Academic journal article Canadian Journal of Public Health

Hepatitis C and HIV Prevalence Using Oral Mucosal Transudate, and Reported Drug Use and Sexual Behaviours of Youth in Custody in British Columbia

Academic journal article Canadian Journal of Public Health

Hepatitis C and HIV Prevalence Using Oral Mucosal Transudate, and Reported Drug Use and Sexual Behaviours of Youth in Custody in British Columbia

Article excerpt

ABSTRACT

Background: Youth in custody have high-risk drug use and sexual behaviours. HIV prevalence in this population was assessed in British Columbia (BC) in 1994 but hepatitis C virus (HCV) prevalence has never been measured. We sought to determine: 1) the performance of the OraSure®, a non-invasive device for oral mucosal transudate (OMT) specimen collection, to detect HCV and HIV antibodies; 2) the prevalence of HCV and HIV among youth in custody; and 3) the factors associated with intravenous drug use and sex for trade.

Methods: OraSure® was validated in 110 adults with known HIV and HCV sero-status. Nurses administered an anonymous survey and collected OMT samples from youth aged 14-19 years in BC youth custody centres.

Results: Antibody detection in OMT had 96.4% sensitivity for HIV and 94.6% for HCV. 417 youth were enrolled; 22% were female; 48% reported Aboriginal ethnicity. Although 98.3% reported ever using drugs, <8% reported injection drug use (IDU). IDU was independently associated with age of first sexual intercourse (inverse association) and sex for trade (sex in exchange for money, drugs, food or shelter) (OR 4.28; 95% CI: 1.56-11.75). Females were >9 times more likely to report sex for trade. Five Aboriginal youth were identified with HCV; prevalence estimate 1.2% (95% CI: 0.53- 2.77%); 3 reported injecting drugs, the other 2 reported using cocaine/crack and sharing non-injection drug paraphernalia. Two youth were identified with HIV, prevalence estimate 0.48% (95% CI: 0.14%-1.72%).

Conclusion: IDU, HCV and HIV prevalence remain low. Interventions are needed to prevent transition to IDU and further opportunities for prevention and harm reduction should be explored while the youth are in custody.

Key words: HIV; hepatitis C; youth

La traduction du résumé se trouve à la fin de l'article. Can J Public Health 2009;100(2):121-24.

Mots clés : VIH; hépatite C; jeunes

Youth in custody report high-risk drug use and sexual behaviours. 1 The prevalence of HIV in British Columbia youth in custody was assessed in 1994;2 hepatitis C virus (HCV) prevalence has never been measured. A recent Ontario study found 1/298 (0.4%) of youth in custody had been HCV-infected and no persons identified with HIV.3 The prevalence of HCV in BC is twice that of Canada.4 Therefore we sought to determine HCV and HIV prevalence, and factors associated with intravenous drug use (IDU) and sex for trade among youth in BC custody centres. To increase acceptability of testing, a non-invasive sampling method was utilized. Oral fluid testing using OraSure® had been previously validated for HIV antibody testing, but less evidence was available for HCV. Therefore we assessed the performance of OraSure® for the detection of HCV and HIV antibodies for prevalence estimations.

BC youth in custody are aged 12-19 years with the majority being 16 or 17. The Youth Criminal Justice Act (2003) encourages moderate sentences and alternatives to imprisonment for less serious crimes. Therefore youth have high rates of short-term confinement; the average stay is <30 days for youth in remand and <60 days for those sentenced. BC has the lowest rate of youth custody admissions in Canada, and youth beds in BC declined from 400 in 1996/7 to 135 in 2004/05.

METHODS

Validation of the OraSure® Collection Device

OraSure® (Orasure Technologies Inc, Bethlehem, PA) is a non-invasive device for oral mucosal transudate (OMT) specimen collection, preservation and transportation. The device, a cotton-fibre pad treated with hypertonic salt solution to enhance OMT, is placed between the lower gum and cheek for 2 minutes. Two OMT samples (one from each side of the mouth) and a blood sample, to confirm serostatus, were collected from 110 adults (24 HCV mono-infected, 27 HIV mono-infected, 29 HCV/HIV co-infected and 30 non-infected).

The OMT was collected and extracted according to the manufacturers instructions. …

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