection among different populations, ii) the numbers infected with HCV, and iii) the current and future HCV disease burden Results An estimated 1% of Scotland's population has HCV; 85-90% of those infected were injecting drug users (IDUs). Reductions in HCV prevalence among young IDUs during the early 1990s suggest that the incidence of HCV had decreased; since then, the absence of further reductions highlight that existing prevention measures are insufficient. Two-thirds of the estimated 37,500 chronically HCV-infected individuals in Scotland remain undiagnosed and two-thirds of this group are former IDUs. An estimated 9,000 former IDUs were living with either ...
Results: Individuals interviewed during the qualitative component of the study reported witnessin... more Results: Individuals interviewed during the qualitative component of the study reported witnessing prolific sharing of needles and syringes (n/s) in hostels. Multi‐factorial logistic regression found that hostel residence was independently associated with injecting with an/s previously ...
Background There is limited evidence of the impact of needle and syringe programmes (NSPs) and op... more Background There is limited evidence of the impact of needle and syringe programmes (NSPs) and opioid substitution therapy (OST) on hepatitis C virus (HCV) incidence among people who inject drugs (PWID), nor have there been any economic evaluations. Objective(s) To measure (1) the impact of NSP and OST, (2) changes in the extent of provision of both interventions, and (3) costs and cost-effectiveness of NSPs on HCV infection transmission. Design We conducted (1) a systematic review; (2) an analysis of existing data sets, including collating costs of NSPs; and (3) a dynamic deterministic model to estimate the impact of differing OST/NSP intervention coverage levels for reducing HCV infection prevalence, incidence and disease burden, and incremental cost-effectiveness ratios to measure the cost-effectiveness of current NSP provision versus no provision. Setting Cost-effectiveness analysis and impact modelling in three UK sites. The pooled analysis drew on data from the UK and Australi...
Background: Bacterial skin and soft tissue infections (SSTI) among people who inject drugs (PWID)... more Background: Bacterial skin and soft tissue infections (SSTI) among people who inject drugs (PWID) are considered a public health concern. There is a lack of qualitative research examining the lived experience of PWID who have had SSTI. This paper explores PWID views and experiences of their SSTI, their perceptions on the causes of their SSTI and their harm reduction (HR) behaviours. The implications for HR service delivery and practice will be discussed. Methods: Between October 2015-January 2016, 22 in-depth interviews were conducted with PWID who had experienced a SSTI within the past year. Interviewees were recruited from an injecting equipment provision service and a drug treatment service in Glasgow and Edinburgh respectively. The interview transcripts were transcribed verbatim and underwent thematic analysis. Results: We found that the experience of SSTI can cause strong negative feelings, including panic and stigma and that there was limited knowledge of SSTI prior to first hand experience. The awareness of the unacceptable social and physical consequences of SSTI fostered a sense of personal responsibility and agency which led to the introduction or improved HR uptake. However, when PWID were struggling
To reduce hepatitis C virus (HCV) transmission among people who inject drugs (PWID), Scottish Gov... more To reduce hepatitis C virus (HCV) transmission among people who inject drugs (PWID), Scottish Government-funded national strategies, launched in 2008, promoted scaling-up opioid substitution therapy (OST) and needle and syringe provision (NSP), with some increases in HCV treatment. We test whether observed decreases in HCV incidence post-2008 can be attributed to this intervention scale-up. A dynamic HCV transmission model among PWID incorporating intervention scale-up and observed decreases in behavioural risk, calibrated to Scottish HCV prevalence and incidence data for 2008/09. Scotland, UK. PWID. Model projections from 2008 to 2015 were compared with data to test whether they were consistent with observed decreases in HCV incidence among PWID while incorporating the observed intervention scale-up, and to determine the impact of scaling-up interventions on incidence. Without fitting to epidemiological data post-2008/09, the model incorporating observed intervention scale-up agree...
To estimate the impact of existing high-coverage needle and syringe provision (HCNSP, defined as ... more To estimate the impact of existing high-coverage needle and syringe provision (HCNSP, defined as obtaining more than one sterile needle and syringe per injection reported) and opioid substitution therapy (OST) on hepatitis C virus (HCV) transmission among people who inject drugs (PWID) in three UK settings and to determine required scale-up of interventions, including HCV treatment, needed to reach the World Health Organization (WHO) target of reducing HCV incidence by 90% by 2030. HCV transmission modelling using UK empirical estimates for effect of OST and/or HCNSP on individual risk of HCV acquisition. Three UK cities with varying chronic HCV prevalence (Bristol 45%, Dundee 26%, Walsall 19%), OST (72-81%) and HCNSP coverage (28-56%). Relative change in new HCV infections throughout 2016-30 if current interventions were stopped. Scale-up of HCNSP, OST and HCV treatment required to achieve the WHO elimination target. Removing HCNSP or OST would increase the number of new HCV infect...
