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Journal of Public Health Advance Access originally published online on July 11, 2009
Journal of Public Health 2009 31(3):374-382; doi:10.1093/pubmed/fdp067
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© The Author 2009, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Assessing IDU prevalence and health consequences (HCV, overdose and drug-related mortality) in a primary care trust: implications for public health action



Mathew Hickman, Reader in Public Health and Epidemiology1

Vivian Hope, Surveillance Co-ordinator (Injecting Drug Use) & Senior Lecturer2

Barbara Coleman, Associate Director of Public Health3

John Parry, Deputy Director Virus Reference Department & Honorary Professor2

Maggie Telfer, Managing Director4

John Twigger, Research Officer3

Charles Irish, Consultant in Communicable Disease5

John Macleod, Reader in Primary Care Epidemiology1

Hugh Annett, Director of Public Health3
1 Department of Social Medicine, University of Bristol, Canynge Hall, Bristol, UK
2 London School of Hygiene and Tropical Medicine & CfI HPA Colindale, London, UK
3 Bristol PCT, Bristol, UK
4 Bristol Drug Project, Bristol, UK
5 Avon Health Protection Unit, HPA, Bristol, UK

Address correspondence to Mathew Hickman, E-mail: matthew.hickman{at}bristol.ac.uk


  Abstract

Background We report on an exercise to estimate the prevalence of injecting drug use (IDU) and associated harms in a single primary care trust.

Methods Covariate capture–recapture methods to estimate (i) IDU prevalence; respondent driven sampling to measure (ii) prevalence of HCV and HIV and record linkage to measure (iii) mortality risk.

Results (i) The overall estimated number of IDU was 5540 (95% confidence interval, CI: 4710–6780) for all cases and 3280 (95% CI: 1940–4610) for cases matched to primary care register, i.e. a prevalence of 2.2 and 1.3% aged 15–54, respectively. (ii) The prevalence of HCV, hepatitis B and HIV was: 53, 32 and 0.7%. Over 70% of IDU in Bristol reported having at least one vaccination for HBV; more than half of those who were HCV positive were undiagnosed. (iii) The all-cause and overdose mortality rates for IDU were 0.75 and 0.4% respectively; and the standardized mortality ratio was 7.8 (95% CI: 5.4–10.8).

Conclusion Locally specific and useful intelligence on injecting and its health consequence can be generated to inform local public health action, and may contribute information to validate national prevalence estimates.


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