INTRODUCTION: Linkage to care among individuals with substance misuse remains a barrier to the elimination of the hepatitis C virus (HCV). We aimed to determine whether point-of-care (PoC) education, screening and staging for liver disease with direct access to hospitals would improve linkage to care among this group. METHODS: All participants were offered PoC education and HCV screening. HCV-positive participants were randomised to standard care (controls) or direct access, which provided a direct pathway to hospitals. Linkage to care was determined by reviewing electronic medical records. Linkage of care cascade was defined as attendance at the specialist clinic, confirmation of viraemia by HCV RNA testing, discussion about HCV treatment and initiation of treatment. RESULTS: 351 halfway house residents were screened. The overall HCV prevalence was 30.5% (n = 107), with 69 residents in the control group and 38 in the direct access group. The direct access group had a significantly higher percentage of cases linked to specialist review for confirmatory RNA testing (63.2% vs. 40.6%, p = 0.025), HCV treatment discussion (p = 0.009) and treatment initiation (p = 0.01) compared to the controls. Overall, only 12.6% (n = 13) had treatment initiation during follow-up. PoC HCV screening with direct access referral had significantly higher linkage to HCV treatment initiation (adjusted odds ratio 9.13, p = 0.005) in multivariate analysis. CONCLUSION PoC HCV screening with direct access improves linkage to care and simplifies the HCV care cascade, leading to improved treatment uptake. PoC education, screening, diagnosis and treatment may be an effective strategy to achieving HCV micro-elimination in this population.
Antiviral Agents/therapeutic use* ; Halfway Houses ; Hepacivirus/genetics* ; Hepatitis C/epidemiology* ; Humans ; Pilot Projects ; Point-of-Care Systems ; RNA ; Referral and Consultation ; Substance Abuse, Intravenous/epidemiology*

INTRODUCTION: To study the prevalence of hepatitis C virus (HCV) infection in blood donor (BD), haemodialysis (HD) and intravenous drug user (IVDU) populations in Singapore and assess the IL28B polymorphism if HCV positive. METHODS: The BD population were healthy volunteers, the HD population were patients who were on haemodialysis for at least six months of follow-up between January 2009 and December 2014. IVDU population was from inmates at halfway houses who consented. RESULTS: Between 2011 and 2014, of 161,658 individuals who underwent screening prior to blood donation, 95 (0.059%) were positive for HCV. Of the 42 sera available, common genotypes (GTs) were GT-3 (47.6%) and GT-1 (31.0%). Of 1,575 HD patients, 2.2% were anti-HCV positive. The HCV GT distribution was HCV GT-1 (32.4%), HCV GT-3 (20.5%) and GT-6 (8.8%). 83 halfway house inmates were screened. Of the 47 IVDUs, 36.2% were anti-HCV positive with predominant GT-3 (%). IL28B polymorphism was noted to be CC predominantly 85.3%. CONCLUSION Prevalence of HCV infection has decreased in both the BD and HD populations. However, it remains high in the IVDU population. GT-1 remains the most common in the HD population; however, GT-3 infection is now more common among the BD population in Singapore. IL28B - CC is the predominant variant among the HCV-infected individuals in Singapore.
Acute Kidney Injury ; blood ; complications ; Adult ; Alleles ; Blood Donors ; Female ; Genotype ; Hepatitis C ; epidemiology ; Humans ; Interleukins ; genetics ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; Prevalence ; Renal Dialysis ; Singapore ; epidemiology ; Substance Abuse, Intravenous ; blood ; epidemiology ; Young Adult

