Hepatitis: Rhodes T

Rhodes T, Treloar C. · Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, University of London, London, UK. · Addiction. · Pubmed #18821870 No free full text.

Abstract: BACKGROUND: Intervention impact on reductions in hepatitis C virus (HCV) incidence among injecting drug users (IDUs) are modest. There is a need to explore how drug injectors' interpret HCV risk. AIMS: To review English-language qualitative empirical studies of HCV risk among IDUs. METHODS: Qualitative synthesis using a meta-ethnographic approach. Searching of eight electronic databases and reference lists identified manually papers in peer-reviewed journals since 2000. Only studies investigating IDU perspectives on HCV risk were included. Themes across studies were identified systematically and compared, leading to a synthesis of second- and third-order constructs. FINDINGS: We included 31 papers, representing 24 studies among over 1000 IDUs. Seven themes were generated: risk ubiquity; relative viral risk; knowledge uncertainty; hygiene and the body; trust and intimacy; risk environment; and the individualization of risk responsibility. Evidence supports a perception of HCV as a risk accepted rather than avoided. HCV was perceived largely as socially accommodated and expected, and in relative terms to human immunodeficiency virus (HIV) as the 'master status' of viral dangers. Symbolic knowledge systems, rather than biomedical risk calculus, and especially narratives of hygiene and trust, played a primary role in shaping interpretations of HCV risk. Critical factors in the risk environment included policing, homelessness and gendered risk. CONCLUSIONS: Appealing to risk calculus alone is insufficient. Interventions should build upon the salience of hygiene and trust narratives in HCV risk rationality, and foster community changes towards the perceived preventability of HCV. Structural interventions in harm reduction should target policing, homelessness and gendered risk.

Aceijas C, Rhodes T. · Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, University of London, London, UK. <> · Int J Drug Policy. · Pubmed #17854722 No free full text.

Abstract: OBJECTIVE: In this paper, we review evidence of HCV prevalence among injecting drug users (IDUs) worldwide. METHODS: We undertook a desk-based review of both 'grey' and published literature released between 1998 and 2005. RESULTS: Data on HCV prevalence among IDUs was found in 57 countries and in 152 sub-national areas. We found reports of HCV prevalence of at least 50% among IDUs in 49 countries or territories. Available regional estimates varied widely, from 10 to 96% in Eastern Europe and Central Asia, from 10 to 100% in South and South-East Asia, from 34 to 93% in East-Asia and the Pacific, from 5 to 60% in North Africa and the Middle-East, from 2 to 100% in Latin America, from 8 to 90% in North America, from 25 to 88% in Australia and New Zealand, and from 2 to 93% in Western Europe. Only in Colombia and Lebanon were all HCV prevalence estimates below 20%. In addition, evidence of HIV/HCV co-infection among IDUs was found in 16 countries. In China, Poland, Puerto Rico, Russia, Spain, Switzerland, Thailand and Viet Nam, estimates of the prevalence of HIV/HCV co-infection among IDUs reached 90%. DISCUSSION: Taken together, data suggest high global prevalence of HCV and HIV/HCV co-infection among IDUs. We suggest exploring protective factors in sites of low HCV prevalence.

Judd A, Rhodes T, Johnston LG, Platt L, Andjelkovic V, Simić D, Mugosa B, Simić M, Zerjav S, Parry RP, Parry JV. · MRC Clinical Trials Unit, London, UK. · BMC Infect Dis. · Pubmed #19203380 links to  free full text

