Kirby Institute, Level 6 Seminar Room, Wallace Wurth Building, UNSW
Professor Lisa Maher - "Opioid substitution treatment protects against hepatitis C virus acquisition in people who inject drugs: The HITS-c study."
Background: While evidence of the effectiveness of opioid substitution treatment (OST) in reducing HIV transmission among people who inject drugs (PWID) is strong, less is known about its impact on hepatitis c virus (HCV) transmission. Despite increasing evidence of the protective effects of OST in combination with other interventions, a recent systematic review concluded there was insufficient evidence of the effectiveness of OST alone in preventing HCV infection in PWID.
Methods: We aimed to estimate HCV incidence and identify associated risk and protective factors among PWID in Sydney, Australia. HCV antibody negative PWID were enrolled in a prospective observational study – the Hepatitis C Incidence and Transmission Study – community (HITS-c). Interviewer-administered behavioural questionnaires and serological assessments were conducted every 24 weeks. Incidence was estimated using the person-time method.
Results: Incidence of HCV infection was 7.9/100 py, substantially lower than the 44.1/100 py observed a decade earlier in a similar cohort in Sydney. Younger age ((AHR 5.66; 95% CI 1.69, 18.95, p=0.005) and daily or more frequent injecting (AHR 4.06; 95% CI 1.15, 14.30, p= 0.03) were independently associated with incident infection. Opioid substitution therapy was protective among those who mainly injected heroin and associated with a reduced risk of incident infection (AHR 5.64; 95% CI 1.30, 24.42, p< 0.02).
Conclusions: Incidence of HCV among PWID in Sydney has declined substantially over the last decade. Ours is the first community-based prospective observational study to observe an independent protective effect of OST against HCV infection. This is likely due to increased coverage of OST and needle and syringe programs combined with a decrease in the population of PWID.
Ethnographic, epidemiological and clinical research on drug use and related harms and studies of behavioural and biomedical prevention interventions designed to prevent infectious diseases in vulnerable populations, including injecting drug users and female sex workers.
Broad Research Areas:
Viral Hepatitis, HIV/AIDS, Drug-related Harm, Infectious Diseases, Epidemiology, Population Health
Society Memberships & Professional Activities:
Journal Editorial Boards: Drug and Alcohol Review, International Journal of Drug Policy, Journal of Drug Issues, Harm Reduction Journal (Senior Editor, Infectious Disease);
Societies: Australian Professional Society Alcohol and Other Drugs, Australasian Society for HIV Medicine (ASHM), International Harm Reduction Association;
Board and Committee Membership: Communicable Diseases Network of Australia National Strategies HIV STI BBV Sub-Committee, Hepatitis C Working Group Chair (2010-2011), Lotus House Refuge Board of Management, Board of Trustees Lionel Murphy Foundation, Multicultural HIV and Hepatitis Service Advisory Group (Chair), NHMRC Centre for Research Excellence (Immunisation in Under Studied and Special Risk Populations) Scientific Advisory Board, NSW Ministerial Advisory Council on Hepatitis (MACH), NSW Users and AIDS Association Expert Advisory Committee, National Centre in HIV Social Research Scientific Advisory Committee, WHO Guidelines Development Working Group – Prevention of Viral Hepatitis among People Who Inject Drugs;
Panels and Review: NHMRC, Canadian Institutes of Health Research (CIHR), Economic and Social Research Council (UK), International Harm Reduction Conference, International AIDS Conference, Microbicides 2012, Australasian Viral Hepatitis Conference.