Objective: To estimate the prevalence of HIV/HCV co-infection and explore the influence factors and their interaction on HIV/HCV co-infection of patient's access to methadone maintenance treatment (MMT). Methods: A face to face interviews were conducted among 750 patients at two MMT clinics in Guangxi Zhuang Autonomous Region. The questionnaires information included demographic characteristics, HIV and HCV infection status, history of drug abuse, urine test for morphine, high risk sex behaviors, needle sharing, dropped out etc. Methods of χ(2) test one-way, multivariate logistic regression and interactions were used to analyze the related factors of HIV/HCV co-infection. Results: The study subjects included 750 participants, 18.31% (127/691) of patients were co-infected with HIV and HCV. The HIV/HCV co-infection rate in patients who shared needles with others or dropped out of treatment was 35.84% (81/226) and 19.88% (64/322) respectively, which were higher than those who have never shared needles or dropped out (9.89%, 46/465 and 17.07%, 63/369). Logistic regression analysis results showed that after adjusted for confounding factors, patients who shared needles (OR=4.50, 95%CI: 2.72-7.43) and dropped out of treatment (OR=1.71, 95%CI: 1.04-2.80) were more likely to be infected with HIV/HCV. Interaction analysis showed that sharing needles and dropping out of treatment exist additive effect on co-infection of HIV and HCV (RERI=4.21, AP=0.44, SI=1.95). Conclusions: Needle sharing and dropping out of treatment are associated with HIV/HCV co-infection. Health education, psychological counseling and other measures should be taken to reduce needle sharing and dropping out of MMT.
China/epidemiology* ; Coinfection/epidemiology* ; Female ; HIV Infections/epidemiology* ; Hepatitis C/diagnosis* ; Humans ; Logistic Models ; Male ; Methadone/therapeutic use* ; Morphine ; Needle Sharing ; Opiate Substitution Treatment ; Prevalence ; Risk Factors ; Sexual Behavior ; Substance Abuse, Intravenous/drug therapy* ; Substance-Related Disorders

INTRODUCTIONThere is paucity of local data on the prevalence of blood transmitted infections (BTIs), such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV) infections, among illicit drug users. This study aimed to examine the prevalence of BTIs among substance dependent inpatients and identify the factors associated with BTIs.

METHODSWe conducted a retrospective analysis of clinical notes of 170 inpatients with a diagnosis of substance dependence who were admitted at the National Addictions Management Service, Singapore, between 1 June 2009 and 31 May 2010.

RESULTSMajority of the 170 inpatients were male (88.2%) and Chinese (58.2%). The mean age of the patients was 43.1 years, and the main drug of abuse was opioids (86.5%). BTIs were found in 70 (41.2%) inpatients; the prevalence of hepatitis B, hepatitis C and HIV infections was 3.7%, 39.6% and 0%, respectively. Lifetime intravenous drug use, but not needle-sharing, was more common among inpatients who were positive for BTIs (p < 0.01). Logistic regression analysis showed that lifetime intravenous drug use (OR 4.3, 95% CI 1.7- 10.8, p < 0.01) was the only significant predictor of BTIs.

CONCLUSIONA large proportion (41.2%) of the substance users seeking help was positive for at least one BTI. Lifetime intravenous drug users were found to be more than four times more likely to have a BTI. Early detection and prevention is essential to improve prognosis.

Adult ; Analgesics, Opioid ; therapeutic use ; Female ; HIV Infections ; blood ; complications ; Hepatitis B ; blood ; complications ; Hepatitis C ; blood ; complications ; Humans ; Inpatients ; Male ; Middle Aged ; Needle Sharing ; Odds Ratio ; Prevalence ; Prognosis ; Retrospective Studies ; Singapore ; Substance Abuse, Intravenous ; blood ; complications ; epidemiology

OBJECTIVETo explore seroepidemiological status and vaccine coverage of hepatitis B among drug users in Xi'an.

METHODS545 drug users in the Xi'an Compulsory Detoxification Center were asked to answer questionnaire and provide blood sample (3-5 ml) for test of HBsAg, anti-HBc and anti-HBs from March to June 2013. Totally, 545 subjects were surveyed and tested. All of them effectively completed the survey.