The International journal on drug policy, Feb 1, 2018
Although people who inject drugs (PWID) are at greatest risk of hepatitis C (HCV), treatment upta... more Although people who inject drugs (PWID) are at greatest risk of hepatitis C (HCV), treatment uptake in this population has historically been low. Highly effective direct acting antiviral (DAA) treatments for HCV have recently become available. Our aim was to assess the awareness among PWID of these new therapies and their effectiveness. A national survey of PWID attending injecting equipment provision sites in Scotland during 2015-2016 included questions to gauge the awareness in this population of antiviral treatment and the high cure rates associated with new therapies (defined here as >80%). Among 2623 PWID, 92% had ever been tested for HCV. After excluding those ever treated for HCV (n = 226), 79% were aware of HCV treatment. Awareness was more likely among those who had ever been tested and self-reported either a positive (adjusted odds ratio: 16.04, 95%CI 10.57-24.33) or negative (3.11, 2.30-4.22) test result, compared to those who were never tested. The minority of all res...
Women who inject drugs (WWID) are an especially vulnerable group of drug users. This study determ... more Women who inject drugs (WWID) are an especially vulnerable group of drug users. This study determined the prevalence of psychiatric comorbidity and intimate partrner violence (IPV), and factors associated with psychiatric comorbidity among WWID recruited from drug treatment services (67%) and harm reduction services in five European regions in Austria, Catalonia, Italy, Poland, and Scotland. Psychiatric comorbidity was assessed among 226 WWID using the Dual Diagnosis Screening Instrument. IPV was assessed using the Composite Abuse Scale and injecting and sexual risk behaviors were assessed using a battery of questionnaires adapted and developed for the study. Eighty-seven percent met criteria for at least one lifetime psychiatric disorder. The most common disorders were depression (76%), panic (54%), and post-traumatic stress (52%). WWID recruited in drug treatment services were almost three times as likely (OR 2.90 95% CI 1.30-6.43; p = 0.007) to meet criteria for a lifetime psychi...
The International journal on drug policy, Mar 24, 2017
There is no research on public health interventions that alert people who inject drugs (PWID) to ... more There is no research on public health interventions that alert people who inject drugs (PWID) to clusters/outbreaks of severe bacterial infections. In Scotland, during the botulism cluster/outbreak of Dec 2014-July 2015 harm reduction (HR) messages detailed on a postcard (Botulism Postcard) were distributed to PWID between Feb-April 2015. We examined the impact of the Botulism Postcard on cluster/outbreak awareness, healthcare seeking and HR behaviours among PWID; and their views on such clusters/outbreaks. The Botulism Postcard questionnaire survey was undertaken with 288 PWID recruited in Greater Glasgow and Clyde between May-August 2015. Multivariate logistic regression was undertaken. Between Oct 2015-January 2016 22 in-depth interviews were conducted with PWID in Glasgow and Edinburgh, these underwent thematic analysis. 38% (108/284) had never seen the postcard, 14% (40/284) had only seen it, 34% (98/284) read but not discussed it and 13% (38/284) had discussed it with service ...
There is considerable evidence that needle/syringe exchange provision has helped to control HIV t... more There is considerable evidence that needle/syringe exchange provision has helped to control HIV transmission among injecting drug users (IDUs) [1]. However, the indications are that current interventions may be reducing, but are not controlling, the spread of hepatitis C infection (HCV) [2].
The lead author* affirms that he had full access to all of the data in the study and had final re... more The lead author* affirms that he had full access to all of the data in the study and had final responsibility for the decision to submit for publication.
Background Novel Psychoactive Substance (NPS) use has increased in recent years and generated sig... more Background Novel Psychoactive Substance (NPS) use has increased in recent years and generated significant concern within public health. People who inject drugs (PWID) are at increased risk of blood borne viruses, in particular Hepatitis C virus (HCV). However, little is known about the extent of NPS injecting at a national level and its association with HCV. This study provides one of the first epidemiological analyses of the association between NPS injecting and HCV among a population level sample of PWID. Methods Five cross sectional surveys of almost 13,000 PWID attending services providing injecting equipment across Scotland between 2008 and 2016 were analysed. Logistic regression was used to determine associations between NPS injecting and HCV. Results The proportion of PWID reporting that they had injected NPS in the previous six months increased from 0.2% in 2008-09 to 11.0% in 2015-16. Those who reported injecting NPS were considerably more likely to be resident in the Lothian NHS Board area at the time of the study (AOR 5.6 (95% CI 4.1-7.5)) and to have had recent experience of homelessness (AOR 1.4 (95% CI 1.0-1.9)). People who injected NPS were also significantly more likely to be HCV positive (AOR 1.7 (95% CI 1.2-2.4)). In Lothian, HCV prevalence rose from around 30% between 2008 and 2012 to 41% and then 48% in 2013-14 and 2015-16 respectively. Increases in prevalent HCV infection in Lothian may be partly attributed to increases in NPS injecting. Conclusion In Scotland, people who had injected Novel Psychoactive Substances were at increased risk of hepatitis C virus. Novel Psychoactive Substance injecting poses a threat to HCV elimination strategies.
