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American Journal of Epidemiology Advance Access originally published online on June 22, 2009
American Journal of Epidemiology 2009 170(3):352-360; doi:10.1093/aje/kwp141
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American Journal of Epidemiology © 2009 The Authors
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ORIGINAL CONTRIBUTIONS

Hepatitis C Infection Among Injecting Drug Users in England and Wales (1992–2006): There and Back Again?

Michael J. Sweeting, Vivian D. Hope, Matthew Hickman, John V. Parry, Fortune Ncube, Mary E. Ramsay and Daniela De Angelis

Correspondence to Dr. Michael Sweeting, Medical Research Council Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge CB2 0SR, United Kingdom (e-mail: michael.sweeting{at}mrc-bsu.cam.ac.uk).

Received for publication February 5, 2009. Accepted for publication May 1, 2009.

Changes in hepatitis C virus (HCV) prevalence from 1992 to 2006 were examined by using 24,311 records from unlinked anonymous surveillance of injecting drug users in England and Wales. Bayesian logistic regression was used to estimate annual prevalence, accounting for changing recruitment patterns (age, gender, injecting duration, geographic region, interactions) and the sensitivity and specificity of different oral fluid testing devices. After controlling for these differences, the authors found that the adjusted HCV prevalence decreased from 70% (95% credible interval: 62, 78) in 1992 to 47% (95% credible interval: 43, 51) in 1998 before rising again to 53% (95% credible interval: 48, 58) in 2006. Women injecting drug users had a higher HCV risk than did men (odds ratio = 1.50, 95% credible interval: 1.31, 1.73). Two regions (London and North West) had a markedly higher HCV prevalence than did the rest of England and Wales. Among individuals who had injected for less than 1 year, the adjusted HCV prevalence in 2006 was higher than that in 1992 (28% vs. 19%, respectively). HCV infection can be prevented. The public health challenge in England and Wales is to increase action in order to regain a downward trend in HCV risk and the benefit that has been lost since 1998.

England; hepatitis C; prevalence; sentinel surveillance; substance abuse, intravenous; Wales

Abbreviations: AIC, Akaike Information Criterion; CI, confidence interval; HCV, hepatitis C virus; HIV, human immunodeficiency virus; IDU, injecting drug user


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