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Title: Protecting injecting drug users against blood-borne viruses : modelling the impact of prison-based interventions
Author: Sutton, Andrew
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2006
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Injecting drug use is a key risk factor, and injecting drug users (lDUs) are a core group for several blood-borne viruses (BBV) including hepatitis B (HBV) and hepatitis C (HCV). In 2003 the Unlinked Anonymous Prevalence Monitoring Programme reported that 62% of surveyed IDUs in England and Wales were found to ever having been imprisoned. Thus prison may provide a good opportunity to administer health interventions against BBVs to this hard to reach population. The aim of the thesis is to examine a number of alternative intervention measures that target IDUs in a prison setting against BBVs. Methods to inform as to the characteristics of the IOU population and its risk of infection from BBVs are also proposed. A method to determine the age specific rates at which individuals enter and leave the IOU population is presented. An age-specific dynamic model is developed that describes the flow of IDUs and non-IDUs through prison. This model is used to assess the potential impact of the HBV vaccination programme in England and Wales on the vaccination coverage of the IOU population showing that over 70% of IDUs may be captured with vaccination. Taking data that describes the prevalence of HBV and HCV in current IDUs in England and Wales, the injecting career length specific forces of infection for HBV and HCV in the IOU popUlation in England and Wales are estimated, these provide further evidence that new initiates to injecting may be at increased risk of infection compared to more experienced IDUs. Parameterised models are used to assess the impact that prison vaccination will have on HBV transmission within the IDU population with results showing that prison vaccination may result in a 75% reduction in acute infections in IDUs within 12 years from the start of the programme. Finally the cost effectiveness of HCV casefinding on prison reception is investigated showing the importance of encouraging current or former IDUs to accept ELISA testing on prison reception. The results provide further evidence that prison may be a good location in which to implement intervention measures against BBVs. The results also provide an increased understanding of the characteristics of IOU population in England and Wales and in particular its risk of infection from HBV and HCV.
Supervisor: Not available Sponsor: Department of Health and Social Security
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RC Internal medicine