While it is increasingly recognized that recovery from dependent use of heroin or alcohol is poss... more While it is increasingly recognized that recovery from dependent use of heroin or alcohol is possible, little is known about the long-term process of recovery. A study in Glasgow, Scotland used interviews and self-completed questionnaires to investigate the recovery journeys of former problematic users of heroin or alcohol. Qualitative data showed that recovery was understood as including but transcending freedom from dependence, and that most participants saw their own recovery as an ongoing process rather than a time-limited milestone. Motivating factors were usually negative personal experiences—with former heroin users more likely to cite “the lifestyle” and former alcohol users their behavior and health problems - and more positively around issues of personal identity. Social factors were often cited as key in sustaining recovery, especially peer support. An understanding of the views and perceptions of those who have experienced recovery from dependent use of alcohol or heroin...
Introduction In 2004, Scotland's Health Minister stated that the hepatitis C virus (HCV) “is ... more Introduction In 2004, Scotland's Health Minister stated that the hepatitis C virus (HCV) “is one of the most serious and significant public health risks of our generation” Methods To appreciate the prevention and care challenges posed by HCV in Scotland, we reviewed all country-specific data on i) the prevalence of infection among different populations, ii) the numbers infected with HCV, and iii) the current and future HCV disease burden Results An estimated 1% of Scotland's population has HCV; 85-90% of those infected were injecting drug users (IDUs). Reductions in HCV prevalence among young IDUs during the early 1990s suggest that the incidence of HCV had decreased; since then, the absence of further reductions highlight that existing prevention measures are insufficient. Two-thirds of the estimated 37,500 chronically HCV-infected individuals in Scotland remain undiagnosed and two-thirds of this group are former IDUs. An estimated 9,000 former IDUs were living with either ...
Results: Individuals interviewed during the qualitative component of the study reported witnessin... more Results: Individuals interviewed during the qualitative component of the study reported witnessing prolific sharing of needles and syringes (n/s) in hostels. Multi‐factorial logistic regression found that hostel residence was independently associated with injecting with an/s previously ...
Background There is limited evidence of the impact of needle and syringe programmes (NSPs) and op... more Background There is limited evidence of the impact of needle and syringe programmes (NSPs) and opioid substitution therapy (OST) on hepatitis C virus (HCV) incidence among people who inject drugs (PWID), nor have there been any economic evaluations. Objective(s) To measure (1) the impact of NSP and OST, (2) changes in the extent of provision of both interventions, and (3) costs and cost-effectiveness of NSPs on HCV infection transmission. Design We conducted (1) a systematic review; (2) an analysis of existing data sets, including collating costs of NSPs; and (3) a dynamic deterministic model to estimate the impact of differing OST/NSP intervention coverage levels for reducing HCV infection prevalence, incidence and disease burden, and incremental cost-effectiveness ratios to measure the cost-effectiveness of current NSP provision versus no provision. Setting Cost-effectiveness analysis and impact modelling in three UK sites. The pooled analysis drew on data from the UK and Australi...
Background: Bacterial skin and soft tissue infections (SSTI) among people who inject drugs (PWID)... more Background: Bacterial skin and soft tissue infections (SSTI) among people who inject drugs (PWID) are considered a public health concern. There is a lack of qualitative research examining the lived experience of PWID who have had SSTI. This paper explores PWID views and experiences of their SSTI, their perceptions on the causes of their SSTI and their harm reduction (HR) behaviours. The implications for HR service delivery and practice will be discussed. Methods: Between October 2015-January 2016, 22 in-depth interviews were conducted with PWID who had experienced a SSTI within the past year. Interviewees were recruited from an injecting equipment provision service and a drug treatment service in Glasgow and Edinburgh respectively. The interview transcripts were transcribed verbatim and underwent thematic analysis. Results: We found that the experience of SSTI can cause strong negative feelings, including panic and stigma and that there was limited knowledge of SSTI prior to first hand experience. The awareness of the unacceptable social and physical consequences of SSTI fostered a sense of personal responsibility and agency which led to the introduction or improved HR uptake. However, when PWID were struggling
To reduce hepatitis C virus (HCV) transmission among people who inject drugs (PWID), Scottish Gov... more To reduce hepatitis C virus (HCV) transmission among people who inject drugs (PWID), Scottish Government-funded national strategies, launched in 2008, promoted scaling-up opioid substitution therapy (OST) and needle and syringe provision (NSP), with some increases in HCV treatment. We test whether observed decreases in HCV incidence post-2008 can be attributed to this intervention scale-up. A dynamic HCV transmission model among PWID incorporating intervention scale-up and observed decreases in behavioural risk, calibrated to Scottish HCV prevalence and incidence data for 2008/09. Scotland, UK. PWID. Model projections from 2008 to 2015 were compared with data to test whether they were consistent with observed decreases in HCV incidence among PWID while incorporating the observed intervention scale-up, and to determine the impact of scaling-up interventions on incidence. Without fitting to epidemiological data post-2008/09, the model incorporating observed intervention scale-up agree...
