Biomedical subjects

V D Hope

Publications and source records attributed to V D Hope.

13 recordsLinked to original sources

PubMed2006

Modelling the force of infection for hepatitis B and hepatitis C in injecting drug users in England and Wales.

BACKGROUND: Injecting drug use is a key risk factor, for several infections of public health importance, especially hepatitis B (HBV) and hepatitis C (HCV). In England and Wales, where less than 1% of the population are likely to be injecting drug users (IDUs), approximately 38% of laboratory reports of HBV, and 95% of HCV reports are attributed to injecting drug use. METHODS: Voluntary unlinked anonymous surveys have been performed on IDUs in contact with specialist agencies throughout England and Wales. Since 1990 more than 20,000 saliva samples from current IDUs have been tested for markers of infection for HBV, HCV testing has been included since 1998. The analysis here considers those IDUs tested for HBV and HCV (n = 5,682) from 1998-2003. This study derives maximum likelihood estimates of the force of infection (the rate at which susceptible IDUs acquire infection) for HBV and HCV in the IDU population and their trends over time and injecting career length. The presence of individual heterogeneity of risk behaviour and background HBV prevalence due to routes of transmission other than injecting are also considered. RESULTS: For both HBV and HCV, IDUs are at greatest risk from infection in their first year of injecting (Forces of infection in new initiates 1999-2003: HBV = 0.1076 95% C.I: 0.0840-0.1327 HCV = 0.1608 95% C.I: 0.1314-0.1942) compared to experienced IDUs (Force of infection in experienced IDUs 1999-2003: HBV = 0.0353 95% C.I: 0.0198-0.0596, HCV = 0.0526 95% C.I: 0.0310-0.0863) although independently of this there is evidence of heterogeneity of risk behaviour with a small number of IDUs at increased risk of infection. No trends in the FOI over time were detected. There was only limited evidence of background HBV infection due to factors other than injecting. CONCLUSION: The models highlight the need to increase interventions that target new initiates to injecting to reduce the transmission of blood-borne viruses. Although from the evidence here, identification of those individuals that engage in heightened at-risk behaviour may also help in planning effective interventions. The data and methods described here may provide a baseline for monitoring the success of public health interventions.

England↗

PubMed2006

Modelling the hepatitis B vaccination programme in prisons.

A vaccination programme offering hepatitis B (HBV) vaccine at reception into prison has been introduced into selected prisons in England and Wales. Over the coming years it is anticipated this vaccination programme will be extended. A model has been developed to assess the potential impact of the programme on the vaccination coverage of prisoners, ex-prisoners, and injecting drug users (IDUs). Under a range of coverage scenarios, the model predicts the change over time in the vaccination status of new entrants to prison, current prisoners and IDUs in the community. The model predicts that at baseline in 2012 57% of the IDU population will be vaccinated with up to 72% being vaccinated depending on the vaccination scenario implemented. These results are sensitive to the size of the IDU population in England and Wales and the average time served by an IDU during each prison visit. IDUs that do not receive HBV vaccine in the community are at increased risk from HBV infection. The HBV vaccination programme in prisons is an effective way of vaccinating this hard-to-reach population although vaccination coverage on prison reception must be increased to achieve this.

Adolescent↗

PubMed2006

Monitoring the effectiveness of HIV and STI prevention initiatives in England, Wales, and Northern Ireland: where are we now?

Primary and secondary prevention are essential components of the response to HIV and sexually transmitted infections (STIs). We present findings from nationally implemented HIV/STI prevention interventions. In 2003, of those attending STI clinics at least 64% of men who have sex with men (MSM) and 55% of heterosexuals accepted a confidential HIV test; 88% of all HIV infections in women giving birth in England were diagnosed before delivery; 85% of MSM eligible for hepatitis B vaccination received a first dose of vaccine at their first STI clinic attendance; 74% of STI clinic attendees for emergency appointments, and 20% of those for routine appointments were seen within 48 hours of initiating an appointment; the National Chlamydia Screening Programme in England found a positivity of 10% and 13% among young asymptomatic women and men, respectively. Prevention initiatives have seen recent successes in limiting further HIV/STI transmission. However, more work is required if current levels of transmission are to be reduced.

Adult↗

PubMed2004

Hepatitis B and hepatitis C seroprevalence and risk behaviour among community-recruited drug injectors in North West Wales.

We estimated the prevalence of markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and injecting risk behaviour, among community-recruited injecting drug users (IDUs) in North West Wales in 2001 and 2002. Sample collection was undertaken by trained current and former IDUs. Oral fluid samples (n = 153) were tested as part of the Unlinked Anonymous Prevalence Monitoring Programme ongoing survey of IDUs. Approximately 12% of the sample reported that they were currently in a drug treatment programme. Of the 153 samples screened 27% (95% CI 20%-34%, 41/153) were anti-HBc positive, and 23% (95% CI 16%-30%, 35/153) were anti-HCV positive. Sixteen per cent (95% CI 10%-22%, 25/ 153) of the samples were positive for both anti-HBc and anti-HCV. Of the subjects 15% (95% CI 9%-20%) knew they had been vaccinated against hepatitis B. Direct sharing of needles and syringes in the 28 days prior to interview was reported by 44% (95% CI 35%-54%), and sharing of any equipment including that used for drug preparation prior to injection was reported by 66% (95% CI 57%-76%). In North West Wales, syringe sharing is a common practice, and a high proportion of IDUs have been exposed to bloodborne viruses. Hepatitis B vaccination coverage within this population appears to be low and needs to be increased. Further efforts are needed to improve the availability of clean injecting equipment.

