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RESEARCH ARTICLE

Blood-borne virus transmission in an urban, culturally diverse neighbourhood: results from a cross-sectional bio-behavioural survey using innovative outreach methods in a hard-to-reach population

Elizabeth Peach A G , Shelley Cogger A , Kat Byron B , Penny Francis C , Daniel O’Keefe A D , Peter Higgs A E , Mark Stoove A D , Kasey Elmore C , Paul Dietze A D and Margaret Hellard A D F
+ Author Affiliations
- Author Affiliations

A Centre for Population Health, Burnet Institute, Melbourne, Vic. 3004, Australia.

B Victorian Aboriginal Community Controlled Organisation, Melbourne, Vic. 3066, Australia.

C North Richmond Community Health Centre, Melbourne, Vic. 3121, Australia.

D School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.

E School of Psychology and Public Health, Department of Public Health, La Trobe University, Melbourne, Vic. 3086, Australia.

F Infectious Diseases Unit, Alfred Hospital, Melbourne, Vic. 3004, Australia.

G Corresponding author. Email: liz.peach@burnet.edu.au

Sexual Health - https://doi.org/10.1071/SH16219
Submitted: 29 November 2016  Accepted: 10 July 2017   Published online: 12 October 2017

Abstract

Background: Following a HIV outbreak among Aboriginal people in a culturally diverse inner-city suburb of Melbourne, a blood-borne virus (BBV) screening program was conducted to inform public health interventions to prevent transmission and facilitate timely diagnosis and linkage to care. Methods: In August–September 2014, community health workers recruited people who inject drugs (PWID) from a local needle and syringe program. Participants were tested for hepatitis C virus (HCV), hepatitis B virus (HBV), HIV and syphilis and completed a bio-behavioural questionnaire. Results: In total, 128 PWID participated in the study. Serological evidence of exposure to HCV and HBV was detected among 118 (93%) and 57 participants (45%) respectively. Five participants were HIV positive. Independent risk factors for needle sharing were Aboriginality (AOR = 6.21, P < 0.001), attending health care for mental health problems (AOR = 2.79, P = 0.023) and inability to access drug treatment in the previous 6 months (AOR = 4.34, P = 0.023). Conclusions: BBV prevalence in this sample was much higher than reported in other recent Australian studies. This local population is at high risk of further BBV transmission, particularly Aboriginal PWID. Individual and service-related factors associated with risk in the context of a dynamic urban drug culture and HIV outbreak suggest an urgent need for tailored harm-reduction measures.

Additional keywords: Aboriginal health, hepatitis B virus, hepatitis C virus, HIV, injecting drug use, people who inject drugs, risk factors, viral hepatitis.


References

[1]  The Kirby Institute. HIV, viral hepatitis and sexually transmitted infections in Australia. Annual Surveillance Report 2015 [Internet]. Sydney: Kirby Institute, University of New South Wales; 2015. Available online at: https://kirby.unsw.edu.au/report-type/annual-surveillance-reports [verified 7 September 2017].

[2]  Hellard ME, Nguyen OK, Guy RJ, Jardine D, Mijch A, Higgs PG. The prevalence and risk behaviours associated with the transmission of blood-borne viruses among ethnic-Vietnamese injecting drug users. Aust N Z J Public Health 2006; 30 519–25.
The prevalence and risk behaviours associated with the transmission of blood-borne viruses among ethnic-Vietnamese injecting drug users.CrossRef |

[3]  Ward J, Topp L, Iversen J, Wand H, Akre S, Kaldor J, Maher L. Higher HCV antibody prevalence among Indigenous clients of needle and syringe programs. Aust N Z J Public Health 2011; 35 421–6.
Higher HCV antibody prevalence among Indigenous clients of needle and syringe programs.CrossRef |

[4]  Kratzmann M, Mitchell E, Ware J, Banach L, Ward J, Ryan J, Sutton L, Griffiths P, Saunders M. Injecting drug use and associated harms among Aboriginal Australians [Internet]. Canberra: Australian National Council On Drugs; 2011. Available online at: http://www.healthinfonet.ecu.edu.au/uploads/resources/20713_20713.pdf [verified 7 September 2017].

