Has the HCV cascade of care changed among people who inject drugs in England since the introduction of direct-acting antivirals?

BACKGROUND

In England, over 80 % of those with hepatitis C virus (HCV) infection have injected drugs. We quantified the HCV cascade of care (CoC) among people who inject drugs (PWID) in England and determined whether this improved after direct-acting antivirals (DAAs) were introduced.

METHODS

We analysed data from nine rounds of national annual cross-sectional surveys of PWID recruited from drug services (2011-2019; N = 12,320). Study rounds were grouped as: 'Pre-DAAs' (2011-2014), 'Prioritised DAAs' (2015-2016) and 'Unrestricted DAAs' (2017-2019). Participants were anonymously tested for HCV antibodies and RNA and completed a short survey. We assessed the proportion of PWID recently (current/previous year) tested for HCV. For participants ever HCV treatment eligible (past chronic infection with history of treatment or current chronic infection), we assessed the CoC as: HCV testing (ever), received a positive test result, seen a specialist nurse/doctor, and ever treated. We used logistic regression to determine if individuals progressed through the CoC differently depending on time-period, whether time-period was associated with recent testing (all participants) and lifetime HCV treatment (ever eligible participants), and predictors of HCV testing and treatment in the Unrestricted DAAs period.

RESULTS

The proportion of ever HCV treatment eligible PWID reporting lifetime HCV treatment increased from 12.5 % in the Pre-DAAs period to 25.6 % in the Unrestricted DAAs period (aOR:2.40, 95 %CI:1.95-2.96). There were also increases in seeing a specialist nurse/doctor. The largest loss in the CoC was at treatment for all time periods. During the Unrestricted DAAs period, recent (past year) homelessness (vs never, aOR:0.66, 95 %CI:0.45-0.97), duration of injecting (≤3 years vs >3 years; aOR:0.26, 95 %CI:0.12-0.60), never (vs current, aOR:0.31, 95 %CI:0.13-0.75) or previously being prescribed OAT (vs current, aOR:0.67, 95 %CI:0.47-0.95), and never using a NSP (vs past year, aOR:0.27, 95 %CI:0.08-0.89) were negatively associated with lifetime HCV treatment. The proportion of PWID reporting recent HCV testing was higher during Unrestricted DAAs (56 %) compared to Pre-DAAs (48 %; aOR:1.28, 95 %CI:1.06-1.54).

CONCLUSION

COC stages from seeing a specialist onwards improved after DAAs became widely available. Further improvements in HCV testing are needed to eliminate HCV in England.

Adverse health outcomes among people who inject drugs who engaged in recent sex work: findings from a national survey

OBJECTIVES

This study explores trends in sex work among people who inject drugs (PWID) by gender and the relationship between sex work and adverse health outcomes including overdose, injection-site, and blood-borne virus (BBV) infections.

STUDY DESIGN

The Unlinked Anonymous Monitoring Survey of PWID is an annual cross-sectional survey that monitors BBV prevalence and behaviours, including transactional sex, among PWID recruited through specialist services in England, Wales, and Northern Ireland.

METHODS

Trends in sex work among PWID (2011-2021) were described. Data were analysed to assess differences between PWID who engaged in sex work in the past year (sex workers [SWs]) and those who did not (non-SWs) by gender (Pearson Chi2 tests) (2018-2021). Associations between sex work in the past year and adverse health outcomes were investigated using logistic regression.

RESULTS

Between 2011 and 2021, sex work among PWID remained stable, with 31% of women and 6.3% of men who inject, reporting having ever engaged in sex work, and 14% of women and 2.2% of men engaging in sex work in the past year. Between 2018 and 2021, SWs had greater odds of reporting symptoms of an injection-site infection (adjusted odds ratio (aOR): 1.68 [95% confidence interval {CI}: 1.31-2.16], P < 0.001) and reporting overdose (aOR: 2.21 [CI: 1.74-2.80], P < 0.001) than non-SWs had in the past year. Among men, SWs had 243% greater odds of having HIV than non-SWs (aOR: 3.43 [CI: 1.03-11.33], P = 0.043).

CONCLUSIONS

Our findings highlight disproportionate vulnerability and intersection of overlapping risk factors experienced by PWID SWs and a need for tailored interventions which are inclusive and low-threshold.

Preliminary indications of the burden of COVID-19 among people who inject drugs in England and Northern Ireland and the impact on access to health and harm reduction services

Objective

The aim of the study was to describe the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic on people who inject drugs (PWID) in England, Wales and Northern Ireland.

Study design

This is a cross-sectional Unlinked Anonymous Monitoring (UAM) Survey of PWID.

Methods

People who had ever injected psychoactive drugs were recruited to the UAM Survey by specialist drug/alcohol services in England, Wales and Northern Ireland. From June 2020, in addition to providing a dried blood spot sample and completing the UAM behavioural questionnaire, participants were asked to complete an enhanced coronavirus disease 2019 (COVID-19) questionnaire. Preliminary data are presented to the end of October and were compared with data from the 2019 UAM Survey, where possible.

