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Type of submission: Oral
Conference track: Research
Topics: Needle and Syringe Programmes; Viral Hepatitis and Tuberculosis
Presenting author: Pascale Leclerc
Pascale Leclerc, Michel Alary, Karine Blouin, Carole Morissette, Élise Roy, Caty Blanchette, Bouchra Serhir, the SurvUDI Working Group
Background: An HIV/HCV surveillance network is ongoing among people who inject drugs (PWID) in Eastern Central Canada (province of Québec and City of Ottawa) since 1995. Data were analysed to estimate HIV and HCV prevalence (2003-2015) and examine trends (over available years) in HIV and HCV incidence and use of syringes previously used by someone else (“used syringes”).
Methods: PWID having injected recently (past 6 months) are recruited in harm reduction and health programs. They complete an interviewer-administered questionnaire and provide saliva samples for antibody testing. Multiple visits by a repeater are linked through a unique identifier to measure incidence. The bootstrap method was used for trend analyses.
Results: As of 03/31/2015, 14,137 PWID had completed 26,859 interviews. Overall, 75.5% were males with a median age of 36 years (females: 30 years). From 2009 to 2015, 70.7% had recently injected cocaine, 63.1% prescription opioids, and 33.6% heroin. HIV prevalence was 14.0% [95% Confidence Interval (95%CI): 13.2-14.9%] and HCV prevalence was 63.3% [95%CI: 62.1-64.4%], with a co-infection rate of 11.9%. Overall HIV incidence (1995-2015) was 2.1 per 100 person-years (PY) [95%CI: 1.9-2.3 per 100 PY; 324 seroconversions among 3,530 repeaters initially HIV-negative] but decreased significantly from 5.0 to 0.7 per 100 PY (1995-2013; p<0.001). Overall HCV incidence (1997-2015) was 21.9 per 100 PY [95%CI: 20.1-23.7 per 100 PY; 559 seroconversions among 1,177 repeaters initially HCV-negative] but oscillated between 28.3 (1999) and 12.1 per 100 PY (2011) for a significant overall decrease (1998-2013; p=0.004). Recent injection with “used syringes” significantly decreased from 43.4% to 18.5% (1995-2014; p<0.001) but was stable from 2011 to 2014.
Conclusions: The three decreasing trends are encouraging. However, HIV and HCV incidence remain unacceptably high and the last proportions of “used syringes” use are of concern. Harm reduction programs must be strengthened to curb both epidemics among PWID.