[5]  Bryant J, Ward J, Wand H, Byron K, Bamblett A, Waples-Crowe P, Betts S, Coburn T, Delaney-Thiele D, Worth H, Kaldor J, Pitts M. Illicit and injecting drug use among Indigenous young people in urban, regional and remote Australia. Drug Alcohol Rev 2015; 35 447–55.
Illicit and injecting drug use among Indigenous young people in urban, regional and remote Australia.CrossRef |

[6]  Australian Injecting and Illicit Drug Users League. ‘Why wouldn’t I discriminate against all of them?’, A report on stigma and discrimination towards the injecting drug user community [Internet]. Canberra: AIVL; 2011. Available online at: http://www.aivl.org.au/resource/why-wouldnt-i-discriminate-against-all-of-them-a-report-on-stigma-discrimination-towards-the-injecting-drug-user-community/ [verified 7 September 2017].

[7]  Wand H, Spiegelman D, Law M, Jalaludin B, Kaldor J, Maher L. Estimating population attributable risk for hepatitis C seroconversion in injecting drug users in Australia: implications for prevention policy and planning. Addiction 2009; 104 2049–56.
Estimating population attributable risk for hepatitis C seroconversion in injecting drug users in Australia: implications for prevention policy and planning.CrossRef |

[8]  Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology 2013; 57 1333–42.
Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence.CrossRef |

[9]  Falster K, Kaldor JM, Maher L, Hepatitis C. Virus acquisition among injecting drug users: a cohort analysis of a national repeated cross-sectional survey of needle and syringe program attendees in Australia, 1995–2004. J Urban Health 2009; 86 106–18.
Virus acquisition among injecting drug users: a cohort analysis of a national repeated cross-sectional survey of needle and syringe program attendees in Australia, 1995–2004.CrossRef |

[10]  Eicher AD, Crofts N, Benjamin S, Deutschmann P, Rodger AJ. A certain fate: spread of HIV among young injecting drug users in Manipur, North-East India. AIDS Care 2000; 12 497–504.
A certain fate: spread of HIV among young injecting drug users in Manipur, North-East India.CrossRef | 1:STN:280:DC%2BD3M%2FltFakug%3D%3D&md5=17e07c27252b675d5f928ade99df6b15CAS |

[11]  Kuo I, Ul-Hasan S, Galai N, Thomas DL, Zafar T, Ahmed MA, Strathdee SA. High HCV seroprevalence and HIV drug use risk behaviors among injection drug users in Pakistan. Harm Reduct J 2006; 3 26
High HCV seroprevalence and HIV drug use risk behaviors among injection drug users in Pakistan.CrossRef |

[12]  Wood E, Montaner JSG, Li K, Zhang R, Barney L, Strathdee SA, Tyndall MW, Kerr T. Burden of HIV infection among Aboriginal injection drug users in Vancouver, British Columbia. Am J Public Health 2008; 98 515–9.
Burden of HIV infection among Aboriginal injection drug users in Vancouver, British Columbia.CrossRef |

[13]  Maher L, Jalaludin B, Chant KG, Jayasuriya R, Sladden T, Kaldor JM, Sargent PL. Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia. Addiction 2006; 101 1499–508.
Incidence and risk factors for hepatitis C seroconversion in injecting drug users in Australia.CrossRef |

[14]  Mapfumo L, Waples-Crowe P, Ware J. “Action Research - Addressing HIV risks related to injecting drug use in Victorian Aboriginal Communities”, A report for the Victorian Department of Health [Internet]. Melbourne: ANEX; 2010. Available online at: http://www.healthinfonet.ecu.edu.au/key-resources/programs-projects?pid=1110 [verified 7 September 2017].

[15]  Paquette D, McEwan M, Bryant J. Risk practices among Aboriginal people who inject drugs in New South Wales, Australia. AIDS Behav 2013; 17 2467–73.
Risk practices among Aboriginal people who inject drugs in New South Wales, Australia.CrossRef |

[16]  White B, Haber PS, Day CA. Community attitudes towards harm reduction services and a newly established needle and syringe automatic dispensing machine in an inner-city area of Sydney, Australia. Int J Drug Policy 2016; 27 121–6.
Community attitudes towards harm reduction services and a newly established needle and syringe automatic dispensing machine in an inner-city area of Sydney, Australia.CrossRef |

[17]  Victorian Department of Health. Chief Health Officer Advisory: risk of HIV infection in people who inject drugs – 6 October 2014 [Internet]. Melbourne: Victorian Department of Health; 2014. Available online at: https://www2.health.vic.gov.au/searchresults?q=risk%20of%20hiv [verified 7 September 2017].

