1. A Profile of People Who Inject Drugs in London, Ontario Report on the Public Health Agency of Canada I-Track Survey, Phase 3 Canadian Public Health Association May 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 questions in 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 RESULTS LONDON, 2012

11. Demographics Sex and AgeLondonNational Participants2042,687 Male73.5%68.2% Female26.5%31.8% Age (mean)3639

12. Demographics (cont’d) CharacteristicLondonNational < $1,000 / month income43.8%54.1% Unstable housing56.9%38.7% Incarcerated in past 6 months 20.1%11.5% Unstable housing and recent incarceration higher in London sample than national sample

13. Selected Drugs Injected in Past 6 Months DrugLondon Percent (rank) National Percent (rank) Non-prescribed morphine 75.5% (1)47.0% (3) Hydromorphone (Dilaudid) 75.5% (1)47.2% (2) Oxycontin / Oxycodone69.1% (3)37.7% (4) Methamphetamine68.1% (4)Not available Ritalin66.2% (5)Not available Cocaine58.3% (6)64.3% (1) Crack49.0% (7)24.8% (6) Heroin17.2% (8)26.7% (5)

14. Injection Risk Behaviours Behaviour in past six months LondonNational Borrowed needles19.6%15.5% Borrowed any other injection equipment (e.g. water, cookers) 42.9%34.5% Lent needles to others26.6%15.5% Lent any other injection equipment 43.6%33.1% Borrowing and lending needles and equipment higher in London sample than national sample

15. Hepatitis C and HIV Prevalence LondonNational Hepatitis C79.1%68.0% HIV5.5%10.9% Unaware HIV positive60% (6/10)21.4% 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 Inject Drugs in London, Ontario Report on the Public Health Agency of Canada I-Track Survey, Phase 3 Canadian Public Health Association May 28, 2014 Authors: Hilary Caldarelli, BSc MPH Alison Locker, BSc MSc Bryna Warshawsky, MDCM MHSc CCFP FRCPC