Abstract: BACKGROUND: Little is known about the prevalence of HIV or HCV in injecting drug users (IDUs) in Serbia and Montenegro. We measured prevalence of antibodies to HIV (anti-HIV) and hepatitis C virus (anti-HCV), and risk factors for anti-HCV, in community-recruited IDUs in Belgrade and Podgorica, and determined the performance of a parallel rapid HIV testing algorithm. METHODS: Respondent driven sampling and audio-computer assisted survey interviewing (ACASI) methods were employed. Dried blood spots were collected for unlinked anonymous antibody testing. Belgrade IDUs were offered voluntary confidential rapid HIV testing using a parallel testing algorithm, the performance of which was compared with standard laboratory tests. Predictors of anti-HCV positivity and the diagnostic accuracy of the rapid HIV test algorithm were calculated. RESULTS: Overall population prevalence of anti-HIV and anti-HCV in IDUs were 3% and 63% respectively in Belgrade (n = 433) and 0% and 22% in Podgorica (n = 328). Around a quarter of IDUs in each city had injected with used needles and syringes in the last four weeks. In both cities anti-HCV positivity was associated with increasing number of years injecting (eg Belgrade adjusted odds ratio (AOR) 5.6 (95% CI 3.2-9.7) and Podgorica AOR 2.5 (1.3-5.1) for >or= 10 years v 0-4 years), daily injecting (Belgrade AOR 1.6 (1.0-2.7), Podgorica AOR 2.1 (1.3-5.1)), and having ever shared used needles/syringes (Belgrade AOR 2.3 (1.0-5.4), Podgorica AOR 1.9 (1.4-2.6)). Half (47%) of Belgrade participants accepted rapid HIV testing, and there was complete concordance between rapid test results and subsequent confirmatory laboratory tests (sensitivity 100% (95%CI 59%-100%), specificity 100% (95%CI 98%-100%)). CONCLUSION: The combination of community recruitment, ACASI, rapid testing and a linked diagnostic accuracy study provide enhanced methods for conducting blood borne virus sero-prevalence studies in IDUs. The relatively high uptake of rapid testing suggests that introducing this method in community settings could increase the number of people tested in high risk populations. The high prevalence of HCV and relatively high prevalence of injecting risk behaviour indicate that further HIV transmission is likely in IDUs in both cities. Urgent scale up of HIV prevention interventions is needed.

Rhodes T, Zikic B, Prodanović A, Kuneski E, Bernays S. · Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK. · Soc Sci Med. · Pubmed #18201809 No free full text.

Abstract: Hepatitis C virus (HCV) infection is a significant cause of mortality and morbidity related to injecting drug use. In Serbia, recent estimates suggest that approximately a third of drug injectors are hepatitis C positive. We undertook the first qualitative study of drug injecting in Serbia with a focus on exploring drug injectors' accounts of hepatitis C risk. Drawing upon 67 qualitative interviews with drug injectors in Belgrade, we explore accounts of hepatitis C risk and its transmission. We find that accounts portray a social context of pervasive risk in relation to hepatitis C. Hepatitis C is characterised as ubiquitous among drug injectors, and as a hardy virus with immense transmission potential. Narratives of hygiene emerge as core to accounts of transmission, in which the virus is linked to dirt, including dirty environments, dirty drugs and dirty injecting equipment. These hygiene narratives not only have symbolic function but also appear to stem from ambiguities in accounts wherein hepatitis C is conflated with the signs, symptoms and transmission routes of hepatitis A. In addition, accounts portrayed hepatitis C risk management as a responsibility of individuals in the absence of secure trust or certainty in knowledge about risk, including in relation to others' disclosed antibody status. Hygiene narratives are a core and symbolic feature of injectors' accounts of hepatitis C transmission. There is an urgent need for health promotion fostering hepatitis C risk awareness and risk avoidance among drug injectors in Serbia.

Mateu-Gelabert P, Treloar C, Calatayud VA, Sandoval M, Zurián JC, Maher L, Rhodes T, Friedman SR. · Center for Drug Use and HIV Research, National Development Research Institutes, New York City, NY, United States. <> · Int J Drug Policy. · Pubmed #17854720 links to  free full text

Abstract: Significant advances have been made in preventing HIV infection among injectors but we still know little about preventing hepatitis C (HCV). Both prevalence and incidence of hepatitis C can remain high among IDUs even in the context of widespread implementation of harm reduction programmes. We need to develop new ways to fill the knowledge gap regarding HCV prevention. One way is to learn from the experts--those IDUs who, after long-term injection in social milieus of high hepatitis C prevalence, nonetheless remain uninfected. We describe a recently commenced program of research that focuses on understanding the strategies, behaviours, and environmental factors associated with "staying safe". This represents a 180-degree turn in IDU research where the focus has traditionally been on risk. Since social, cultural and environmental factors, as well as the vagaries of human strategic discovery by drug users can vary among localities, researchers in four different contexts--New York City, Valencia, Sydney and London--are collaborating in parallel Staying Safe studies. These studies aim to provide the conceptual basis for developing a new generation of HCV prevention programs to assist both new and experienced IDUs to remain uninfected over the long run.

Sarang A, Rhodes T, Platt L, Kirzhanova V, Shelkovnikova O, Volnov V, Blagovo D, Rylkov A. · Russian Harm Reduction Network, Moscow, Russia. · Addiction. · Pubmed #17156178 No free full text.

