London School of Hygiene & Tropical Medicine

A team of researchers, led by the London School of Hygiene & Tropical Medicine, have conducted the first global review to quantify the impact of needle syringe programmes (NSP) and opioid substitution treatment (OST) in reducing the risk of becoming infected with the hepatitis C virus (HCV).

The study, funded by the National Institute for Health Research (NIHR), was published in Cochrane Library Drug and Alcohol Review Group and in the journal Addiction, and has implications for millions of people who are ‘at risk’ from infection.

Dr Lucy Platt, lead author and Associate Professor in Public Health Epidemiology at the London School of Hygiene & Tropical Medicine, said: “This is the first global systematic review of quantitative studies on the effectiveness of OST and NSP on reducing hepatitis C. Our findings provide strong evidence that OST especially in combination with high coverage of NSP can reduce HCV transmission. Up to half of people who inject drugs have hepatitis C: there is an urgent need to scale up these interventions to prevent on-going transmission, unnecessary deaths and illness.”

Over 70 million people live with hepatitis C and there are three to four million people newly infected each year. The main risk for becoming infected in developing countries is associated with illicit drug use and sharing used needles and syringes.  In many countries, at least half the people who have injected drugs such as heroin, cocaine or methamphetamine have hepatitis C.

It is known that the provision of sterile injecting equipment through NSPs or providing OST such as methadone or buprenorphine reduces injecting risk behaviour, and there is evidence also that OST and NSP reduces HIV transmission. However, until this study there was insufficient evidence that OST and NSP can also protect against HCV infection.  

Researchers from the School, University of Bristol, and other institutions around the world examined whether needle syringe programmes and opioid substitution treatment, provided alone or together, are effective in reducing the chances of becoming infected with hepatitis C in people who inject drugs.

The team identified 28 research studies across Europe, Australia, North America and China. On average across the studies, the rate of new hepatitis C infections per year was 19.0 for every 100 people. Data from 11,070 people who inject drugs who were not infected with hepatitis C at the start of the study were combined in the analysis. Of the sample, 32% were female, 50% injected opioids, 51% injected daily, and 40% had been homeless.

There was consistent and strong evidence that current use of OST (defined as use at the time of survey or within the previous six months) reduces risk of hepatitis C infection by 50% and when combined with high coverage NSP reduces risk by 74%.  However, there was more uncertainty on the effectiveness of NSP alone.  Studies in Europe which tended to measure high coverage in terms of the people who receive 100% sterile syringes per injection showed more than 50% reduction in HCV, but studies in North America which often measured coverage in terms of frequency of NSP attendance showed little effect.  There were no randomised controlled trials of either OST or NSP on HCV.

Publications:

Lucy Platt et al. Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Library Drugs and Alcohol Review Group. DOI: 10.1002/14651858.CD012021.pub2

Lucy Platt et al. Needle syringe programmes and opioid substitution therapy for preventing HCV transmission among people who inject drugs: findings from a Cochrane Review and meta-analysis. Addiction. DOI: 10.1111/add.14012