Key findings from a national enhanced HIV surveillance system: 2010 - 2012.

Abstract

People who inject drugs represent an important risk group in Canada's HIV epidemic. I-Track is a national public health surveillance system designed to monitor HIV and hepatitis C prevalence and associated risk behaviour factors among people who inject drugs in Canada. Information is collected through cross-sectional surveys conducted periodically at sentinel sites across Canada. I-Track Phase 3 was conducted between April 26, 2010 and August 7, 2012 across 11 participating sentinel sites. To assess the prevalence of HIV, lifetime exposure to hepatitis C and associated risk behaviours among people who inject drugs in Canada to guide and help evaluate HIV and hepatitis C prevention, treatment and control activities. People who had injected drugs in the six months prior to the interview and who met the minimum age of consent participated in an interviewer administered survey and provided a blood sample for HIV and hepatitis C antibody testing. Descriptive analyses were performed with sex-based comparisons. There were 2,687 people who participated in the survey. 68.2% were male, 60.9% were between the ages of 30 and 49 years and 36.2% self-identified as Aboriginal. Among the participants who provided a blood sample of sufficient quantity for testing, 11.2% were HIV seropositive and their lifetime exposure to hepatitis C infection was 68.0%. Drugs commonly injected included cocaine (64.3%), hydromorphone (47.2%), non-prescribed morphine (47.0%), oxycodone (37.7%) and heroin (26.7%). Injecting with previously used needles and/or other injection equipment was reported by 15.5% and 34.5% of participants, respectively. Just over one-third reported having two or more sex partners in the six months prior to the interview (34.4%) and using a condom at last sex (36.6%). The majority of participants had tested at least once in their lifetime for HIV or hepatitis C (92.9% and 91.4%, respectively). A large proportion of the participants who reported being HIV positive were under the care of a doctor (95.0%) and nearly two-thirds were taking medications prescribed for their HIV infection at the time of the interview (66.0%). HIV seroprevalence and lifetime exposure to hepatitis C infection were high among I-Track Phase 3 participants. Although many participants reported safe injection and safe sexual practices, a high proportion of participants reported risk behaviours associated with acquisition and transmission of HIV and hepatitis C. People who inject drugs continue to represent an important risk group in Canada's HIV epidemic and the I-Track Phase 3 survey findings highlight the need for continued treatment and prevention services, as well as routine and integrated testing among people who inject drugs.