Program Prevention of HCV infections PROGRAM SUPPORTED BY A GRANT FROM SWITZERLAND TROUGH THE SWISS CONTRIBUTION TO THE ENLARGEMENT EUROPEAN UNION AND BY MINISTRY OF HEALTH OF REPUBLIC OF POLAND The main objective of the Program is to provide a basis for planning a long- term strategy for preventing HCV and combating hepatitis C in Poland. Narodowy Instytut Zdrowia Publicznego – Państwowy Zakład Higieny w Warszawie Instytut Psychiatrii I Neurologii w Warszawie Uniwersytet Medyczny w Lublinie Główny Inspektorat Sanitarny

Main partner: Narodowy Instytut Zdrowia Publicznego – Państwowy Zakład Higieny w Warszawie Instytut Psychiatrii I Neurologii w Warszawie Uniwersytet Medyczny w Lublinie Główny Inspektorat Sanitarny Narodowy Instytut Zdrowia Publicznego – Państwowy Zakład Higieny w Warszawie Instytut Psychiatrii I Neurologii w Warszawie Narodowy Instytut Zdrowia Publicznego – Państwowy Zakład Higieny w Warszawie Instytut Psychiatrii I Neurologii w Warszawie Narodowy Instytut Zdrowia Publicznego – Państwowy Zakład Higieny w Warszawie Uniwersytet Medyczny w Lublinie Instytut Psychiatrii I Neurologii w Warszawie Narodowy Instytut Zdrowia Publicznego – Państwowy Zakład Higieny w Warszawie Uniwersytet Medyczny w Lublinie Instytut Psychiatrii I Neurologii w Warszawie Partners: Narodowy Instytut Zdrowia Publicznego – Państwowy Zakład Higieny w Warszawie

Estimation of prevalence of HCV among IDUs in Poland and identification of risk factors Janusz Sierosławski Institute of Psychiatry and Neurology ASA EG NDPHS Meeting Oslo, 15–16 October 2015

Introduction Objectives of the project – to cover IDUs population by evidence based HCV prevention measures – to increase institutional capacity to response HCV problem among IDUs Outputs of the project – Model HCV prevention program targeting IDUs – Proposals for National HCV Prevention and Control Strategy HCV prevalence study: – initial assessment for developing HCV prevention program – baseline for evaluation of prevention program First preliminary results as a subject of presentation

Method Population under study – drug users using regularly illicit substances and experience problems Inclusion criteria: – daily or almost daily drug use during at least 1 month in the last 3 years, or – lifetime injecting drug use Snowball sampling in 15 localization around Poland Testing saliva samples (anti-HCV antibodies) and collecting standardized interviews Sample size – 1219 (average per localization – 81) Data collected in March-June 2014

HCV antibodies and injecting drug use Lifetime injecting and non- injecting drug use (numbers) HCV antibodies among IDUs and non IDUs (percentages) Statistically significant p 0,01 General population - about 1%

HCV antibodies among IDUs Lifetime use of needles or syringes used by others HCV antibodies and use of used needles or syringes Statistically significant p 0,01

Risk of HCV antibodies among IDUs – logistic regression model Variables (reference category) Odds ratio CI lower CI higher Variables not included in the model: Age Gender Homelessness Number of years since first injection Interaction between age and number of years since first injection Model fitting: 76,8% correctly classified R 2 Nagelkerke = 0,39 Sharing needles or syringes (no) Imprisonment (no) Education (secondary and higher)

Risk of use of used needles or syringes in last 30 days – logistic regression model Variables (reference category) Odds ratio CI lower CI higher Variables not included in the model: Homelessness (no) 2,3591,4353,879 Gender Age Education Number of years since first injection Imprisonment experiences Model fitting: 78,1% correctly classified R 2 Nagelkerke = 0,19 Risky places of injections (no) 1,9861,1333,483 Injection every day (once a week or less frequently) 3,4301,7466,737 Injection 2-6 times per week (once a week or less frequently) 1,6940,8523,367 Tested HCV+ (no tested) 0,6560,3871,109 Tested HCV- (no tested) 0,2990,1310,685 N = 424

Conclusions -1 Prevalence of HCV antibodies among problem drug users without any injecting experiences six times higher than in the general population – prevention program should be addressed also to non injecting drug users Prevalence of HCV antibodies among lifetime IDUs ten times higher than among other problem drug users Rick factors for HCV antibodies among IDUs: Increasing age Needles or syringes sharing Low education Experience in imprisonment Prevention measures should be different for different groups of problem drug users

Conclusions -2 The study results suggest that use of used injecting equipment is related to two „environmental” factors : Homelessness Injecting in risky places Response should include intervention focused not only on injectors but also on environment Injection rooms should be the best offer for homeless and IDUs who inject in risky places

PROGRAM SUPPORTED BY A GRANT FROM SWITZERLAND TROUGH THE SWISS CONTRIBUTION TO THE ENLARGEMENT EUROPEAN UNION AND BY MINISTRY OF HEALTH OF REPUBLIC OF POLAND Narodowy Instytut Zdrowia Publicznego – Państwowy Zakład Higieny w Warszawie Instytut Psychiatrii I Neurologii w Warszawie Uniwersytet Medyczny w Lublinie Główny Inspektorat Sanitarny Project webpage (English):