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Variations in the rate of infectious diseases in intravenous substance users entering the Detoxification Unit of the Programme for Substance Users' Treatment and Rehabilitation. Implementation of a treatment programme for all patients tested positive for hepatitis B and C
© The Author(s) 2006
- Published: 28 February 2006
- Substance User
- Intravenous Drug User
- Biochemical Control
- Therapeutic Community
All patients admitted to the Detoxification Unit of the Programme for Substance Users' Treatment and Rehabilitation at the Psychiatric Hospital of Thessaloniki are being tested for hepatitis B and C and for HIV. Patients also receive a complete blood and biochemical control as well as a chest x-ray. In view of the high percentage of hepatitis C we have developed and implemented a prevention and treatment programme throughout the various treatment stages in the facilities of our Programme. There is a four-sessions health-educational group on hepatitis/HIV/contraception, taking place in the Detoxification Unit and facilitated by nurses. All patients being transferred to the Therapeutic Community (expected length of stay 1 year) are referred to a Hepatology Department and receive an assessment (Virus load count, Ultra-sound and in some cases liver biopsy) in order to determine the necessity or not of medication. Patients on medication receive peginterferone alpha-2b and ribavirin for six months and regular follow-ups. All patients negative for hepatitis B are being vaccinated.
We studied all first admissions only of the years 1999 and 2004 and tried to compare the socio-demographic data.
45% of all first admissions only tested positive for hepatitis C in 1999 (85.8% men and 14.2% women) vs 37.6% (90% men and 10% women) in 2004. Mean age of those having tested positive was 27.8 years in 1999 and 26.3% in 2004.
Hepatitis B positive tested only 4% of first admissions in 1999 and 0% in 2004.
There were no HIV-positive cases concerning first admissions either in 1999 or in 2004.
51% of first admissions in 1999 were negative for all infectious diseases tested vs 62.3% in 2004.
40 patients of the 52 admitted to the Therapeutic Communuty were engaged in the vaccination for hepatitis B. The rest either refused or had to start the interferone treatment immediately on medical grounds. 27 completed the vaccination process, the rest interrupted their stay in the community and their treatment.
All patients positive for hepatitis C have been assessed by a Hepatology Department and 6 completed or are still receiving medication.
The infection rate of hepatitis C shows a decline trend in Greece between the years 1999 and 2004 and our results are in concordance to them (41.2–81.6% in 1999 vs 35.8–67.2% in 2004 according to the treatment modality) [1, 2]. The same applies to hepatitis B. The rates have declined and remain at very low levels, (whereas the prevalence in european countries is 40–70%: 2–6.3% in 1999 vs 2.3–5.8% in 2004) [1, 2].
The HIV rate remains surprisingly low in Greece comparing to the other european countries: only 3.9% of all HIV positive cases reported at the Greek Infectious Diseases Control Centre until June 2003 were intravenous drug users. We literally had no cases at all, which doesn't mean that there aren't any. Most HIV positive cases enter substitution programmes.
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