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Table 1 Epidemiology Pre-2008

From: Hepatitis C virus infection in Irish drug users and prisoners – a scoping review

  Date and author Setting Sample (n) Data collection Design Main results
Prisoners
[18] 2000 Alwright et al National Multi-site 9/15 prison locations Prisoners (1205; m = 1148) Sept – Nov 1998 Cross-sectional randomised prevalence study Anti-HCV = 37% (95% CI = 34.3 to 39.9%)
 • 80% among prisoners with a Hx of IDU
 • 60% of women and 42% of men had Hx of IDU
 • 20% first IV in prison and 71% shared needles
Significant risk factors (p < 0.05):
 • IDU
 • Hx of sharing while in prison
[16] 2000 Thornton et al National Multi-site 9/15 prison locations Prisoners (1205; m = 1148) Sept – Nov 1998 Cross-sectional study comparing reported vs actual HCV status Anti-HCV = 37%
Self-report anti-HCV = 19%
 • Among those self-reporting being anti-HCV positive, 5% were negative on oral fluid assay.
 • Among those reporting a previous negative result, 37% were positive on oral fluid assay.
[38] 2001 Long et al National Multi-site 5 of 7 committal prisons Prisoners (607; m = 555) April–May 1999 Cross sectional prevalence study on new entrants and risk factors Anti-HCV = 22% (CI: 19–25%)
 • anti HCV = 72% (Hx of IDU)
 • anti HCV = 3% (Never in prison)
Significant risk factors (p < 0.05):
 • IDU
PWUD
[39] 2001 Fitzgerald Dublin Multi-site 5 Drug Treatment centre sites Opiate users on MMT > 4 weeks (138/715; m = 99) 1997 Cross-sectional
retrospective prevalence study - randomised sample (chart review)
Anti-HCV = 78.8%
• 60% screened
• Among those < 25 yrs., anti-HCV prevalence decreases to 52%
[42] 2003 Cullen et al ERHA Multi-site 42 GP locations Drug users on MMT (531; m = 443) Not reported Cross sectional
prevalence study and associated risks
Anti-HCV = 78%
 • 67% screening documented
 • 193 had screen completed by GP, 74 another service and 113 no screen but self-report from patient
 • Predictors of being screened
 • Hx of imprisonment
 • documented HIV neg
 • Hx of IDU
Significant risk factors (p < 0.05):
 • age >  26
 • Hx of IDU
 • Hx of imprisonment drug use prior to 1989
 • HIV pos/HBV pos
[41] 2004 Moloney et al Dublin Single-site Community drug treatment programme for young people Adolescent drug users (54; heroin smoking = 64%) 1998–2001 (Letter – response to Kavanagh et al. 2003) Anti-HCV = 27%
Anti-HCV among declared injectors = 55%
Mean duration of injecting:
 • Anti-HCV positive = 1.42 yrs.
 • Anti-HCV negative = 1.16 yrs.
[37] 2005 Grogan et al Dublin Multi-site Community drug treatment centres (21) Drug users on MMT (358; m = 214) 2001 Cross-sectional- retrospective (one in four consecutive sampling) Anti-HCV = 66%
Incidence 24,5 per 100 years
88% tested for HCV
Significant risk factors (p < 0.05):
 • age >  25
[44] 2007 Cullen Multi-site 25 GP practices Dublin PWUD on MMT (196; m = 100)   Cross-sectional Prevalence Anti-HCV = 69%
 • 77% screened for HCV
 • 36% of those anti-HCV were tested for HCV-RNA
 • 30% were referred to hepatology
 • 24% attended the clinic
 • 13% had a liver biopsy
 • 3% had started treatment
[54] 2008 O’Carroll et al. DublinMulti-site Homeless (393; m = 61%; drug users = 64%) 2005 A census of homeless adults (researcher administered questionnaire) Anti-HCV = 36% (95% CI: 31–41%)
[40] Noonan et al. 2009 Single site NDTC Drug users receiving MMT (103; m = 67) Sept-Dec 2002 Cross-sectional survey Anti-HCV = 81.6% (untested = 2.8%)
HCV RNA = 15.6% (untested = 65%)
 • Most of the study participants had accurate self-reported of HCV status
Problem drinking:
 • Prevalence (audit score) = 41% (95% CI 33–51%).
 • 98% agreed that ‘alcohol may worsen HCV related liver disease’
 • 92% agreed that ‘reducing
 • alcohol consumption may help HCV related liver disease’.
