A literature review of the effectiveness of primary prevention measures to reduce transmission of hepatitis C infection in injecting drug users 

Abstract

The hepatitis C virus (HCV) is an important public health problem because the majority of infections do not resolve but lead to serious long-term consequences. A high proportion of these infections are attributable to injecting drug use, making the high rates of HCV transmission in this group a serious cause for concern. There are major challenges in the development of an effective vaccine; available treatments are only partly effective and not always offered to injecting drug users (IDUs). The challenge of reducing the rate of spread of HCV infection among IDUs is considerable and must at present mainly rely on primary initiatives. A literature review of the published literature on the effectiveness of primary prevention interventions to reduce either prevalence or incidence of HCV infections was undertaken. A synthesis of main observational studies was used to determine the most effective interventions, and if there were any significant gaps in the research. The review resulted in the inclusion of 26 relevant, but not methodologically strong studies. Thus the research evidence base has been dominated by ‘lower’ levels of evidence, which will in turn receive lower grades of recommendation. Decreasing transmission of HCV amongst IDUs will be dependent on the commissioning of a range of prevention activities together with increased testing, diagnosis and treatment for IDUs. Needle exchange will have a key role to play in prevention strategies. Public health interventions must comprise all IDUs, including newly initiated IDUs, and must be sustained for many years to reduce HCV infection 

Keywords: Hepatitis C virus, Transmission, Chronic liver infection, Injecting drug users