Healthcare professionals and partners

Latest figures from the Health Protection Agency's Unlinked Anonymous Monitoring Survey of HIV and Hepatitis in injecting drug users for 2010 show that, within the last decade, HIV rates among injectors  appear to have leveled off, with four English regions reporting a decrease in the numbers who tested positive and two regions who report 0% HIV prevalence within the last decade. Hepatitis B prevalence among people who inject drugs is now at its lowest ever rate of 17%, down significantly since records began in 1990 – proof of the positive impact of a national drive to increase the uptake of hepatitis B vaccination in both prisons and community drug treatment settings. Three quarters of drug injectors reported having been vaccinated against hepatitis B – the highest ever level. Prevalence of hepatitis C among injectors  has decreased in four English regions, and national prevalence has remained static at 49% since 2009. Uptake of voluntary confidential testing for hepatitis C among people who inject drugs has increased markedly in recent years.  Rates of hepatitis C testing are increasing in all settings (drug services, primary care and prisons). Levels of reported sharing of injecting equipment (the single biggest factor in blood-borne virus transmission among this group) has steadily decreased among injectors. This is further evidence of positive behaviour changes among people who inject drugs who are engaging with drug treatment."

Needle and syringe programmes: providing people who inject drugs with injecting equipment, published in February 2009 by the National Institute for Health and Clinical Excellence (NICE), endorses the schemes currently provided by pharmacies and drug services in England to reduce the harms caused by injecting drugs. It sets out a blueprint of best practice for those working in the NHS, local authorities and the wider public and voluntary sector about the important role that needle and syringe programmes play in tackling the spread of blood-borne viruses, including hepatitis C and HIV.

The guidance states that there should be an increase in access to and availability of sterile injecting equipment, and an increase in the proportion of injectors who receive 100% coverage of sterile injecting equipment in relation to their injecting frequency. It also states that there should be an increase in the proportion of people from each group of people who inject drugs who are in contact with NSPs.

NICE also published a commissioning guide for NSPs, to support the local implementation of the guidance. The guide complements a range of other NSP implementation resources, all available from the NICE website.

It is expected that NHS organisations, and those commissioned by them, will review their current practice and consider the resources and time needed to implement NICE guidance. 

A needle and syringe programme coverage calculator has also been developed, which is an online tool produced by Exchange Supplies for the NTA as part of the Harm Reduction Works campaign. The coverage calculator is designed to help estimate the extent to which the number of syringes being distributed to people who inject drugs within an area compares to an estimate of the potential need for sterile injecting equipment.

The Needle Exchange Monitoring System (NEXMS) is a simple web-based data collection tool, separate from NDTMS, which was developed to facilitate the monitoring of needle exchange activity throughout England and to provide benchmarks for future increases in distribution.

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Hepatitis B and C are important causes of morbidity and mortality, but although there are NICE approved treatments, large numbers of people are still not being diagnosed.

With this in mind, the Royal College of General Practitioners (RCGP), in collaboration with the Health Protection Agency (HPA), have designed the RCGP certificate in the Detection, Diagnosis & Management of Hepatitis B & C in Primary Care. This will be particularly useful for GPs with a special interest in substance misuse, drugs workers and those involved in needle and syringe provision. The Certificate can also be completed by other interested parties including commissioners, public health practitioners, community based practitioners, pharmacists and service users.

It aims to improve confidence in detecting, diagnosing and managing patients with Hepatitis B and C, as well as familiarity with the available treatments and referral pathways.

The Certificate consists of a free online e-module plus a one day training component. The e-module can be accessed at www.elearning.rcgp.org.uk. Please check the Courses & Events page of the SMMGP website for details of forthcoming training days.

(expected Dec. 2012)

The National Institute for Health and Clinical Excellence (NICE) is currently developing public health guidance on the most cost-effective ways of offering tests to those at risk of infection from hepatitis B and C.  This is expected to be available in December 2012.

This guidance will support a number of related policy documents and guidelines including  the Hepatitis C action plan for England (DH 2004); the Hepatitis C strategy for England (DH 2002b); and Immunisation against infectious diseases – the green book (DH 2006).

It will provide recommendations for good practice, based on the best available evidence of effectiveness, including cost effectiveness. It is aimed at commissioners, managers and practitioners with public health as part of their remit working within the NHS, local authorities and the wider public, private, voluntary and community sectors. It may also be of interest to members of the public, particularly people who have contracted, or who are at greatest risk of contracting, hepatitis B or C.

The guidance will support other NICE guidance on: hepatitis treatment, immunisation, antenatal care and needle and syringe programmes.

For more information please visit the NICE website.

The 2010 Drug Strategy and proposals to transition into Public Health England have signalled that treatment of a wider range of substance misuse, including steroids, should be integrated. This new approach is accompanied by a shift in power to local areas, who will commission services to meet locally assessed need. As the NTA's Good practice in harm reduction report (2008) noted, some local areas are already responding to demand for needle and syringe provision to PIEDs users. However, this has been, and will likely remain a matter for local areas to decide upon as prevalence of steroid use varies widely across the country.

In 2010, the Advisory Council on the Misuse of Drugs (ACMD) considered the evidence of harms on the use of anabolic steroids, and provided advice on potential interventions to reduce these harms. See here for their report.

Many users of anabolic steroids, and other performance-image enhancing drugs such as hormones and melanotan, are injecting them. They are potentially at risk of a number of associated serious harms. Harms include damage to the injection site as a result of poor injecting technique; bacterial and fungal infections (such as localised abscesses and systemic infections) as a result of poor injecting technique, contaminated drug products, and sharing vials and/or reusing injecting equipment; and, blood-borne viruses such as HIV, Hepatitis B and hepatitis C as a result of sharing used injecting equipment or sharing vials (that have become contaminated through reuse of injecting equipment) with others.

General principles of health protection from the wider drug using population have been adapted for PIEDs users, and are implemented in a number of services (in particular NSPs) across the UK. NSPs have typically focussed on intravenous injectors, initially those using opiates and more recently those engaged in polydrug use. However, it appears that they have been increasingly accessed by those injecting anabolic steroids