Tag Archives: Syringe Service Programs

International Research Effort Shows U.S. Lags in Interventions

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

Research published in The Lancet Global Health found that the U.S. lags behind other countries in terms of HIV and Hepatitis C (HCV) interventions in drug user populations. The study gathered and analyzed data from peer-reviewed, online, grey literature (government reports, issues papers, theses, dissertations, et cetera) databases, and disseminated data requests via social media and targeted E-mails to international experts (Larney, et al, 2017). The study found that just 93 of 179 countries with evidence of Injection Drug Use (IDU) have some form of needle or Syringe Services Programs (SSPs) available (Steptoe, 2017). This comes after previous reports indicating that the U.S. has fallen behind other first-world peers in the goal of eliminating HCV by 2030 (Kaltwasser, 2017).

Medical technician counting needles.

Photo Source: Daily Beast

SSPs are vital tools in the fight to end the spread of HCV and HIV amongst not only People Who Inject Drugs (PWID), but within the general population, as well. While HCV has been thought to be inefficiently transmitted via sexual intercourse, recent studies have shown an increased risk of sexually transmitted HCV if a patient is co-infected with another Sexually Transmitted Disease (STD) or HIV, has sex with multiple partners, or has rough sex (Centers for Disease Control and Prevention, 2017). This higher transmission risk is especially pronounced among Men who have Sex with Men (MSM).

SSPs are meant to serve as intervention points for PWID, providing not only syryinge exchange services, but access to basic health services such as HIV, STD, HCV, and HBV screening, some clinical services, referrals for disease and addiction treatment, counseling, and referrals for Medication Assisted Treatment (MAT) – currently the most effective method for treating opioid addiction. While many othern Western nations long ago saw the efficacy of these programs in preventing the spread of HIV/AIDS, STDs, and other blood borne illnesses, the U.S. has consistently dragged its feet in implementing this effective harm reduction measure across the nation.

Opposition to SSPs in the U.S. (and elsewhere) consistently rely upon fear-based messaging that imagines droves of drug peddling heroin addicts shambling into town like zombies, leaving in their wake a wasteland of used needles just waiting to be stepped on by unsuspecting children and white suburbanites. Recent HIV outbreaks in rural and suburban areas have convinced states and counties to begin allowing government-funded SSPs to open in areas previously thought unlikely to host such facilities. These are generally operated at and by county health departments and their employees, thought there are no standardized national guidelines on what data they must collect and report.

Other intervention points do exist within various healthcare settings – at routine checkups, visits to emergent care, et cetera – but PWID are a notoriously difficult population to integrate into traditional healthcare continua. Furthermore, few, if any, states have compulsory “opt-out” HCV screening regulations that require healthcare providers to screen for the disease in every setting. These measures would allow emergent care workers (for example) to screen from HCV once overdose victims regain consciousness and are able to provide informed denial of screening. Such compulsory screening would play a vital role in helping to eradicate HCV in the U.S…should it be implemented. Realistically, it likely won’t.

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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Increase in HCV Cases Calls for Updated Screening Protocols

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

We, here at HEAL Blog, attempt to provide coverage of local outbreaks of Viral Hepatitis (VH), as well as to investigate and report them using evidence-based data to accurately characterize the issues at play. What consistently comes to the forefront of Hepatitis C (HCV) infection is the issue of Injection Drug Use (IDU) and the People Who Inject Drugs (PWID). More than any other risk factor, IDU in consistent across Hepatitis A (HAV), Hepatitis B (HBV), and HCV. According to the Centers for Disease Control and Prevention (CDC), in 2015, IDU was reported as a risk factor in 36.1% of all Acute HAV cases, ~34.3% of all Acute HBV cases, and 64.2% of all Acute HCV cases (CDC, 2017).

Hepatitis Screening

Photo Source: JAMA

In the five of the states with the highest rates of HCV – Massachusetts (MA), West Virginia (WV), Kentucky (KY), Tennessee (TN), Maine (ME), and Indiana (IN) – these data are undeniable:

And yet, none of these states have amended their HCV screening protocols to include compulsory “Opt-Out” screening in every healthcare setting. This is folly, at best, and dereliction of duty, at worst. If a state’s responsibility is to ensure the health and welfare of its citizens, it is incumbent upon them to take non-extraordinary steps to expand screening protocols. Moreover, they must begin regularly surveilling and reporting, including detailed risk-factor reporting.

If this sounds “revolutionary,” it’s simply not. Given the high rates of infection, mortality, co-morbidities, and the fact that there is a functional cure for the disease, there is simply no excuse for failing to expand testing to include compulsory “Opt-Out” screening for HCV, particularly in states where IDU is high. Is it expensive? Yes. But, again, when it comes to the health and welfare of people, sometimes short-term expenditures outweigh long-term costs of care. This is why there are grants; this is why people pay taxes.

Some of the most successful screening efforts are being conducted not in traditional healthcare settings, but at Syringe Services Programs (SSPs), which remain controversial among those who say that they promote and encourage drug use. These services are, however, vital to stemming the spread of disease. Perhaps the least successful screening efforts are conducted in incarceration settings, despite having essentially a captive demographic. These efforts are hampered, again, by cost concerns, as, if the results come back “Positive,” they are required by law to treat.

While expanding screening may be initially costly, it is the best way for us to go about eliminating HCV in the U.S.

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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