Abstract: BACKGROUND: Evidence highlights the prison as a high risk environment in relation to human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission associated with injecting drug use. METHODS: We undertook qualitative studies among 209 injecting drug users (IDUs) in three Russian cities: Moscow (n = 56), Volgograd (n = 83) and Barnaul in western Siberia (n = 70). RESULTS: Over three-quarters (77%) reported experience of police arrest related to their drug use, and 35% (55% of men) a history of imprisonment or detention. Findings emphasize the critical role that penitentiary institutions may play as a structural factor in the diffusion of HIV associated with drug injection in the Russian Federation. While drugs were perceived to be generally available in penitentiary institutions, sterile injection equipment was scarce and as a consequence routinely shared, including within large groups. Attempts to clean borrowed needles or syringes were inadequate, and risk reduction was severely constrained by a combination of lack of injecting equipment availability and punishment for its possession. Perceptions of relative safety were also found to be associated with assumptions of HIV negativity, resulting from a perception that all prisoners are HIV tested upon entry with those found HIV positive segregated. CONCLUSION: This study shows an urgent need for HIV prevention interventions in the Russian penitentiary system.

Rhodes T, Platt L, Maximova S, Koshkina E, Latishevskaya N, Hickman M, Renton A, Bobrova N, McDonald T, Parry JV. · Centre for Research on Drugs and Health Behaviour and Unit for International Public Health and Development, Imperial College London, UK. · Addiction. · Pubmed #16445554 No free full text.

Abstract: OBJECTIVES: To estimate the prevalence of HIV, hepatitis C virus (HCV) and syphilis in injecting drug users (IDUs) in Russia. METHODS: Unlinked anonymous cross-sectional survey of 1473 IDUs recruited from non-treatment settings in Moscow, Volgograd and Barnaul (Siberia), with oral fluid sample collection for HIV, HCV antibody (anti-HIV, anti-HCV) and syphilis testing. RESULTS: Prevalence of antibody to HIV was 14% in Moscow, 3% in Volgograd and 9% in Barnaul. HCV prevalence was 67% in Moscow, 70% in Volgograd and 54% in Barnaul. Prevalence of positive syphilis serology was 8% in Moscow, 20% in Volgograd and 6% in Barnaul. Half of those HIV positive and a third of those HCV positive were unaware of their positive status. Common risk factors associated with HIV and HCV infection across the cities included both direct and indirect sharing of injecting equipment and injection of home-produced drugs. Among environmental risk factors, we found increased odds of anti-HIV associated with being in prison in Moscow, and some association between official registration as a drug user and anti-HIV and anti-HCV. No associations were found between sexual risk behaviours and anti-HIV in any city. CONCLUSIONS: HIV prevalence among IDUs was markedly higher than city routine surveillance data suggests and at potentially critical levels in terms of HIV prevention in two cities. HCV prevalence was high in all cities. Syphilis prevalence highlights the potential for sexual risk and sexual HIV transmission. Despite large-scale testing programmes, knowledge of positive status was poor. The scaling-up of harm reduction for IDUs in Russia, including sexual risk reduction, is an urgent priority.

Rhodes T, Platt L, Judd A, Mikhailova LA, Sarang A, Wallis N, Alpatova T, Hickman M, Parry JV. · The Centre for Research on Drugs and Health Behaviour and Unit for International Public Health and Development, Imperial College, London, UK. · Int J STD AIDS. · Pubmed #16303071 No free full text.

Abstract: The objective of this study was to estimate the prevalence of hepatitis C virus (HCV) infection and co-infection with HIV among injecting drug users (IDUs) in Togliatti City, Russia. Unlinked anonymous cross-sectional survey of IDUs recruited from community settings, with oral fluid sample collection for HCV and HIV antibody (anti-HCV, anti-HIV) testing, was carried out. The anti-HCV prevalence was 87% (357/411), anti-HIV prevalence 56% (234/418), and 93% (214/230) of HIV-positive IDUs were co-infected with HCV. Only 23% (94/411) of those HCV positive self-reported as such. In an adjusted model, increased odds of HCV positivity were associated with needle and syringe, as well as injecting paraphernalia sharing in the last four weeks. IDUs injecting more than once with the same needle also had raised odds. There were no marked associations between HCV positivity and the duration of injecting or age group. Almost all IDUs were HCV positive, and almost all HIV-positive IDUs were HCV co-infected. There is an urgent need to maximize syringe distribution coverage, develop health promotion targeting HCV prevention for IDUs, and improve access among IDUs to treatments for HIV and HCV infection.

Judd A, Hutchinson S, Wadd S, Hickman M, Taylor A, Jones S, Parry JV, Cameron S, Rhodes T, Ahmed S, Bird S, Fox R, Renton A, Stimson GV, Goldberg D. · Department of Primary Care and Social Medicine, Centre for Research on Drugs and Health Behaviour, Imperial College London, London. · J Viral Hepat. · Pubmed #16255768 No free full text.

