Strategic considerations to decrease
HCV prevalence in Austria
EMCDDA Conference 20 years of monitoring and communicating
evidence on drugs, Workshop 7
Martin Busch, September 22nd 2015
Hepatitis C in Austria
„Estimates“ between 18.000 and 130.000, even the number of
diagnosed cases is unknown!
» intravenous drug consumers (also nasal)
» People who got blood transfusions before the end of the
1990ies
» People who donated blood plasma
» Migrants from countries with high infection rates
» Men who have sex with men
» People who have been to prison (tattoos, IDU)
» People who got piercings or tattoos in nonsterile settings (e.g.
on holidays abroad)
Incidence cases seem to be mainly IDUs
In UK it is estimated that > 90% HCV acquired among PWID
(Sweeting et al. Biostatistics 2008; De Angelis et al, Statistics in Med Research 2009; Ross et al EJPH 2011)
HCV rate among IDUs in Austria 2014
Source
In-patient treatment Lukasfeld, Vorarlberg
HCV-Ab-Rate
HIV-Rate
34 % (20/59)
0 % (0/59)
74 % (137/185)
0 % (0/191)
Caritas Marienambulanz, Graz
72 % (59/82)
0 % (0/82)
DOKLI
36 % (12/33)
0 % (0/35)
20 % (20/101)4
51 % (20/39)4
4 % (4/101)4
11 % (4/38)4
Low threshold facility ambulatorium
Vienna
Drug related deaths (verified intoxications)
HCV infection rates (HCV-ab) low threshold facility
ambulatorium Vienna 2006 to 2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2006
2007
2008
2009
2010
HCV-Ab
2011
2012
2013
2014
Strategic considerations to decrease HCV prevalence
(even if the prices of medications decrease)
» There is strong need for better data („estimate“of HCV –
prevalence 18.000 to 130.000 is not sufficient for planning!)
including a better picture on risk groups
» Re-infection rate among IDUs (taking into account the
assumed high HCV prevalence)
» How to deal with high risk environments (e. g. needle
exchange in prison)
» How to ensure compliance (e. g. if the decision is to treat as
many as possible in a short time period)
There has to be a package of measures including prevention and
treatment of HCV
How to get better data
…data on diagnosed HCV cases are already there, but in
different data bases…
Sources of data concerning HCV infections in Austria
»
»
»
»
»
»
»
»
»
Registry of notifiable infectious diseases (Ministry of Health)
Action Hepatitis C database
Statistics of diagnoses given in hospital
TDI DOKLI
Data from low-threshold services for drug addiction (f.e.
Jedmayer Vienna, Marienambulanz Graz)
Data from Hepatitis treatment centers
AHIVCOS cohort study (HIV-co-infections)
Data from the central federation of social insurance agencies
People who got blood transfusions before the end of the
1990ies
Project on HCV data (financed by AbbVie)
» Find out which variables are included in the data sources –
(e.g. way of infection…)
» Analysis of data quality and completeness
» Compiling data on pseudononymised base using the tools of
eSuchtmittel (Idea)
Identification of cases via population registry
Creating of a not traceable identifier
Erase personal data
Database on pseudononymised base which avoids double
counting