The University of Southampton
University of Southampton Institutional Repository

The social and genetic epidemiology of Hepatitis C in an isolated network of people who inject drugs

The social and genetic epidemiology of Hepatitis C in an isolated network of people who inject drugs
The social and genetic epidemiology of Hepatitis C in an isolated network of people who inject drugs
Background and Aims

Hepatitis C (HCV) causes liver cirrhosis, liver cancer and is a leading cause of death worldwide. In the UK the commonest risk factor for HCV is current or previous injecting drug use but many cases are undiagnosed and many known cases are disengaged from treatment services. The Isle of Wight (IOW) is a deprived, rural and geographically isolated population but suffers from the same obstacles to HCV care as larger nearby mainland populations.
The overall aim of this thesis is to understand the burden of HCV in people who inject drugs (PWID) on the IOW and how their social network could be utilised in an HCV elimination strategy.

Method

A sequential mixed method research design was used. Qualitative methods informed the design of a quantitative survey, which recruited PWID via respondent driven sampling (RDS) for a social network questionnaire and HCV bio-behavioural survey. This was used to estimate the population prevalence of HCV and the total population size of PWID on the IOW. Data from the social network survey were combined with a phylogenetic analysis of HCV RNA positive cases and qualitative narratives to give a representation of the HCV transmission network in PWID. This network was then used in an individualbased model (IBM) testing different treatment strategies.

Results

Sixty-nine PWID participated in the HCV bio-behavioural and social network surveys. The estimated prevalence of HCV was 29% (95% CI 13.3-44%) and the estimated total population size was 262 individuals.
The social network survey described 179 PWID, connected together into a cohesive network component via injecting partnerships. Phylogenetic analysis indicated that a number of these partnerships had led to the transmission of HCV and that genotype 3a virus had been transmitted between PWID living on the IOW. 
In the IBM the preferential treatment of well-connected PWID, via injecting and social relationships, led to significantly fewer new infections of HCV than treating at random (9.56 vs. 6.58 P<0.01 and 9.56 vs. 7.84 p=0.011 respectively).

Conclusion

The burden of HCV in PWID on the IOW is lower than expected and existing case-finding initiatives are effective. The qualitative and quantitative results indicate that PWID are linked together in a dense network and the treatment of well-connected nodes within this network may be an effective treatment as prevention strategy for the elimination of HCV on the IOW.
University of Southampton
Buchanan, Ryan Malcolm
a092c890-492a-478f-8d13-0453d482a700
Buchanan, Ryan Malcolm
a092c890-492a-478f-8d13-0453d482a700
Khakoo, Salim
6c16d2f5-ae80-4d9b-9100-6bfb34ad0273
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Grellier, L.F.
ff7abf84-d9df-448a-916c-ab47b0d1a7cb

Buchanan, Ryan Malcolm (2017) The social and genetic epidemiology of Hepatitis C in an isolated network of people who inject drugs. University of Southampton, Doctoral Thesis, 314pp.

Record type: Thesis (Doctoral)

Abstract

Background and Aims

Hepatitis C (HCV) causes liver cirrhosis, liver cancer and is a leading cause of death worldwide. In the UK the commonest risk factor for HCV is current or previous injecting drug use but many cases are undiagnosed and many known cases are disengaged from treatment services. The Isle of Wight (IOW) is a deprived, rural and geographically isolated population but suffers from the same obstacles to HCV care as larger nearby mainland populations.
The overall aim of this thesis is to understand the burden of HCV in people who inject drugs (PWID) on the IOW and how their social network could be utilised in an HCV elimination strategy.

Method

A sequential mixed method research design was used. Qualitative methods informed the design of a quantitative survey, which recruited PWID via respondent driven sampling (RDS) for a social network questionnaire and HCV bio-behavioural survey. This was used to estimate the population prevalence of HCV and the total population size of PWID on the IOW. Data from the social network survey were combined with a phylogenetic analysis of HCV RNA positive cases and qualitative narratives to give a representation of the HCV transmission network in PWID. This network was then used in an individualbased model (IBM) testing different treatment strategies.

Results

Sixty-nine PWID participated in the HCV bio-behavioural and social network surveys. The estimated prevalence of HCV was 29% (95% CI 13.3-44%) and the estimated total population size was 262 individuals.
The social network survey described 179 PWID, connected together into a cohesive network component via injecting partnerships. Phylogenetic analysis indicated that a number of these partnerships had led to the transmission of HCV and that genotype 3a virus had been transmitted between PWID living on the IOW. 
In the IBM the preferential treatment of well-connected PWID, via injecting and social relationships, led to significantly fewer new infections of HCV than treating at random (9.56 vs. 6.58 P<0.01 and 9.56 vs. 7.84 p=0.011 respectively).

Conclusion

The burden of HCV in PWID on the IOW is lower than expected and existing case-finding initiatives are effective. The qualitative and quantitative results indicate that PWID are linked together in a dense network and the treatment of well-connected nodes within this network may be an effective treatment as prevention strategy for the elimination of HCV on the IOW.

Text
Buchanan_thesis 5-1 - Version of Record
Available under License University of Southampton Thesis Licence.
Download (8MB)

More information

Published date: December 2017

Identifiers

Local EPrints ID: 417993
URI: https://eprints.soton.ac.uk/id/eprint/417993
PURE UUID: 766b43a8-185a-4c3a-86af-228f1d125a3b

Catalogue record

Date deposited: 20 Feb 2018 17:30
Last modified: 13 Mar 2019 18:52

Export record

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×