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Table 2 Epidemiology post 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
[13] 2014 Drummond et al National Multi-site Prisons (15) Prisoners (817; m = 772; Hx IDU = 26%) 2011 Observational Cross-sectional prevalence study including self- administered drug and risk questionnaire Anti-HCV prevalence = 13%
Significant risk factors (p < 0.05):
• Hx of IDU and sharing drug taking equipment
• Older age
• female gender
• prison tattoo
[57] 2014 Galander Dublin Single site Prison Male prisoners on MMT (119) October 2011 Patient Survey
Retrospective chart review
Anti-HCV = 38%
• Anti-HCV negative = 33%
• Unknown HCV status = 29%
• Number anti-HCV on treatment = 0
PWUD
[62] 2014 McCormick et al. Dublin Single site Drug treatment clinic Drug Users fibroscaned attending MMT (84; m = 66)   Letter – reporting on five year follow up study Anti-HCV = 74.4%
HCV-RNA = 58.3%,
Heavy alcohol use = 37%
Five-year mortality = 15% (Liver related deaths = 6; probable liver related = 1; drug overdose = 5; laryngeal carcinoma = 1)
• 5/6 patients who died of liver disease, were HCV RNA-positive with heavy alcohol use
• Mean liver stiffness values were higher in patients who died compared with survivors (28.5 kPa ±7.9 vs. 9.0 ± 1.5, P = 0.0045)
• Mean liver stiffness values were higher in patients with liver-related death compared with survivors (50.6 ± 11.2, P < 0.0002).
• 12 patients with fibroscan score > 14 kPa, (7 died; 4 developed liver failure)
• Fibroscan scores were higher in patients with a history of heavy alcohol use (23 ± 4.5 vs. 5.6 ± 0.3, P < 0.0001).
• A single liver stiffness measurement was highly predictive of liver-related mortality
[58] Ryan and Ryan 2014 Limerick Single site Community drug treatment centre Drug users on MMT(174) 2010–2012 Retrospective prevalence study (log review) Anti-HCV 2010 = 6%
Anti-HCV 2011 = 13%
Anti-HCV 2012 = 24%
On average 58 HCV tests ordered annually
  2014 Horan Cork Single site Community drug treatment Centre Drug users on MMT (30) 2-week periods ×2 separated by a few months in 2014 Chart audit of HCV screening measuring the effect of chart labelling (star) • No evidence of HCV screen = 50%
• Follow up audit = 72.7% had evidence of documentation of an HCV screen
  Burke M. Audit of HCV screening using retrospective patient records [Unpublished audit] Dublin Multi-site Community drug treatment centres (23) PWUD - Opioid users on MMT (358; 40% of eligible population; PWID = 79%) 2015 Audit of HCV screening using retrospective patient records Anti-HCV = 66%
HCV RNA = 65%
• Screening uptake = 95%
• RNA tested = 208
[63] 2016 McCombe et al. Dublin Multi-site GP (16) PWUD attending primary care for MMT (106) 2015 Commentary (letter) Secondary analysis of data collected during a feasibility study of an alcohol brief intervention for patients attending primary care for MMT Anti-HCV = 51%
• HCV tested = 99%
• Self-reported HCV treatment = 19%
Problem alcohol use = 45%
• 37% were anti-HCV and had problem alcohol use
Patients’ knowledge of HCV care can best be optimised through community-based approaches to HCV treatment
[59] Keegan et al. 2017 Dublin Single site Community drug treatment centre PWUD attending for MMT (228; m = 168) January 2015 Cross sectional prevalence study (retrospective chart review) with associated risk factors Anti-HCV = 63.6% with no significant
gender difference (p = 0.717)
Significant risk factors for HCV infection (p < 0.05):
• age
• age of first drug use
• age of first injection
• type of first drug used
• early age of MMT entry
Those with no IDU had decreased odds of being HCV positive by 91.1%.
  (Burke M: Audit of HCV screening using retrospective patient records, unpublished) Dublin Multi-site Community drug treatment centre (23) PWUD on MMT (282; PWID = 79%) 2016 Audit; Retrospective chart review Anti-HCV = 79%
HCV RNA = 65%
[60] 2017 Murtagh et al. Dublin GPs Multi-site (n = 14) Drug users on OST (133; m = 81) 2017 Cross-sectional Prevalence Anti-HCV = 77.2%
• 92.5% had been screened for HCV
• 14 (14.7%) patients previously diagnosed with HCV had ever initiated HCV treatment
[9] 2017 Garvey et al National General population > 18 years (3795; m = 1860) 2014–2016 Anonymised and randomised laboratory analysis of residual serum samples at the NVRL Anti-HCV = 1.4%
HCV RNA = 0.57% (95% CI: 0.40–0.81%)
• higher in men (0.91%; 95% CI: 0.61–1.4%)
• east of the country (1.4%; 95%CI: 0.99–2.0%)
• 0–39 years (1.1% (95% CI: 0.59–2.0%)
• 40–49 years (1.1% (95% CI: 0.64–1.9%)
• Men born between 1965 and 1984 from the east of the country have the highest rate of chronic HCV infection.
PWID
[61] 2014 O’Connor et al Dublin Single site Hospital ED PWID (146; m = 101) January – March 2010 Prospective observational study Anti-HCV = 74%
• High levels of comorbid illness
[19] 2016 Carew et al. National PWID registered on NDTRS (14,320; m = 10,597) 1991–2014 Mathematical modelling Number of PWID with HCV infection = 12,423 (95% CI 10,799-13,161)
Number of PWID with chronic HCV infection = 9317 (95% CI 8022-9996)
• Estimated number of new infections peaked in 1997.
• By 2014, more than one quarter (27.0%) of PWIDs with chronic HCV infection were estimated to have been infected for 0–10 years, 43.4% for 11–20 years, 22.8% for 21–30 years and 6.7% for over 30 years.