Efficacy of Syringe Services Programs in Preventing the Spread of HCV

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Over the past two weeks, HEAL Blog has covered two separate counties within the state of California that have taken two very different approaches to dealing with access to Syringe Services Programs (SSPs) and the prevention of the spread of diseases such as HIV, Hepatitis B (HBV), and Hepatitis C (HCV).

This past week, Here and Now, a program produced by WBUR, Boston’s National Public Radio (NPR) station, has also been covering issues related to SSPs in a series of interviews. These interviews included:

  • Chelsi Cheatom, Program Manager for Trac-B Exchange in Clark County, Nevada, which established the nation’s first syringe vending machine in Las Vegas, NV (Here and Now, 2018b);
  • Ricky Bluthenthal, Professor of Preventative Medicine at University of Southern California, who studies the efficacy of these programs (Here and Now, 2018a);
  • Danny Jones, Mayor of Charleston, West Virginia, who has led a very vocal campaign against the county health department’s Harm Reduction Clinic (Here and Now, 2018c)

Each of these interviews provides a set of perspectives that are very important to the discussion of SSPs, their efficacy, and their existence in the U.S. – an academic perspective that researches these issues and argues that data show these programs to be highly efficacious; a program worker who can attest to the successes and challenges of these programs; an elected official who must deal with and respond to the outcry and fallout of the very existence of SSPs creates in local settings. While each of these perspectives are important, it is Mayor Jones’ take on the issues in Charleston, WV with which I take issue.

Mayor Jones has, for the past five months, been waging a war against Kanawha County’s Harm Reduction Clinic, and he has, unfortunately, won. As of May 14th, the Clinic is now officially suspended by the state of West Virginia in response to an audit requested by Jones and Interim Health Officer Dr. Dominic Gaziano. The reasons for the suspension, and the findings of the audit, indicate that the clinic failed to build and maintain community support, lack of data indicating that drug users were actually informed of other programs (including treatment and recovery services), insufficient evidence to support the safe recovery and disposal of needles, and insufficient evidence regarding the total number and types of referrals made to drug treatment programs (Takitch & Hoak, 2018).

Kanawha-Charleston Health Department

Photo Source: WV Metro News

I began interviewing the head of the Kanawha County Clinic in September 2017 regarding the successes and challenges of establishing SSPs in the state of West Virginia. This Clinic, in particular, faced significant challenges because it served as one of only two public SSPs that served clients from 9 southern WV counties (Boone, Cabell, Kanawha, Lincoln, Logan, Mason, Mingo, Putnam, and Wayne). Since our conversation, two addition clinics have opened, but they are further East, and stilldo not serve those communities.

To put this into better perspective, here are some frightening statistics regarding HCV in those counties:

  • The rate of new Acute JBV infections in the state of West Virginia is 14.6 (per 100,000) – the highest rate in the nation
  • The rate of new HCV infections in the state of West Virginia is a staggering 7.2 (per 100,000) – the highest rate in the nation
  • The rates of HBV and HCV infection for the aforementioned counties are as follows (WVDHHR, 2018):
    • Boone – (HBV) – 34.2; (HCV) – 0.0
    • Cabell – (HBV) – 17.6; (HCV) – 10.3
    • Kanawha – (HBV) – 29.2; (HCV) – 14.9
    • Lincoln – (HBV) – 56.0; (HCV) – 0.0
    • Logan – (HBV) – 17.3; (HCV) – 8.6
    • Mason – (HBV) 25.9; (HCV) – 0.0
    • Mingo – (HBV) 31.6; (HCV) – 7.9
    • Putnam – (HBV) 28.1; (HCV) – 3.5
    • Wayne – (HBV) 14.6; (HCV) – 0.0
  • The state of West Virginia has an overall drug overdose death rate of 52.0 (per 100,000) – the highest rate in the nation
    • Roughly 86% of those overdose deaths were opioid-related
    • WV has the highest rate over opioid overdose deaths in the nation, with a rate of 44.9
    • These nine counties have the highest rates of drug overdose deaths in the state of West Virginia

To say that the burden placed upon the Kanawha/Putnam Harm Reduction Clinic was high is a gross understatement. If you notice the rate of HCV being lower in some counties, it’s because the state only requires that physicians offer HCV testing to people in the Birth Cohort (born 1945-1965) unless the physician knows about another risk factor in a patient, meaning that patients are disinclined to say they inject drugs. So, HCV cases very likely exist, there, but physicians are not required to test for it on a regular basis, which is dumb, given the high rates of Injection Drug Use in those counties.

In addition to serving essentially nine counties, the Clinic had to do so on a shoestring budget, as state law prohibits the use of funds for specific drug-related expenditures. They had to secure funding for syringes and disposal on their own, meaning significant time was spent fundraising to pay for the very reason why they were there.

Additionally, the Clinic repeatedly requested funds for the purchase and installation of Biohazard Disposal Kiosks – steel, locked mailboxes into which sharps can safely be disposed. Each individual unit costs around $1,500, which includes the cost of purchase, shipping, signage, and installation. The county refused to fund these kiosks (which didn’t stop the Mayor and Police Chief from complaining about the additional biohazard sharps waste around the city), and they were only able to secure funding for a single unit – funding which came notfrom the health department budget, but from the Emergency Medical Technician budget, who were kind enough to supply the funds.

The arguments being made by Mayor Jones and the Police Chief are understandable – there has been an increase in needle waste in the city of Charleston and the surrounding areas…in no small part, because the city steadfastly refused to pony up the funds to install disposal kiosks in these areas.

Additionally, both men argue that the privately run facility – Health Right – is doing a better job of providing the service. Perhaps, this is because each client has to be enrolled and create a paper trail to participate? For anyone who’s ever worked with, done research about, or been around People Who Inject Drugs (PWID), the last thing they want to do is create a paper trail that authorities can use to follow them back to their homes and arrest them for illicit drug use, possession, and possession of paraphernalia. This is why the Kanawha facility had exponentially more clients than Health Right – they weren’t creating a paper trail.

Did the Kanawha/Putnam County Harm Reduction Clinic have its issues? Absolutely. The program operated for barely three years, and there will always be a learning period. But, thanks to the unreasonable efforts of Danny Jones, PWID in those nine counties now get to enjoy traveling even further to obtain clean supplies.

Mark my words – this is going to have a serious deleterious impact on the already-highest-in-the-nation infection rates in the state of West Virginia.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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