[18]  King T, Ritter A, Berends L. Victorian pharmacotherapy review. Sydney: National Drug and Alcohol Research Centre, University of New South Wales; 2011.

[19]  Nolan S, Dias Lima V, Fairbairn N, Kerr T, Montaner J, Grebely J, Wood E. The impact of methadone maintenance therapy on hepatitis C incidence among illicit drug users. Addiction 2014; 109 2053–9.
The impact of methadone maintenance therapy on hepatitis C incidence among illicit drug users.CrossRef |

[20]  Degenhardt L, Mathers B, Vickerman P, Rhodes T, Latkin C, Hickman M. Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed. Lancet 2010; 376 285–301.
Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed.CrossRef |

[21]  Bruggmann P, Litwin AH. Models of care for the management of hepatitis C virus among people who inject drugs: one size does not fit all. Clin Infect Dis 2013; 57 S56–61.
Models of care for the management of hepatitis C virus among people who inject drugs: one size does not fit all.CrossRef |

[22]  Alvarez-del Arco D, Monge S, Azcoaga A, Rio I, Hernando V, Gonzalez C, Alejos B, Caro AM, Perez-Cachafeiro S, Ramirez-Rubio O, Bolumar F, Noori T, Del Amo J. HIV testing and counselling for migrant populations living in high-income countries: a systematic review. Eur J Public Health 2013; 23 1039–45.
HIV testing and counselling for migrant populations living in high-income countries: a systematic review.CrossRef |

[23]  de la Fuente L, Delgado J, Hoyos J, Belza MJ, Alvarez J, Gutiérrez J, Neira-León M, Suárez M, Madrid Rapid HIV Testing Group Increasing early diagnosis of HIV through rapid testing in a street outreach program in Spain. AIDS Patient Care STDS 2009; 23 625–9.
Increasing early diagnosis of HIV through rapid testing in a street outreach program in Spain.CrossRef | 1:STN:280:DC%2BD1Mrmt1Ontw%3D%3D&md5=f4b13570e40fcb412289e073642ef4fdCAS |

[24]  Suthar AB, Ford N, Bachanas PJ, Wong VJ, Rajan JS, Saltzman AK, Ajose O, Fakoya AO, Granich RM, Negussie EK, Baggaley RC. Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches. PLoS Med 2013; 10 e1001496
Towards universal voluntary HIV testing and counselling: a systematic review and meta-analysis of community-based approaches.CrossRef |

[25]  Spielberg F, Kurth A, Reidy W, McKnight T, Dikobe W, Wilson C. Iterative evaluation in a mobile counseling and testing program to reach people of color at risk for HIV-new strategies improve program acceptability, effectiveness, and evaluation capabilities. AIDS Educ Prev 2011; 23 110–6.
Iterative evaluation in a mobile counseling and testing program to reach people of color at risk for HIV-new strategies improve program acceptability, effectiveness, and evaluation capabilities.CrossRef |

[26]  Douglas BF, Freil S, Denniss R, Morawetz D. Advance Australia Fair? What to do about growing inequality in Australia [Internet]. Weston: Australia21 and The Australia Institute; 2014. Available online at: https://australia21.org.au/product/advance-australia-fair-what-to-do-about-inequality-in-australia/ [verified 7 September 2017].

[27]  Wilkinson RG. The impact of inequality: how to make sick societies healthier. Revised edition. Oxfordshire: Routledge; 2005.

[28]  Dube SR, Felitti VJ, Dong M, Chapman DP, Giles WH, Anda RF. Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics 2003; 111 564–72.
Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study.CrossRef |

[29]  Wilkie M. Bringing them home: report of the National Inquiry into the separation of Aboriginal and Torres Strait Islander children from their families [Internet]. Sydney: Human Rights and Equal Opportunity Commission; 1997. Available online at: https://www.humanrights.gov.au/publications/bringing-them-home-report-1997 [verified 7 September 2017].

[30]  Urbis. A review of enablers and barriers of Indigenous drug users accessing needle and syringe programs – a report for the COAG Multilateral Group on Needle and Syringe Programs [Internet]. Canberra: Department of Health and Ageing; 2008. Available online at: http://www.health.gov.au/internet/main/publishing.nsf/content/needle-indig [verified 7 September 2017].

[31]  National Aboriginal Community Controlled Health Organisation. Definitions [Internet]. Canberra: NACCHO; 2014. Available online at: http://www.naccho.org.au/aboriginal-health/definitions/ [verified 7 September 2017].



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