RESULTSThe positive rates of HBsAg, anti-HBc and anti-HBs were 29.4% (160/545), 60.0% (327/545) and 56.1% (306/545), respectively. Eighty five subjects (15.6%) were negative for all of the three markers. The prevalence of HBsAg and anti-HBc among injection drug users were 40.0% (94/235) and 65.6% (154/235), which was significantly higher than non- injection drug users' (21.6% (52/241), 58.5% (141/241)) and mixed non-injection and injection drug users ((20.3% (14/69), 46.4% (32/69)) (χ(2) = 23.518 and 9.017, respectively, P < 0.05) . The HBsAg positive rate (30.6% (153/500)) of subjects with more than once per day of drug using within one year was significantly higher than those who used drugs for 2-3 times per week (15.6% (7/45)) (χ(2) = 4.51, P < 0.05). Only 11.7% (64/545) of drug users had a clear history of hepatitis B vaccination. The vaccination rate of subjects (3.5% (5/141)) with primary education or below was significantly lower than those with high school (16.3% (45/276)) (χ(2) = 26.61, P < 0.05). The vaccination rate of subjects (7.8% (12/153)) over 45 years old was significantly lower than that of subjects below 30 years old (15.9% (21/132)) and 30-44 years old (11.9% (31/260)) (χ(2) = 30.36, P < 0.05). The vaccinees had a significantly higher positive rate of anti-HBs (73.4% (47/64)) than those who without vaccination (53.8% (259/481)) (χ(2) = 8.81, P = 0.003), but the positive rates of HBsAg (16.7% (11/64)) were lower than those who without vaccination (31.0% (149/481)) (χ(2) = 23.52 and 9.02, respectively;P > 0.05).

CONCLUSIONThe HBV infection status among drug users in Xi'an was in serious condition, while a low vaccination rate was also discovered among them.

Adult ; Age Factors ; China ; epidemiology ; Drug Users ; Hepatitis B ; epidemiology ; Hepatitis B Antibodies ; Hepatitis B Surface Antigens ; Hepatitis B Vaccines ; Humans ; Middle Aged ; Prevalence ; Risk Factors ; Substance Abuse, Intravenous ; epidemiology ; Vaccination

Adult ; Blood Donors ; China ; epidemiology ; Female ; Herpesviridae Infections ; epidemiology ; transmission ; Herpesvirus 8, Human ; Humans ; Male ; Sarcoma, Kaposi ; epidemiology ; virology ; Substance Abuse, Intravenous ; virology

OBJECTIVETo understand the HIV epidemic and its correlation among the community-based drug users in Dongguan, Guangdong province.

METHODSIn 2008, 13 drug users were identified as seeds in Dongguan. Respondent driven sampling was applied to recruit community-based drug users. A structured questionnaire was used for a face to face interview. Intravenous blood samples were collected for the measurement of HIV, HCV and syphilis antibodies. RDS analysis tool (RDSAT) was applied for adjusting the estimates and bivariate analysis.

RESULTSA total of 303 drug users were recruited within 15 weeks and 300 blood samples were collected. After RDSAT adjustment, the prevalence rates of HIV, HCV and syphilis were 14.7% (95%CI: 6.1% - 25.4%), 63.2% (95%CI: 55.7% - 71.7%), and 4.7% (95%CI: 1.8% - 8.2%) respectively. The HIV prevalence rates among those who were HCV seropositive, migration, younger than 26 years at their first drug use, and ever shared needles or syringes were 22.9% (95%CI: 10.8% - 37.0%), 26.9% (95% CI: 11.4% - 44.9%), 19.9% (95%CI: 8.3% - 35.7%), and 29.1% (95%CI: 12.3% - 45.1%) respectively. The proportions of the drug users who were enrolled at methadone maintenance treatment (MMT) of local residency, migration were 20.9% (95%CI: 4.1% - 44.6%), 2.3% (95%CI: 0.0% - 7.0%) respectively.

CONCLUSIONThe HIV epidemic among the community-based drug users in Dongguan is serious. Drug users who are HCV seropositive, migration, younger than 26 years at their first drug use, and ever shared needles or syringes are more likely to be HIV seropositive.

Adolescent ; Adult ; China ; epidemiology ; Drug Users ; Female ; HIV Infections ; epidemiology ; Homosexuality, Male ; Humans ; Male ; Middle Aged ; Prevalence ; Risk-Taking ; Substance Abuse, Intravenous ; epidemiology ; Unsafe Sex ; Young Adult

OBJECTIVETo review HIV/AIDS epidemic history, current situation and prevention policy in China. Data sources Information included in this article was identified by searching PUBMED (1997 - 2006) online resources using the key terms "HIV/AIDS", "epidemic", "prevention", and "China". Study selection Original milestone articles and critical reviews written by major pioneer investigators of the field were selected.