Adult↗

PubMed2001

Prevalence of hepatitis C among injection drug users in England and Wales: is harm reduction working?

OBJECTIVES: This study sought to establish the prevalence of hepatitis C antibodies (anti-HCV) and hepatitis B antibodies (anti-HBc) among injection drug users in England and Wales. METHODS: A voluntary cross-sectional survey collected oral fluid samples and behavioral information; 2203 injectors were recruited through drug agencies, and 758 were recruited in the community. RESULTS: Prevalence was 30% for anti-HCV, 21% for anti-HBc, and 0.9% for HIV antibodies. Anti-HCV prevalence rates were significantly greater among those with longer injecting careers, those in older age groups, those residing in London, those recruited in drug agencies, those positive for anti-HBc, and those with a previous voluntary HIV test. CONCLUSIONS: Anti-HCV prevalence rates among injectors in England and Wales, where comprehensive harm reduction programs exist, are lower than rates in other industrialized countries.

Adult↗

PubMed2001

Failure to vaccinate current injecting drug users against hepatitis B in England and Wales.

In most industrialised countries the elimination of hepatitis B infection is highly reliant on effective vaccine delivery to injecting drug users. This paper highlights the very poor vaccine coverage achieved in England and Wales in the ten years since this problem was officially recognised and targeted. This is despite the existence of a comprehensive and well-utilised network of specialist services for injecting drug users.

Communicable Disease Control↗

PubMed2000

Relation between information and advice provision to male GUM clinic attendees and sexual orientation and ethnic group.

OBJECTIVES: To examine whether the provision of advice and information to male genitourinary medicine (GUM) clinic attendees was related to their reasons for attendance, ethnicity, or sexual orientation. METHOD: Cross sectional survey of men attending a large city centre GUM clinic. Data were collected using an anonymous subject completed questionnaire. RESULTS: Of the 302 men recruited, 72% described themselves as white and 85% reported only female sexual partners. Information and advice provision were generally found to reflect reason for attendance--for example, those attending with a concern about "an STD or urinary problem" were more likely to report advice and information on NSU/chlamydia, herpes, gonorrhoea, or syphilis than those attending without such concerns. For those attending with a concern about HIV less than half (42%) reported receiving advice and information about HIV. The reasons for attendance were found to vary with ethnicity (black men were more likely to attend for a "check up," and less likely to attend about HIV or with genital warts than white men) and sexual orientation (those with male partners were more likely to attend about HIV or hepatitis B than those with only female partners); there were corresponding variations in the provision of advice and information. CONCLUSIONS: The clinic was generally providing advice and information appropriate to the reasons for attendance and this reflected variations in such needs with ethnicity and sexual orientation. The provision of advice and information about HIV could be more comprehensive.

Adolescent↗

PubMed1999

Poor hepatitis B vaccine coverage in injecting drug users: England, 1995 and 1996.

Self-reported data on vaccination status collected in 1995 and 1996 from seven of the 39 drug agencies in England that took part in the unlinked anonymous HIV prevalence monitoring programme of injecting drug users were analysed to estimate hepatitis B vaccine coverage in this population. Twenty-seven per cent (374/1366) of injecting drug users (IDUs) reported vaccination against hepatitis B and 13% (172) reported having received three doses of vaccine. Eighteen per cent of the IDUs who reported vaccination (66/374) were found to have a marker in their saliva of past/current hepatitis B infection (antibody to hepatitis B core (anti-HBc)) compared with 23% (232/992) of those unvaccinated. Over half (760/1366) of all IDUs tested reported not having been vaccinated against hepatitis B were negative for anti-HBc, and therefore remained susceptible to infection. Targeted vaccination for IDUs against hepatitis B in England has had little success so far, suggesting that enhanced or alternative strategies need to be adopted.

Adolescent↗

PubMed1998

The risk of infection with HIV and hepatitis B in individuals who inject steroids in England and Wales.

Data on injecting anabolic steroid users, within the national Unlinked Anonymous HIV Prevalence Monitoring Survey of injecting drug users (IDUs) were analysed to determine their risk of acquiring blood borne viruses. One hundred and forty-nine participants who had injected anabolic steroids in the previous month were identified from 1991-6, contributing 1.4% of all participation episodes in the survey. Rates of needle and syringe sharing by steroid users were low. Three of the 149 (2.0%) had anti-HBc and none had anti-HIV in their salivary specimens. The prevalence of anti-HBc in steroid injectors was significantly lower than in heroin injectors, 275/1509 (18%) (P < 0.001), or in amphetamine injectors, 28/239 (12%) (P < 0.001). The risk of blood borne virus transmission amongst these steroid injectors is low, probably due to hygienic use of injecting equipment and low levels of sharing. It is important to distinguish steroid injectors from other IDUs because they are a distinct group in terms of lifestyle and injecting practice.

