Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report by unknow

Author:unknow
Language: eng
Format: epub
Tags: Health and Medicine: Infectious Disease, Health and Medicine: Public Health and Prevention
Publisher: The National Academies Press
Published: 2016-06-02T00:00:00+00:00

ENDING TRANSMISSION OF HEPATITIS C

Eliminating hepatitis C will require stopping transmission of the virus. In the United States, people who inject drugs have the highest risk of transmitting the virus (Alter, 1997). A strategy to stop transmission in this group should give attention to both reducing the risk of contracting HCV among people who are not infected and to reducing the likelihood of transmission among those who are (Edlin and Winkelstein, 2014; Grebely and Dore, 2014; Hellard et al., 2014). Preventing infection among people who use drugs was key to reducing incidence of HIV, but appears less effective for HCV (Palmateer et al., 2010; Wright and Tompkins, 2006). This is because HCV is more transmissible than HIV (Alter, 2006). Even without sharing a needle, HCV can be spread through shared equipment such tourniquets (Hagan et al., 2001).

Nevertheless, there is some evidence that HCV transmission can be reduced through primary prevention efforts. In a 2011 review, Hagan and colleagues found little evidence that behavioral interventions, substance-abuse treatment, opioid-replacement therapy, or syringe programs reduced incidence of HCV when any one program was implemented alone (Hagan et al., 2011). However, two studies that employed multiple strategies (both including opioid replacement, one with counseling, the other with syringe exchange) reduced HCV incidence among drug injectors by about 75 percent (Hagan et al., 2011). A pooled analysis from the United Kingdom, however, suggested that syringe exchange and opioid replacement could each be effective in reducing infection by about 50 percent when implemented independently, provided the syringe exchange reached a large amount of the target population (Turner et al., 2011). When these programs were combined, their reduction on HCV incidence was near 80 percent, similar to the estimate in the Hagan review (Turner et al., 2011).

There is reason to believe that needle and syringe exchange programs, counselling, and opioid replacement therapy (collectively called harm reduction services) can help reduce the transmission of HCV especially among younger people and those who have more recently begun injecting (Mehta et al., 2011; Tseng et al., 2007). Cities with strong needle and syringe exchange programs, including New York and San Francisco, have seen significant declines in HCV prevalence (Des Jarlais et al., 2005; Tseng et al., 2007). The higher prevalence of HCV among older injectors and those who have been injecting longer suggests that the programs delayed, but did not prevent, the infection (Mehta et al., 2011). The longer time to infection may also prove a valuable window in which to reach young people who inject drugs with information about preventing infection or treating substance use disorders (Mehta et al., 2011). The recent lifting of Congress’ ban on use of federal funds for syringe exchange (with the caveat that the funds cannot be used on needles or syringes) may allow for expanding harm reduction programs.

Comprehensive drug and alcohol programs will be critical to any HCV elimination program. Such programs may be complicated. Injecting drug use is becoming more common in rural areas and small towns, not the just densely populated cities where such programs have a history (Suryaprasad et al.

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