Potential Cost-Effectiveness of Supervised Injection Facilities in Toronto and Ottawa, Canada

BACKGROUND AND AIMS:

Supervised injection facilities (legally sanctioned spaces for supervised consumption of illicitly obtained drugs) are controversial public health interventions. We determined the optimal number of facilities in two Canadian cities using health economic methods.

DESIGN:

Dynamic compartmental model of HIV and hepatitis C transmission through sexual contact and sharing of drug use equipment.

MEASUREMENTS:

Direct health-care costs and quality-adjusted life-years (QALYs) over 20 years, discounted at 5% per year; incremental cost-effectiveness ratios.

FINDINGS:

In Toronto, one facility cost $4.1 million and resulted in a gain of 385 QALYs over 20 years, for an incremental cost-effectiveness ratio (ICER) of $10 763 per QALY [95% credible interval (95CrI): cost-saving to $278 311]. Establishing one facility in Ottawa had an ICER of $6127 per QALY (95CrI: cost-saving to $179 272). At a $50 000 per QALY threshold, three facilities would be cost-effective in Toronto and two in Ottawa. The probability that establishing three, four, or five facilities in Toronto was cost-effective was 17, 21, and 41%, respectively. Establishing one, two, or three facilities in Ottawa was cost-effective with 13, 35, and 41% probability, respectively. Establishing no facility was unlikely to be the most cost-effective option (14% in Toronto and 10% in Ottawa). In both cities, results were robust if the reduction in needle-sharing among clients of the facilities was at least 50% and fixed operating costs were less than $2.0 million.

CONCLUSIONS:

Using a $50 000 per quality-adjusted life-years threshold for cost-effectiveness, it is likely to be cost-effective to establish at least three legally sanctioned spaces for supervised injection of illicitly obtained drugs in Toronto, Canada and two in Ottawa, Canada.

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By:  Enns EA1, Zaric GS2, Strike CJ3,4, Jairam JA3, Kolla G3, Bayoumi AM5,6,7,8.

• 1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA.
• 2Ivey Business School, Western University, London, ON, Canada.
• 3Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
• 4Center for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
• 5Centre for Research on Inner City Health, Li KaShing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
• 6Department of Medicine, University of Toronto, Toronto, ON, Canada.
• 7Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
• 8Division of General Internal Medicine, St Michael's Hospital, Toronto, ON, Canada.

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Social Network Investigation of a Syphilis Outbreak in Ottawa, Ontario

BACKGROUND:

The incidence of syphilis in Ottawa, Ontario, has risen substantially since 2000 to six cases per 100,000 in 2003, again to nine cases per 100,000 in 2007, and recently rose to 11 cases per 100,000 in 2010. The number of cases reported in the first quarter of 2010 was more than double that in the first quarter of 2009.

OBJECTIVE:

In May 2010, the Ontario Ministry of Health and Long Term Care requested the assistance of the Field Epidemiology Program to describe the increase in infectious syphilis rates and to identify social network sources and prevention messages.

METHODS:

Syphilis surveillance data were routinely collected from January 1, 2009 to July 15, 2010, and social networks were constructed from an enhanced social network questionnaire. Univariate comparisons between the enhanced surveillance group and the remaining cases from 2009 on non-normally distributed data were conducted using Kruskal-Wallis tests and χ² tests.

RESULTS:

The outbreak cases were comprised of 89% men. Seventeen of the 19 most recent cases consented to answer the questionnaire, which revealed infrequent use of condoms, multiple sex partners and sex with a same-sex partner. Information regarding social venues where sex partners were met was plotted together with sexual partnerships, linking 18 cases and 40 contacts, representing 37% of the outbreak population and connecting many of the single individuals and dyads.

CONCLUSION:

Uncovering the places sex partners met was an effective proxy measure of high-risk activities shared with infected individuals and demonstrates the potential for focusing on interventions at one named bar and one Internet site to reach a high proportion of the population at risk.

Below:  Reported infectious syphilis (primary, secondary and early latent cases only) rate per 100,000 population, males and females, Ottawa, Ontario, 2000 to 2009. Data source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System, extracted December 23, 2014.

Below:   Reported infectious syphilis cases (primary, secondary and early latent cases only) by month and year of episode, Ottawa, Ontario, January 2009 to June 2010 (includes cases diagnosed up to June 15, 2010 (n=72) [includes only the earliest episode for four cases involving two episodes each of infectious syphilis in 2009 to 2010])

Full article at:  http://goo.gl/a2HcAy

By:  H D’Angelo-Scott, PhD,1 J Cutler, MHSc,1 D Friedman, PhD,2 A Hendriks, MPH,2 and AM Jolly, PhD3

¹Canadian Field Epidemiology Program, Public Health Agency of Canada;

²City of Ottawa Public Health, Centre for Communicable Disease and Infection Control;

³University of Ottawa, Ottawa, Ontario

Correspondence: Dr AM Jolly, Epidemiology and Community Medicine, University of Ottawa, Room 3105 Roger Guindon Hall, 451 Smyth Road, Ottawa, Ontario K1H 8M5. Telephone 613-562-5800 ext 8778, fax 613-562-5465, e-mail ac.awattou@ylloja

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Risk Environments Facing Potential Users of a Supervised Injection Site in Ottawa, Canada

Supervised injection sites (SISs) have been effective in reducing health risks among people who inject drugs (PWID), including those who face issues of homelessness, mental health illness, interactions with local policing practices, and HIV infection. We investigate the risk behaviours and risk environments currently faced by potential users of an SIS in Ottawa to establish the need for such a service and to contribute to the design of an SIS that can address current health risks and reduce harm.