Adolescent↗

PubMed1998

Safer sex and social class: findings from a study of men using the 'gay scene' in the West Midlands region of the United Kingdom.

This article reports on associations between socio-demographic factors and safer sexual behaviour among gay and bisexual men in an English region. A cross-sectional survey using an anonymous self-complete questionnaire collected information on sexual behaviour and socio-demographic characteristics. All men using specified 'gay' venues and groups during the data collection period, were offered inclusion. Of the 858 men returning completed questionnaires, a greater proportion (30.3%) were from manual occupations when compared to previous United Kingdom studies. Of the whole sample, 64.6% reported either consistent condom use (safer sexual behaviour) or no anal sex during the last 12 months. No associations were found between age or ethnicity and consistency of condom use. Social class and employment status, however, were associated: those in manual occupations and those not working were more likely to be inconsistent in their condom use and students were more likely to be consistent. Inconsistent condom use was more likely to occur when having anal sex with 'boyfriends', and data on relationship length suggest that this may be occurring inappropriately in relation to risk of HIV infection. These findings suggest that social class and employment status may be related to safer sex practice.

Adolescent↗

PubMed1997

Acceptability of clinics for sexually transmitted diseases among users of the "gay scene" in the West Midlands.

OBJECTIVES: To examine the acceptability of genitourinary medicine (GUM) clinics (for STDs) to homosexual and bisexual men. DESIGN: A cross sectional survey of men using "gay" venues and groups in the West Midlands region of the UK. Data were collected using an anonymous self-completed questionnaire. RESULTS: 848 completed questionnaires were returned. Two thirds of the respondents reported "safer" sexual behaviour. Those who had ever attended a GUM clinic (55%) differed little in their safer sexual behaviour from those who had never attended. The acceptability of the service was assessed using a range of indicators: the majority of the attendees had told a doctor, nurse or health adviser they have sex with men; and just over half had found all staff to be friendly, helpful or not homophobic. A quarter of attendees found talking about sexual matters difficult; these were less likely to have found the service acceptable. Over half (54%) of the study respondents had not been vaccinated against hepatitis B. Those who had been vaccinated were more likely: to have found the service acceptable; to have found talking about sexual matters easy; and to report safer sexual behaviour. CONCLUSIONS: These findings suggest that many homosexual and bisexual men who may need to use the GUM service have not done so. There is a need to improve the acceptability of the service and to further promote hepatitis B vaccination.

Adult↗

PubMed1996

Accessibility of genitourinary medicine clinics.

OBJECTIVES: to examine and compare the accessibility and acceptability of a range of genitourinary medicine (GUM) clinics. DESIGN: five GUM clinics representing different types of locations in the West Midlands Region were selected. All patients attending over the sampling period were included, with data collected by anonymous self completed questionnaire. RESULTS: 297 completed questionnaires were obtained from 360 attendees; 87.4% of attendees had taken 30 minutes or less to get to the clinic, and 66% had used public transport, with variations found between locations. The majority (72.5%) of attendees visited the clinics during their preferred part of the day. Examination of narrower time preferences showed that those wanting to visit in the evening were less likely to be seen during their preferred time than those wanting daytime visits (32% compared with 90%). Of the attendees 98.6% found clinic staff to be friendly and 97.5% did not feel they were being judged because of their sexual activities. The most common reasons for choosing a clinic were recommendation (38.2%) and proximity (36.4%). CONCLUSIONS: the clinics were generally found to be physically accessible, although clinic opening hours need to be reconsidered. Further work is needed on the acceptability of the service in relation to expectations.

Ambulatory Care Facilities↗

PubMed1996

A comparison of HIV related advice in genitourinary medicine clinics with different histories.

OBJECTIVES: To examine attendees reported experiences of health advice provision in genitourinary (GUM) clinics with different histories. DESIGN: A self-completed anonymous questionnaire was distributed at five clinics in the West Midlands Region of the United Kingdom. RESULTS: 297 of the 360 attendees approached returned completed questionnaires; 89.5% reported receiving health advice, 86.4% found all of this easy to understand and 10.4% wanted more advice. However, 33.9% received no advice on either HIV or safer sex. Those attending new clinics, set up since the HIV pandemic, were more likely than those attending older clinics, to have understood the advice given, to have had advice on both HIV and safer sex, and less likely to have wanted more advice. Among those attending with a concern about HIV, 14% claimed to have received no advice on either HIV or safer sex; with no difference between old and new clinics. For those attending with reasons particularly relevant to receiving HIV related advice, but not with a concern about HIV, 40% claimed to have received neither HIV nor safer sex advice. In this sub-sample, those attending new clinics were more likely to have received advice on HIV as well as safer sex, and less likely to want more advice. CONCLUSIONS: The results indicate that the provision of advice needs to be reconsidered, particularly in older clinics.

Adult↗