Results

Between June and October, 288 PWID were recruited from England and Northern Ireland. One in nine (11%; 29/260) PWID reported testing positive for SARS-CoV-2 or experiencing COVID-19 symptoms. Fifteen percent (26/169) reported injecting more frequently in 2020 than in 2019; cocaine injection in the preceding four weeks increased from 17% (242/1456) to 25% (33/130). One in five PWID (19%; 35/188) reported difficulties in accessing HIV and hepatitis testing, and one in four (26%; 47/179) reported difficulties in accessing equipment for safer injecting.

Conclusions

Our preliminary findings suggest that PWID have experienced negative impacts on health, behaviours and access to essential harm reduction, testing and treatment services owing to the COVID-19 pandemic. Continued monitoring through surveillance and research is needed to understand the subsequent impact of COVID-19 on blood-borne virus transmission in this population and on health inequalities.

Consumer Perception Towards the Enhanced Color of Atypical Dark-Cutting Beef by Nitrite-Embedded Packaging

ObjectivesMeat color is often seen by consumers as an indicator of freshness and wholesomeness. Nitrite-embedded (NE) packaging forms nitric oxide myoglobin, which imparts a bright red color similar to oxymyoglobin. However, limited research has determined the effects of NE packaging to improve the appearance of atypically dark cutting beef. Consumers’ perception of NE packaging ultimately determines its success in the market. Educating consumers through infographics can transfer knowledge more effectively than text alone, potentially being a useful method to introduce and simplify the complexity of NE packaging’s role in improving the surface color of beef steaks. The objectives of this study were to evaluate FreshCase® nitrite-embedded packaging’s effect on atypical dark-cutting beef steaks and to evaluate student consumer perception of nitrite-embedded packaging improving the surface color of beef before and after exposure to infographics containing equal content.Materials and MethodsAtypical dark-cutting (n = 13, pH 5.70 ± 0.09) and normal-pH (n = 13, pH = 5.57 ± 0.1) USDA Low Choice beef strip loins were selected 3 d postharvest. Atypical dark-cutting loins were cut into 2.54 cm thick steaks and randomly packaged in polyvinyl chloride film (PVC) or NE film. Normal-pH control loins were cut 2.54 cm and randomly packaged in PVC overwrap. Packages were placed in a coffin-style retail case under fluorescent lighting for 6 d. Instrumental color was observed every 24 h using a HunterLab MiniScan XE spectrophotometer. The color was determined as a* values and chroma. In the second objective, surveys using a ten-point Likert sliding scale (0 = not familiar at all, 10 = extremely familiar) were randomly allocated and emailed via Qualtrics to students enrolled in the Introduction to Animal Science course at Oklahoma State University. These surveys used a pre-questionnaire to evaluate students’ pre-perception of their knowledge of beef color and NE packaging. After the pre-perception questionnaire students were provided one of the following: a static infographic presented as a still image with annotated graphics, a 46 s video infographic with audio and animated graphics, or both infographic formats. A post-questionnaire followed exposure to students’ respective infographic to evaluate changes in the perception of knowledge.ResultsAtypical dark-cutting steaks treated in NE packaging had higher (P < 0.05, more red intensity) chroma and a* values compared to atypical dark-cutting steaks in PVC on d 4, 5, and 6. There was a significant difference (P < 0.05) in the students’ (n = 288) pre- and post-questionnaire self-assessment of their familiarity with NE packaging. Prior to randomly viewing infographics, students were less familiar (= 3.18) with NE packaging than after viewing infographics (= 6.46). However, there was no significant difference in perceptions (P = 0.22) between viewing the different infographic formats.ConclusionThe results suggest that NE packaging with consumer education can improve their perceptions and knowledge and enhance the appearance of atypical dark-cutting beef.

Non-traumatic lower limb vascular complications in endurance athletes. Review of literature

OBJECTIVES

To review the importance, clinical features, investigations, management and prognosis of non-traumatic vascular injuries, affecting the lower limbs of endurance athletes.

DESIGN

Review of literature.

MATERIALS AND METHODS

A literature search was conducted from Medline, Pubmed, the National Electronic Library for Health, Google and Yahoo search engines for related articles and case reports regarding non-traumatic vascular complications involving the lower limb of endurance athletes.

CONCLUSIONS

Non-traumatic vascular complications affecting the lower limbs include endofibrosis, stenosis/kinking of iliac arteries, dissection of external iliac artery, adductor canal syndrome, popliteal entrapment syndrome, chronic exertional compartment syndrome and effort-induced venous thrombosis. These are important as they affect athletes at the peak of their career and can be confusing to diagnose. The management is relatively well documented and produces good results in short term but the long term results are not known.