Assessing IDU prevalence and health consequences (HCV, overdose and drug-related mortality) in a primary care trust: implications for public health action.
BACKGROUND
We report on an exercise to estimate the prevalence of injecting drug use (IDU) and associated harms in a single primary care trust.


METHODS
Covariate capture-recapture methods to estimate (i) IDU prevalence; respondent driven sampling to measure (ii) prevalence of HCV and HIV and record linkage to measure (iii) mortality risk.


RESULTS
(i) The overall estimated number of IDU was 5540 (95% confidence interval, CI: 4710-6780) for all cases and 3280 (95% CI: 1940-4610) for cases matched to primary care register, i.e. a prevalence of 2.2 and 1.3% aged 15-54, respectively. (ii) The prevalence of HCV, hepatitis B and HIV was: 53, 32 and 0.7%. Over 70% of IDU in Bristol reported having at least one vaccination for HBV; more than half of those who were HCV positive were undiagnosed. (iii) The all-cause and overdose mortality rates for IDU were 0.75 and 0.4% respectively; and the standardized mortality ratio was 7.8 (95% CI: 5.4-10.8).


CONCLUSIONS
Locally specific and useful intelligence on injecting and its health consequence can be generated to inform local public health action, and may contribute information to validate national prevalence estimates.
Hickman
Mathew
M
Department of Social Medicine, University of Bristol, Canynge Hall, Bristol, UK. matthew.hickman@bristol.ac.uk
Hope
Vivian
V
Coleman
Barbara
B
Parry
John
J
Telfer
Maggie
M
Twigger
John
J
Irish
Charles
C
Macleod
John
J
Annett
Hugh
H
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002423:Cause of Death; D019970:Cocaine-Related Disorders / Q000150:complications / Q000453:epidemiology; D016001:Confidence Intervals; D016578:Crack Cocaine; D062787:Drug Overdose / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology; D006509:Hepatitis B / Q000453:epidemiology / Q000209:etiology; D006526:Hepatitis C / Q000453:epidemiology* / Q000209:etiology; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D011634:Public Health; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
D016578:Crack Cocaine