Table 1 Epidemiology Pre-2008

[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

[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’.

[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.