PWID
[45] 1983 Fielding et al. Dublin Single site Hospital PWID with acute hepatitis undergoing biopsy (27; m = 22; mean age = 20.8 yrs.;Hx IDU = 6–120 months) Jan-April 1981 Cross-sectional prevalence study 90% had exposure to non-A non-B (HCV)
[48] 1995 Smyth et al. Dublin Single site Specialist drug treatment service (NDTC) PWID on OST (272; m = 194) Aug 1992–1993 Cross-sectional prevalence study Anti-HCV = 84%
Significant risk factors (p < 0.05):
 • male gender
 • > 2 years Hx IDU
[17] 1998 Smyth et al. Dublin Single site Specialist drug treatment service (NDTC) PWID - new entrants to treatment (733; m = 529) 1992–1997 Cross-sectional prevalence study Anti-HCV = 61.8%
(95% CI = 58.3–65.3) Significant risk factors (p < 0.05):
 • older age
 • longer HX of IDU
 • IDU before 1990
 • daily expenditure > 65 punts
[47] 1999 Smyth et al Dublin Single site Specialist drug treatment Service (NDTC) PWID - new entrants with HX IDU of < 25 months (353; m = 241) July 1993- Dec 1996 Cross-sectional prevalence study Anti-HCV = 52.1%
• ↓ risk for those starting IDU after 1993 and with IDU < 13 months
[55] 2000 Smyth et al Dublin Single site Specialist drug treatment service (NDTC) PWID, first time attendees (119; m = 84) July 1996–January 1997 Prospective evaluation of an HCV testing algorithm Anti-HCV = 54%
• 21/119 completed assessment
 • 48 tested for HCV
 • 13/26 HCV infected left OST treatment before receiving result
 • 4/19 attended on-site hepatology services
[53] 2000 Healy et al Dublin Single site Hospital (Infectious paediatric OPD) HCV+ mothers of infants referred to Paediatric infectious disease service (296; PWID = 244) 1994–1999 Cross-sectional
Prevalence
HCV RNA: 55% (84 tested)
• 82% infected via IVDU
[49] 2003 Kavanagh et al Dublin Single-site PWID (94 - prevalence study; m = 63) PWID = 5519 (mathematical modelling) November 2001 Prevalence of HCV and its Prognostics/co-factors Mathematical modelling to estimate national HCV burden Anti-HCV = 74.5%
HCV RNA = 41.5%
• Genotype 1 = 66.6%
 • Genotype 2 = 2.6%
 • Genotype 3 = 25.6%
Modelling predictions:
 • HCV cirrhosis = 1214 cases (20 yrs.)
 • HCC = 35 per annum
 • Hepatic decompensation = 60 per annum
 • Liver related deaths = 50 per annum
[36] 2003 Smyth et al Dublin Single site Specialist drug treatment service (NDTC) HCV negative PWID (313; Follow up repeat HCV test = 100) Nov 1992 – September 1998 Retrospective cohort study Incidence of HCV infection HCV seroconversion = 67%
Incidence = 66 per 100-person years (CI: 51–84 per 100-person years)
Of 74 patients who were retested within 24 months
 • HCV seroconversion = 61%
 • Incidence = 100 infections/100
 • person years (95% CI: 73/100 to 134/100 person years).
Significant risk factors (p < 0.05):
 • Hx IDU
 • Hx imprisonment
[51] 2005 Smyth et al Dublin Multi-site (10) Community drug treatment clinics (7) Residential drug treatment centres (2) NDTC (1) PWID - IV in the past 6 months / not tested for HCV (159)   Cross-sectional survey Anti-HCV = 61%
Predictors of positive test result (p < 0.05):
 • increased total number of lifetime injecting episodes
 • closer social relationships with other IDUs
 • injecting in the home of other IDUs
Non-predictor of positive result (p > 0.05):
 • Frequency of recipient syringe sharing
 • backloading
 • sharing of injecting paraphernalia
[56] 2006Cullen Dublin Multi-site 26 GP practices PWID-GP 2005 (6-month period) Cluster randomised trial /evaluating the effects of HCV guidelines Intervention group
• ↑ HCV screening (OR = 3.76; 95% CI = 1.3 to 11.3)
 • ↑ referral to a hepatology clinic (p = 0.06)
[6] 2012 Thornton et al National General population (6387; m = 4024) 1989–2009 National HCV prevalence study using data collected from NVRL (1989–2004) notification data (2004–2009)
Mathematical modelling
General population estimate for chronic HCV infection = 20,000–50,000 (0.5–1.2%).
• 10,000 people diagnosed anti-HCV between 1989 and 2004, peaking in 2000.
 • Genotype 1 = 55% and Genotype 3 = 39%.
 • Drug use most likely risk (80%).
 • Median age of diagnosis is 28.
 • 70% of those infected though drug users were male.
 • Median age at diagnosis for those infected through drug use = 25 years for males and 23 years for females.