Research and analysis

HPR volume 13 issue 29: news (16 and 19 August)

Updated 20 December 2019

HIV and viral hepatitis monitoring among PWID: annual report in summary

The latest data tables for the Unlinked Anonymous Monitoring (UAM) Survey of People Who Inject Drugs (PWID) have been published by PHE [1] and a report on the data is included in the infection reports section of this issue of Health Protection Report [2].

The survey measures the prevalence of antibodies to HIV, hepatitis C and hepatitis B – as well as levels of risk and protective behaviours – in the PWID population. The data tables and report now also include data on non-fatal overdoses and carriage of naloxone. The released data is from the 2018 survey of people who injected psychoactive drugs, such as heroin and crack. This annual survey covers England, Wales and Northern Ireland, and data is presented at country level and for the English regions.

Overall, the data from the UAM Survey show that infections remain a problem among people who inject drugs. The data indicate that HIV prevalence remains stable among PWID at 1.2%. The vast majority of those with HIV were aware of their HIV infection.

The survey found that 9.1% of survey respondents had ever been infected with hepatitis B (antibodies to the hepatitis B core antigen) and 0.42% had current hepatitis B infection (HBsAg). The uptake of the vaccine against hepatitis B was 72% and remains steady overall, but there is evidence of a decline in uptake of the vaccine in younger age groups.

Hepatitis C remains the most common infection among this group, with over half (54%) those taking part in 2018 having been infected with the virus during their lifetime. Half of these participants (49%) were currently infected with the virus, which is a decrease from 58% in 2011 when this was first measured, corresponding with the timing of the scale-up of direct-acting antiviral treatment against hepatitis C among PWID.

PWID remain at risk of hepatitis C - the level of hepatitis C infection among the recent initiates to injecting participating in this survey are not suggestive of a decline in hepatitis C transmission in recent years.

Increases were also seen in the proportion of PWID tested for hepatitis C in the current or previous year (from 37% in 2008 to 47% in 2018), and for treatment uptake among those aware of their infection (from 20% in 2008 to 39% in 2018). The survey estimated that in 2018, half (50%) of those with a current infection were aware of their diagnosis.

More than half of participants (54%) have reported symptoms of injection site infections in 2018, an increase from 50% in 2017.

Overall, 18% of those currently injecting had shared needles and syringes in the preceding four weeks, and injecting drugs into higher-risk sites on the body, such as the groin, was common. Injection of crack further increased in 2018, with 60% of those who had injected in the preceding four weeks reporting crack injection, compared to 51% in 2017 and 35% in 2008.

In 2018, overdosing in the preceding year was reported by 21% of those who had injected during that period; this is an increase from 18% in 2013 when it was first measured. Carrying naloxone was reported by 65%, which represents an increase from 54% in 2017.

The report concludes that interventions that aim to prevent infection and overdose through injecting drug use, including needle and syringe programmes, opioid substitution therapy and the provision of take-home naloxone, need to be sustained.

References

1. PHE (14 August). People who inject drugs: HIV and viral hepatitis unlinked anonymous monitoring survey tables (psychoactive): 2019 update.
2. PHE (14 August). Unlinked anonymous monitoring (UAM) survey of HIV and viral hepatitis among PWID: 2019 report.

Infection reports in this issue of HPR

The following infection reports are published in this issue of HPR:

• Laboratory surveillance of Staphylococcus aureus bloodstream infections (EWNI): 2018

• Laboratory surveillance of Enterobacter spp., Serratia spp. and Citrobacter spp. bacteraemia (EWNI): 2018

• Unlinked anonymous monitoring (UAM) survey of HIV and viral hepatitis among PWID: 2019 report