Abstract: Our aim was to compare the prevalence of antibody to hepatitis C virus (anti-HCV) among recently initiated injecting drug users (IDUs) in London and Glasgow, and to identify risk factors which could explain differences in prevalence between the cities. Complementary studies of community recruited IDUs who had initiated injection drug use since 1996 were conducted during 2001-2002. Data on HCV risk behaviours were gathered using structured questionnaires with identical core questions and respondents were asked to provide an oral fluid specimen which was tested anonymously for anti-HCV but was linked to the questionnaire. Sensitivities of the anti-HCV assays for oral fluid were 92-96%. Prevalence of anti-HCV was 35% (122/354) in London and 57% (207/366) in Glasgow (P < 0.001). Multifactorially, factors significantly associated with raised odds of anti-HCV positivity were increasing length of injecting career, daily injection, polydrug use, having had a needlestick injury, and having served a prison sentence. In addition lower odds of anti-HCV positivity were associated with non-injection use of crack cocaine and recruitment from drug agencies. After adjustment for these factors, the increased odds of anti-HCV associated with being a Glasgow IDU were diminished but remained significant. HCV continues to be transmitted among the IDU population of both cities at high rates despite the availability of syringe exchange and methadone maintenance. Effectiveness of harm reduction interventions may be compromised by inadequate coverage and failure to reduce sufficiently the frequency of sharing different types of injecting equipment, as well as the high background prevalence of HCV, and its high infectivity. Comprehensive action is urgently required to reduce the incidence of HCV among injectors.

Davis M, Rhodes T, Martin A. · Centre for Research on Drugs and Health Behaviour, Department of Social Science and Medicine, Imperial College London, The Reynolds Building, St. Dunstan's Road, London SW6 8RP, UK. · Soc Sci Med. · Pubmed #15312916 No free full text.

Abstract: There is little published research about how people who inject drugs are responding to the hepatitis C epidemic. This study seeks to address the prevention of hepatitis C using qualitative interviews with people who inject drugs in London. We explored narratives about risk reduction and hepatitis C in the social and historical context of other risks such as HIV, vein damage and overdose. Themes of the narratives included: the importance of autonomy in the acquisition of safer injecting skills; that safer injection was regarded as 'common sense', normalised and predicated on the risk of HIV; that hepatitis C risk was relativised with HIV risk and thereby seen as less important; and that hepatitis C infection was also seen as unavoidable. These narrative forms represent significant challenges for the management of the hepatitis C epidemic, both in terms of the existing risk reduction efforts designed for HIV and in terms of the articulation of risk reduction for injectors with general public health policy.

Rhodes T, Davis M, Judd A. · Centre for Research on Drugs and Health Behaviour, Department of Social Science and Medicine, Imperial College London, University of London, London, UK. · Addiction. · Pubmed #15078237 No free full text.

Abstract: AIM: Recognizing the dearth of qualitative research on hepatitis C virus (HCV) infection associated with injecting drug use in the UK, this paper summarizes qualitative insights from a study exploring the social relations of HCV risk management among drug injectors in London. METHOD: Adopting an inductive approach to data collection and analysis, 59 depth tape-recorded qualitative interviews were undertaken in 2001 with drug injectors recruited via drug user networks. RESULTS: While access to injecting equipment was reportedly good, needle and syringe sharing continued in exceptional circumstances and in the context of 'trust relationships'. Analyses of drug injectors' accounts of variations of 'I never share' showed that this construction denoted less a descriptor of actual risk behaviour than presentation of perceived risk status. Paraphernalia sharing, including spoons and filters, was common. There was much confusion and uncertainty concerning HCV knowledge, including its medical and transmission risks. Injectors were aware of the provisionality and partiality of their HCV knowledge. Confusion also surrounded the meaning of HCV antibody test results, with some feeling that their positive diagnosis had been 'trivialized' by their experiences of HCV testing. Injectors tended to make sense of HCV risk in relation to HIV. With most viewing HCV prevalence as high and HCV transmission as an inevitable consequence of injecting, HCV risk was perceived as ubiquitous and unavoidable. CONCLUSIONS: There is an urgent need to renew UK policies of harm reduction in order to support perceptions that HCV is avoidable and preventable.

Judd A, Hickman M, Rhodes T. · No affiliation provided · Subst Use Misuse. · Pubmed #12064440 No free full text.

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