The PROUD cohort is a community-based participatory research (CBPR) project that examines the HIV risk environment among people who use drugs in Ottawa. From March to October 2013, 593 people who reported using injection drugs or smoking crack cocaine were enrolled through street-based recruitment in the ByWard Market neighbourhood, an area of the city with a high concentration of public drug use and homelessness. Participants completed a demographic, behavioural, and risk environment questionnaire and were offered HIV point-of-care testing. We undertook descriptive and univariate analyses to estimate potential use of an SIS by PWID in Ottawa and to explore risk behaviours and features of the risk environment faced by potential users of the service.

Of those participants who reported injecting drugs in the previous 12 months (n = 270), 75.2 % (203) reported a willingness to use an SIS in Ottawa. Among potential SIS users, 24.6 % had recently injected with a used needle, 19.0 % had trouble accessing new needles, 60.6 % were unstably housed, 49.8 % had been redzoned by the police, and 12.8 % were HIV positive. Participants willing to use an SIS more frequently injected in public (OR = 1.98, 95 % CI = 1.06–3.70), required assistance to inject (OR = 1.84, 95 % CI = 1.00–3.38), were hepatitis C positive (OR = 2.13, 95 % CI = 1.16–3.91), had overdosed in the previous year (OR = 2.00, 95 % CI = 1.02–3.92), and identified as LGBTQ (OR = 5.61, 95 % CI = 1.30–24.19).

An SIS in Ottawa would be well-positioned to reach its target group of highly marginalized PWID and reduce drug-related harms. The application of CBPR methods to a large-scale quantitative survey supported the mobilization of communities of PWID to identify and advocate for their own service needs, creating an enabling environment for harm reduction action.

Table 2
Risk environment comparison by willingness to use a supervised injection service in Ottawa a
	Intention to use an SIS in Ottawa; no. (and %) of participant b
Characteristic c	Yes	No	OR (and 95 %CI) d
	n = 205	n = 67
Age	42.0	44.0	p value = 0.04
Sexual identity
LGBTQ	29 (93.5)	2 (6.5)	5.61 (1.30–24.19)
Straight	168 (72.1)	65 (27.9)
Injects with other people
Yes	176 (80.0)	44 (20.0)	3.23 (1.66–6.27)
No	26 (55.3)	21 (44.7)
Injects in public
Yes	81 (82.7)	17 (17.3)	1.98 (1.06–3.70)
No	113 (70.6)	47 (29.4)
Assistance to inject
Yes	81 (81.8)	18 (18.2)	1.84 (1.00–3.38)
No	120 (71.0)	49 (29.0)
Last hep C test
Positive	129 (80.1)	32 (19.9)	2.13 (1.16–3.91)
Negative	51 (65.4)	27 (34.6)
Overdosed
Yes	66 (83.5)	13 (16.5)	2.00 (1.02–3.92)
No	137 (71.7)	54 (28.3)

OR odds ratio, CI confidence interval

a Percentages are calculated on the basis of the sum across each row

b Except where indicated otherwise. Because of missing responses, the data for some characteristics do not sum to 272

c Variables are reported for the previous 12 months unless otherwise specified

d For each categorical variable, the reference category is the second category

Shaw et al.

Shaw et al. Harm Reduction Journal 2015 12:49   doi:10.1186/s12954-015-0083-9

Full article at: http://goo.gl/bKMFXL

By: Ashley Shaw^1*, Lisa Lazarus¹, Tyler Pantalone², Sean LeBlanc³, Dolly Lin⁴, Daina Stanley¹, Caleb Chepesiuk¹, Sheetal Patel¹, Mark Tyndall¹⁵ and The PROUD Community Advisory Committee

¹Ottawa Hospital Research Institute, 725 Parkdale Ave., Ottawa K1Y 4E9, Ontario, Canada

²PROUD Committee, 85 Primrose Ave., Ottawa K1R 6M1, Ontario, Canada

³Drug Users Advocacy League, 216 Murray St., Ottawa K1N 5N1, ON, Canada

⁴Department of Medicine, University of Ottawa, 451 Smyth Rd., Ottawa K1H 8M5, Ontario, Canada

⁵University of Ottawa at The Ottawa Hospital, Division of Infectious Disease, 501 Smyth Rd., Ottawa K1H 8L6, ON, Canada

  

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Promoting HIV Testing for Gay and Bisexual Men: An Evaluation of the 2011-2012 Campaign in Toronto and Ottawa

This article reports on a social marketing campaign directed toward high-risk men who have sex with men in Toronto and Ottawa to encourage testing for HIV and syphilis; improve knowledge about HIV transmission, seroconversion symptoms, and the HIV window period; and heighten awareness of syphilis transmission and its relationship to facilitating HIV transmission. Evaluation data were collected from a large-scale online pre-and postcampaign survey of sexually active men who have sex with men and from laboratory testing data. Men who turned up to be tested also filled out an exit survey. 

The campaign websites attracted some 15,000 unique visitors, 

• 54% of whom had an IP address in Toronto or Ottawa. 
• Laboratory data showed a 20% increase in HIV testing in Toronto over the campaign compared to the previous year. 
• The overall rate of HIV-positive tests remained relatively constant. 
• Knowledge levels about seroconversion symptoms, sexually transmitted infection and HIV transmission, and the HIV window period were significantly better among postcampaign survey respondents aware of the campaign compared to postcampaign respondents who were not aware and compared to precampaign respondents.

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By: Adam BD1, Gardner S2, Major C3, Campbell D3, Light L3, Globerman J3.

• 1University of Windsor, Windsor, Ontario, Canada Ontario HIV Treatment Network, Toronto, Ontario, Canada
• 2University of Toronto, Toronto, Ontario, Canada Ontario HIV Treatment Network, Toronto, Ontario, Canada.
• 3Ontario HIV Treatment Network, Toronto, Ontario, Canada.

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