Authors: Hilary Caldarelli BSc MPH Alison Locker BSc MSc

1. A Profile of People Who InjectDrugs in London, OntarioReport on the Public Health Agency of CanadaI-Track Survey, Phase 3Canadian Public Health AssociationMay 28, 2014 Authors: Hilary Caldarelli BSc MPH Alison Locker BSc MSc Bryna Warshawsky MDCM MHSc CCFP FRCPC

2. Overview • Background • Methods • Selected results • Limitations • Summary and local next steps • Acknowledgements

3. Background

4. The Middlesex-London Region • Population 439,151 (2011 Census) • City of London: 366,151 • Remainder of Middlesex County: 73,000 • SW Ontario along the Windsor-Quebec City corridor • Approximately 2 hour drive from Windsor and Toronto

5. What is the I-Track Survey? • Survey of people who inject drugs developed and led by Public Health Agency of Canada (PHAC) • Behavioural and biological surveillance • Occurs regularly at sentinel sites • Middlesex-London Health Unit participated for first time in 2012, during Phase 3 (2010-2012)

6. Why is I-Track Important? • Injection drug use is an important risk factor in acquiring hepatitis C and HIV • People who use injection drugs are a vulnerable population • Middlesex-London had a significantly higher incidence of hepatitis C compared to Ontario • 2010: 53.4 per 100,000 population vs. 33.1 per 100,000 in ON

7. Methods

8. How were I-Track Survey Participants Interviewed? • The Health Unit partnered with Regional HIV/AIDS Connection (RHAC) • Face to face interview • Participants recruited and interviewed through RHAC needle and syringe exchange program (NEP) in January to February 2012 • Approximately 80 questionsin 6 topic areas

9. Who Was Eligible to Participate? • Had injected drugs in the past 6 months • ≥ 16 years of age • Able to provide informed consent • Able to speak English or French • Had not already participated in Phase 3 of the I-Track survey

10. Selected I-Track Survey ResultsLondon, 2012

11. Demographics

12. Demographics (cont’d) • Unstable housing and recent incarceration higher in London sample than national sample

13. Selected Drugs Injected in Past 6 Months

14. Injection Risk Behaviours • Borrowing and lending needles and equipment higher in London sample than national sample

15. Hepatitis C and HIV Prevalence • London sample has higher hepatitis C prevalence rates, but lower HIV prevalence rates compared to the national sample

16. Hepatitis C and HIV Prevalence Rates in I-Track vs. General Canadian Population

17. Limitations, Summary and local next steps

18. Limitations • Non-random convenience sample • Hard to reach population • Self-reported • Leveraged existing relationships between interviewers and participants to minimize social desirability bias • Other potential biases • Recall, selection

19. Summary • Active local population of people who inject drugs with a high prevalence of hepatitis C and HIV • Opioid drugs were most commonly injected • Higher prevalence of injection risk behaviours compared to national sample

20. Local Next Steps • Overview of local withdrawal management services and needle disposal and recovery • Assess NEP services in County area • Additional reporting on impacts of drug use in Middlesex-London • Collaborate with municipal and community partners to develop a comprehensive community drug strategy

21. Acknowledgements • Survey participants • Regional HIV/AIDS Connection (RHAC) • Public Health Agency of Canada (PHAC)

22. Thank you!

23. A Profile of People Who InjectDrugs in London, OntarioReport on the Public Health Agency of CanadaI-Track Survey, Phase 3Canadian Public Health AssociationMay 28, 2014 Authors: Hilary Caldarelli, BSc MPH Alison Locker, BSc MSc Bryna Warshawsky, MDCM MHSc CCFP FRCPC