RESULTSThe key issues related to the HIV/AIDS epidemic situation in China and Chinese government prevention policy were summarized. HIV/AIDS epidemic groups and trends for HIV transmission were discussed.

CONCLUSIONIn January 2006, 650 000 people were estimated to be living with HIV in China. The overall HIV/AIDS epidemic is at a low level (0.05%) and concentrated in several at risk populations. However, the data show that new cases of HIV infection are growing every year and spreading from at risk populations to the general population. Premier WEN Jia-bao announced the "Four frees and one care" policy and the Chinese government has developed a series of programs with strong policy measures to stop the spread of HIV/AIDS in China.

Acquired Immunodeficiency Syndrome ; epidemiology ; prevention & control ; Blood Donors ; China ; epidemiology ; HIV Infections ; epidemiology ; prevention & control ; transmission ; Health Education ; Health Policy ; Homosexuality, Male ; Humans ; Male ; Sex Work ; Substance Abuse, Intravenous ; complications

OBJECTIVETo investigate HIV-1 molecular epidemiology of drug users in Jiangxi Province to analyze epidemic situation, subtype, origin of strain, and variation, and to provide information for prevention and control of AIDS.

METHODSCombining principles of traditional epidemiology and molecular epidemiology, the authors analyzed the epidemiologically related factors, the gene sequences and systematic mutation of HIV-1 gene in nine drug users in Jiangxi province.

RESULTSThe HIV spread through the drug users in Jiangxi not only by injection but also by sexual contacts. The main epidemic strain found by sequence analysis was HIV-1 CRF01-AE that was closely related to the strain among drug users in Vietnam and Guangxi Zhuang Autonomous Region, with the average gene distance of 9.00 +/- 2.27 from the Vietnam strain. The origin of strain among drug users in the province was entirely the same.

CONCLUSIONAt present, HIV-1 CRF01-AE strain has spread in the whole province among the drug users. Vigorous behavioral interventions should be developed in drug users and un-safe sexual behavior population to prevent the epidemic.

Acquired Immunodeficiency Syndrome ; epidemiology ; virology ; Adult ; China ; epidemiology ; DNA, Viral ; chemistry ; genetics ; Disease Outbreaks ; prevention & control ; Genetic Variation ; HIV-1 ; classification ; genetics ; Humans ; Male ; Molecular Epidemiology ; Sequence Analysis, DNA ; Substance Abuse, Intravenous ; epidemiology ; virology

OBJECTIVETo estimate the human immunodeficiency virus (HIV-1) prevalence of injecting drug users (IDUs) in Chongqing city.

METHODSTo apply BED-capture enzyme immunoassay (CEIA) which was based on the principle of HIV-antibody varies as the disease progress, in order to estimate both the HIV incidence and prevalence of IDUs from two IDUs surveillance sites in Chongqing.

RESULTSDuring the research period, 4711 serum samples were tested by ELISA and 130 were HIV-1 positive, confirmed by Western blot. The prevalence of IDUs surveillance site A from 1999 to 2006 were 0.73%, 2.02%, 1.54%, 2.96% and 2.80%, and the incidence rates were 0.57%, 0.93%, 0,1.24% and 1.68% respectively. The prevalence of IDUs surveillance site B appeared to be 4.21%, 9.96%, 8.13%, and the incidence rates were 0.95%, 1.04% and 0.90% respectively, from 2004 to 2006.

CONCLUSIONMany of the IDUs HIV carriers in Chongqing had been infected for long time, and the incidence rates among them were steady, keeping at the same level for 1-2 years. Promotion on intervention for IDUs had produced certain effects but more attention still needs to be paid.

AIDS Serodiagnosis ; methods ; China ; epidemiology ; Drug Users ; HIV Antibodies ; blood ; HIV Infections ; blood ; epidemiology ; HIV Seroprevalence ; Humans ; Immunoenzyme Techniques ; Incidence ; Population Surveillance ; Prevalence ; Substance Abuse, Intravenous ; epidemiology ; virology ; Urban Population ; statistics & numerical data