To estimate the impact of existing high-coverage needle and syringe provision (HCNSP, defined as ... more To estimate the impact of existing high-coverage needle and syringe provision (HCNSP, defined as obtaining more than one sterile needle and syringe per injection reported) and opioid substitution therapy (OST) on hepatitis C virus (HCV) transmission among people who inject drugs (PWID) in three UK settings and to determine required scale-up of interventions, including HCV treatment, needed to reach the World Health Organization (WHO) target of reducing HCV incidence by 90% by 2030. HCV transmission modelling using UK empirical estimates for effect of OST and/or HCNSP on individual risk of HCV acquisition. Three UK cities with varying chronic HCV prevalence (Bristol 45%, Dundee 26%, Walsall 19%), OST (72-81%) and HCNSP coverage (28-56%). Relative change in new HCV infections throughout 2016-30 if current interventions were stopped. Scale-up of HCNSP, OST and HCV treatment required to achieve the WHO elimination target. Removing HCNSP or OST would increase the number of new HCV infect...
The International journal on drug policy, Feb 1, 2018
Although people who inject drugs (PWID) are at greatest risk of hepatitis C (HCV), treatment upta... more Although people who inject drugs (PWID) are at greatest risk of hepatitis C (HCV), treatment uptake in this population has historically been low. Highly effective direct acting antiviral (DAA) treatments for HCV have recently become available. Our aim was to assess the awareness among PWID of these new therapies and their effectiveness. A national survey of PWID attending injecting equipment provision sites in Scotland during 2015-2016 included questions to gauge the awareness in this population of antiviral treatment and the high cure rates associated with new therapies (defined here as >80%). Among 2623 PWID, 92% had ever been tested for HCV. After excluding those ever treated for HCV (n = 226), 79% were aware of HCV treatment. Awareness was more likely among those who had ever been tested and self-reported either a positive (adjusted odds ratio: 16.04, 95%CI 10.57-24.33) or negative (3.11, 2.30-4.22) test result, compared to those who were never tested. The minority of all res...
Women who inject drugs (WWID) are an especially vulnerable group of drug users. This study determ... more Women who inject drugs (WWID) are an especially vulnerable group of drug users. This study determined the prevalence of psychiatric comorbidity and intimate partrner violence (IPV), and factors associated with psychiatric comorbidity among WWID recruited from drug treatment services (67%) and harm reduction services in five European regions in Austria, Catalonia, Italy, Poland, and Scotland. Psychiatric comorbidity was assessed among 226 WWID using the Dual Diagnosis Screening Instrument. IPV was assessed using the Composite Abuse Scale and injecting and sexual risk behaviors were assessed using a battery of questionnaires adapted and developed for the study. Eighty-seven percent met criteria for at least one lifetime psychiatric disorder. The most common disorders were depression (76%), panic (54%), and post-traumatic stress (52%). WWID recruited in drug treatment services were almost three times as likely (OR 2.90 95% CI 1.30-6.43; p = 0.007) to meet criteria for a lifetime psychi...
The International journal on drug policy, Mar 24, 2017
There is no research on public health interventions that alert people who inject drugs (PWID) to ... more There is no research on public health interventions that alert people who inject drugs (PWID) to clusters/outbreaks of severe bacterial infections. In Scotland, during the botulism cluster/outbreak of Dec 2014-July 2015 harm reduction (HR) messages detailed on a postcard (Botulism Postcard) were distributed to PWID between Feb-April 2015. We examined the impact of the Botulism Postcard on cluster/outbreak awareness, healthcare seeking and HR behaviours among PWID; and their views on such clusters/outbreaks. The Botulism Postcard questionnaire survey was undertaken with 288 PWID recruited in Greater Glasgow and Clyde between May-August 2015. Multivariate logistic regression was undertaken. Between Oct 2015-January 2016 22 in-depth interviews were conducted with PWID in Glasgow and Edinburgh, these underwent thematic analysis. 38% (108/284) had never seen the postcard, 14% (40/284) had only seen it, 34% (98/284) read but not discussed it and 13% (38/284) had discussed it with service ...
Uploads
Papers by Avril Taylor