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      Effectiveness of Methadone Maintenance Treatment in Prevention of Hepatitis C Virus Transmission among Injecting Drug Users

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          Abstract

          Background

          Injecting drug users (IDUs) are a major and most important risk factor for rising hepatitis C virus (HCV) prevalence in Iran.

          Objectives

          The objective of this study was to determine the effectiveness of methadone maintenance treatment (MMT) in prevention of HCV infection transmission among IDUs.

          Patients and Methods

          A mathematical modeling has been used to estimate number of HCV infections averted. The input parameters used in the model were collected by self-reported method from 259 IDUs before registering and one year after MMT. Nonparametric statistical tests have been used to compare risky injecting and sexual behaviors among IDUs before and after participating in MMT program. Deterministic sensitivity analyses were done to show the effects of parameters’ uncertainty on outcome.

          Results

          Of the 259 participants, 98.4% (255) were men, the mean age ± SD was 33.1 ± 7.58 years and HCV prevalence was 50%. The studied IDUs reported lower rate of risky injecting and sexual behavior after participation in MMT program. The cumulative incidence of HCV per 100 IDUs due to sharing injection and unsafe sexual contact with MMT program were 13.84 (95% CI: 6.17 -21.51), 0.0003 (0.0001 - 0.0005) and without it 36.48 (25.84 - 47.11) and 0.0004 (0.0002-0.0006) respectively.

          Conclusions

          The MMT program is an effective intervention to prevent HCV infection transmission, although it is essential to compare its effectiveness with other interventions before implementing it in nationwide.

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          Most cited references35

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          Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence.

          Khayriyyah Mohd Hanafiah, Justina Groeger, Abraham Flaxman … (2013)
          In efforts to inform public health decision makers, the Global Burden of Diseases, Injuries, and Risk Factors 2010 (GBD2010) Study aims to estimate the burden of disease using available parameters. This study was conducted to collect and analyze available prevalence data to be used for estimating the hepatitis C virus (HCV) burden of disease. In this systematic review, antibody to HCV (anti-HCV) seroprevalence data from 232 articles were pooled to estimate age-specific seroprevalence curves in 1990 and 2005, and to produce age-standardized prevalence estimates for each of 21 GBD regions using a model-based meta-analysis. This review finds that globally the prevalence and number of people with anti-HCV has increased from 2.3% (95% uncertainty interval [UI]: 2.1%-2.5%) to 2.8% (95% UI: 2.6%-3.1%) and >122 million to >185 million between 1990 and 2005. Central and East Asia and North Africa/Middle East are estimated to have high prevalence (>3.5%); South and Southeast Asia, sub-Saharan Africa, Andean, Central, and Southern Latin America, Caribbean, Oceania, Australasia, and Central, Eastern, and Western Europe have moderate prevalence (1.5%-3.5%); whereas Asia Pacific, Tropical Latin America, and North America have low prevalence (<1.5%). The high prevalence of global HCV infection necessitates renewed efforts in primary prevention, including vaccine development, as well as new approaches to secondary and tertiary prevention to reduce the burden of chronic liver disease and to improve survival for those who already have evidence of liver disease. Copyright © 2012 American Association for the Study of Liver Diseases.
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            The prevalence of hepatitis C virus infection in the United States, 1999 through 2002.

