Local trends in HCV prevalence in people who inject drugs: variation between Operational Delivery Network (ODN) areas
PHE ePoster Library. Harris R. Apr 9, 2019; 257484; 15343
Mr. Ross Harris
Mr. Ross Harris
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Abstract Introduction
: HCV prevalence in people who inject drugs (PWID) is a key monitoring metric for elimination goals. New direct-acting antiviral drugs are being delivered across 22 Operational Delivery Network (ODN) areas in England. We explored local variation and trends in HCV prevalence across ODNs.
: Serological survey data from the Unlinked Anonymous Monitoring (UAM) study of PWID were used. Subjects injecting for 1-19 years with a test for HCV antibodies in the years 2009-2017 were included. Multiple sites are sampled within each ODN; multilevel mixed effects logistic regression was therefore used to determine variation in HCV prevalence between and within ODNs, with fixed effects for each sample year, injecting duration, sex and tertiles of age first injected. Linear trends across ODNs from 2013-2017 were also examined.
: 21 ODNs were sampled across 92 sites (with N>10), with a median of 4 sites sampled per ODN (range 1-12) and 7338 individuals in total. HCV antibody prevalence ranged from 35% to 68% across ODNs. Mixed-effects logistic regression models indicated high variability in prevalence between ODNs (σ=0.31) and higher within-ODN variability (σ=0.54). There was no conclusive evidence of a change in HCV antibody prevalence over the years 2009-2017 (p=0.117); nor for a linear trend over 2013-2017 (p=0.234) or variation in trends between ODNs (p=0.268).
After accounting for the multilevel structure of the data and differences in covariates across sample sites, there was no evidence of a change in HCV antibody prevalence in the last 9 years. There is substantial variability in HCV prevalence between ODNs, and high variability between sites, which should be considered in the analysis of ODN-level data. Retrospective RNA testing is currently underway such that the direct effect of new treatments can be determined; these results provide evidence that background antibody prevalence is stable.
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