Changes in Substance Use and Risk Behaviours for Hepatitis C Infection Among People Experiencing Homelessness Who Inject Drugs in Northern Ireland During the COVID-19 Pandemic

Author: Christopher Nugent Sarah Arnold Susan Semple Bronagh McBrien Gillian Armstrong Diarmuid O'Donovan

Theme: Epidemiology & Public Health Research Year: 2022

In Northern Ireland (NI) in 2017, during a Hepatitis C outbreak, a behavioural survey was conducted
to understand risk behaviours for Hepatitis C infection (HCV) among a population of people
experiencing homelessness who injected drugs. Heroin was the most commonly injected drug with
spoon, filter, needle and syringe sharing frequent. HCV cases displayed increased odds of injecting in
public toilets. In 2020, a new cluster was identified, with cases largely from the same population. This
study aims to understand the current pattern of HCV risk behaviours in this population and identify
differences with the 2017 cluster.
A cross-sectional survey using a convenience sample was conducted during May-August 2021.
Participants concurrently reported HCV status and information about recent risk behaviours. Data
analysis is ongoing and will include description of the most prevalent risk behaviours and
multivariable logistic regression adjusting for confounders. Comparison of the most prevalent
behaviours between 2017 and 2021 will be performed using chi-squared or Fishers exact tests.
Preliminary analyses suggests increased odds of HCV for those sharing needles (OR=5.57, 95%CI:
1.99-17.01), spoons (OR=4.92, 95%CI: 1.75-14.99), filters (OR=9.81, 95% CI: 2.78-46.52) and syringes
(OR=4.30, 95%CI: 1.37-15.17) and using a condom ‘sometimes’ rather than ‘always’ (OR=5.50,
95%CI: 1.15-32.90). Initial comparison with the 2017 survey suggests cocaine is now the most
commonly injected drug (69% in 2021 vs 57% in 2017) with needle-sharing also increasing (29% vs
27%). Full results (including multivariable) will be available in due course.
This work describes changes in substance use and risk behaviour in a vulnerable population, set
against the Covid-19 pandemic and will inform implementation of public health control measures. It
will also interest public health specialists and outreach workers more widely- providing information
about impact of the pandemic on this population, highlighting risk behaviours potentially applicable
to their own community.
Disclosure of Interest Statement:
This study received no specific grant from any funding agency, commercial or not-for-profit sectors.

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