            Gregory Armstrong, Annemarie Wasley, Edgar Simard … (2006)
            Defining the primary characteristics of persons infected with hepatitis C virus (HCV) enables physicians to more easily identify persons who are most likely to benefit from testing for the disease. To describe the HCV-infected population in the United States. Nationally representative household survey. U.S. civilian, noninstitutionalized population. 15,079 participants in the National Health and Nutrition Examination Survey between 1999 and 2002. All participants provided medical histories, and those who were 20 to 59 years of age provided histories of drug use and sexual practices. Participants were tested for antibodies to HCV (anti-HCV) and HCV RNA, and their serum alanine aminotransferase (ALT) levels were measured. The prevalence of anti-HCV in the United States was 1.6% (95% CI, 1.3% to 1.9%), equating to an estimated 4.1 million (CI, 3.4 million to 4.9 million) anti-HCV-positive persons nationwide; 1.3% or 3.2 million (CI, 2.7 million to 3.9 million) persons had chronic HCV infection. Peak prevalence of anti-HCV (4.3%) was observed among persons 40 to 49 years of age. A total of 48.4% of anti-HCV-positive persons between 20 and 59 years of age reported a history of injection drug use, the strongest risk factor for HCV infection. Of all persons reporting such a history, 83.3% had not used injection drugs for at least 1 year before the survey. Other significant risk factors included 20 or more lifetime sex partners and blood transfusion before 1992. Abnormal serum ALT levels were found in 58.7% of HCV RNA-positive persons. Three characteristics (abnormal serum ALT level, any history of injection drug use, and history of blood transfusion before 1992) identified 85.1% of HCV RNA-positive participants between 20 and 59 years of age. Incarcerated and homeless persons were not included in the survey. Many Americans are infected with HCV. Most were born between 1945 and 1964 and can be identified with current screening criteria. History of injection drug use is the strongest risk factor for infection.
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              Global estimates of prevalence of HCV infection among injecting drug users.

              Carmen Aceijas, Tim Rhodes (2007)
              In this paper, we review evidence of HCV prevalence among injecting drug users (IDUs) worldwide. We undertook a desk-based review of both 'grey' and published literature released between 1998 and 2005. Data on HCV prevalence among IDUs was found in 57 countries and in 152 sub-national areas. We found reports of HCV prevalence of at least 50% among IDUs in 49 countries or territories. Available regional estimates varied widely, from 10 to 96% in Eastern Europe and Central Asia, from 10 to 100% in South and South-East Asia, from 34 to 93% in East-Asia and the Pacific, from 5 to 60% in North Africa and the Middle-East, from 2 to 100% in Latin America, from 8 to 90% in North America, from 25 to 88% in Australia and New Zealand, and from 2 to 93% in Western Europe. Only in Colombia and Lebanon were all HCV prevalence estimates below 20%. In addition, evidence of HIV/HCV co-infection among IDUs was found in 16 countries. In China, Poland, Puerto Rico, Russia, Spain, Switzerland, Thailand and Viet Nam, estimates of the prevalence of HIV/HCV co-infection among IDUs reached 90%. Taken together, data suggest high global prevalence of HCV and HIV/HCV co-infection among IDUs. We suggest exploring protective factors in sites of low HCV prevalence.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Hepat Mon
                Journal ID (iso-abbrev): Hepat Mon
                Journal ID (doi): 10.5812/hepatmon
                Journal ID (publisher-id): Kowsar
                Title: Hepatitis Monthly
                Publisher: Kowsar
                ISSN (Print): 1735-143X
                ISSN (Electronic): 1735-3408
                Publication date (Electronic): 17 August 2013
                Publication date Collection: August 2013
                Volume: 13
                Issue: 8
                Electronic Location Identifier: e12411
                Affiliations
                [1 ]Baqiatallah Research Center for Gastrointestinal and Liver Diseases, Baqiatallah University of Medical Sciences, Tehran, IR Iran
                [2 ]Middle East Liver Disease Center, Tehran, IR Iran
                [3 ]HIV/AIDS Research center, Shiraz University of Medical Sciences, Shiraz, IR Iran
                [4 ]Health Management and Economics Research Center, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, IR Iran
                [5 ]Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran
                [6 ]Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran
                Author notes
                [* ]Corresponding author: Mohammad Hadian, Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran., Tel.: +98-9122278220, Fax: +98-2144017935, E-mail: hadianmohamad@ 123456yahoo.com .
                Article
                DOI: 10.5812/hepatmon.12411
                PMC ID: 3782738
                PubMed ID: 24069039
                SO-VID: c3a932b5-cc6b-4597-ac80-98768e8a5104
                Copyright © Copyright © 2013, Kowsar Corp.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 22 May 2013
                Date revision received : 29 June 2013
                Date accepted : 15 July 2013
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: hepatitis c,effectiveness,methadone,maintenance,incidence,iran
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: hepatitis c, effectiveness, methadone, maintenance, incidence, iran

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