National survey of HIV and hepatitis testing and vaccination services provided by drug and alcohol agencies in Australia

Adam R Winstock, Caroline M Anderson and Janie Sheridan
Med J Aust 2006; 184 (11): 560-562.


Objectives: To identify the prevalence of blood-borne viruses (BBVs) testing, counselling and vaccination services by drug and alcohol services for injecting drug users in Australia.

Design, setting and participants: Cross-sectional survey of drug and alcohol agencies throughout Australia.

Outcome measures: Current availability of testing, counselling and vaccination services for hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV; availability of medical coverage; and barriers to greater provision of services.

Results: Survey responses were provided by 222 agencies nationally (61% response rate). About three-quarters of agencies provided some access to HIV, HBV, and HCV testing and HBV vaccinations, but only a third offered these services routinely on site. HBV vaccination availability differed depending on the primary function of the agency, with drug dependence units and needle and syringe programs more likely to provide vaccination on site. The major barriers preventing agencies from providing routine on-site BBV services are lack of access to medical staff and trained personnel; the cost of providing these services; and a lack of facilities.

Conclusions: The restricted provision of BBV services represents missed opportunities to reduce individual and community morbidity and to maximise the potential savings from preventable disease in relation to HBV infection. To address key barriers and patient retention issues, it is necessary to expand the role of non-medical staff, increase the use of shorter HBV vaccination schedules, and identify and maintain local clinical partnerships between public and private service providers.

  • Adam R Winstock1,2
  • Caroline M Anderson1
  • Janie Sheridan3

  • 1 Drug Health Services, Sydney South West Area Health Service, Sydney, NSW.
  • 2 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW.
  • 3 School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.


We thank Kerry Chant for arranging the payment of postage and associated administration costs through the Public Health Unit, Sydney South West Area Health Service, and Reckitt Benckiser for allowing us to use their database of drug treatment agencies. We are grateful to Marine Lye for data entry and administrative support for this project. We acknowledge the valuable feedback provided by Vikki Sinnott, Sydney South West Area Health Service; Stuart Loveday, Hepatitis C Council of NSW Inc; and the MJA reviewers in the preparation of this paper.

Competing interests:

Adam Winstock has received funding from Reckitt Benckiser to provide training in the field of drug and alcohol problems. Reckitt Benckiser provided the database used to obtain the survey sample, but had no input into the study design or analysis.

  • 1. Dore GJ, Law M, MacDonald M, Kaldor JM. Epidemiology of hepatitis C virus infection in Australia. J Clin Virol 2003; 26: 171-184.
  • 2. National Centre in HIV Epidemiology and Clinical Research. HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia: annual surveillance report, 2005. Sydney: NCHECR, 2005. Available at: (accessed Apr 2006).
  • 3. Loxley W, Phillips M, Carruthers SJ, Bevan J. The Australian Study of HIV and Injecting Drug Use. Part I: Prevalence for HIV, hepatitis B and hepatitis C among injecting drug users in four Australian cities. Drug Alcohol Rev 1997; 16: 207-214.
  • 4. Crofts N, Aitken CK. Incidence of bloodborne virus infection and risk behaviours in a cohort of injecting drug users in Victoria, 1990–1995. Med J Aust 1997; 167: 17-20. <MJA full text>
  • 5. Maher L, Chant K, Jalaludin B, Sargent P. Risk behaviors and antibody hepatitis B and C prevalence among injecting drug users in south-western Sydney, Australia. J Gastroenterol Hepatol 2004; 19: 1114-1120.
  • 6. Marsh A, Loxley W, Hawks DV, Quigley A. Changes in drug use and HIV/AIDS risk-taking 1989–90. Drug Alcohol Rev 1995; 14: 201-212.
  • 7. Wodak A, Dolan K. Managing HIV. Part 8: Controlling an epidemic. 8.5 HIV prevention in the community: injecting drug users. Med J Aust 1996; 165: 266-267.
  • 8. Crofts N, Aitken CK, Kaldor JM. The force of numbers: why hepatitis C is spreading among Australian injecting drug users while HIV is not. Med J Aust 1999; 170: 220-221. <MJA full text>
  • 9. National Health and Medical Research Council Hepatitis B Working Party. Recommendations on hepatitis B immunisation. Canberra: AGPS, 1996.
  • 10. Australian National Council on AIDS, Hepatitis C and Related Diseases, Intergovernmental Committee on AIDS and Related Diseases. HIV testing policy. Canberra: Commonwealth of Australia, 1998. Available at: (accessed Apr 2006).
  • 11. Australian National Council on AIDS, Hepatitis C and Related Diseases. National hepatitis C testing policy. Canberra: Commonwealth of Australia, 2003. Available at: (accessed Apr 2006).
  • 12. Australian Government Department of Health and Ageing. National hepatitis C strategy 2005–2008. Canberra: Commonwealth of Australia, 2005. Available at: (accessed Apr 2006).
  • 13. National Health and Medical Research Council. The Australian immunisation handbook. 8th ed. Canberra: NHMRC, 2003. Available at: (accessed Apr 2006).
  • 14. Winstock AR, Sheridan J, Lovell S, et al. National survey of hepatitis testing and vaccination services provided by drug services in England and Wales. Eur J Clin Microbiol Infect Dis 2000; 19: 823-828.
  • 15. McGregor J, Marks PJ, Hayward A, et al. Factors influencing hepatitis B vaccine uptake in injecting drug users. J Public Health Med 2003; 25: 165-170.
  • 16. Kwiatkowski CF, Fortuin Corsi K, Booth RE. The association between knowledge of hepatitis C virus status and risk behaviors in injection drug users. Addiction 2002; 97: 1289-1294.
  • 17. Hopwood M. New treatment for hepatitis C infection. Social Research Briefs [National Centre in HIV Social Research] 2003; (3): 1-2. Available at: (accessed Apr 2006).
  • 18. Best D, Noble A, Finch E, et al. Accuracy of perceptions of hepatitis B and C status: cross sectional investigation of opiate addicts in treatment. BMJ 1999; 319: 290-291.
  • 19. Aitken CK, Kerger M, Crofts N. Peer-delivered hepatitis C testing and counselling: a means of improving the health of injecting drug users. Drug Alcohol Rev 2002; 21: 33-37.
  • 20. Hopwood M, Treloar C. Receiving a hepatitis C-positive diagnosis. Intern Med J 2004; 34: 526-531.
  • 21. Siggins Miller Consultants. Mapping national drug treatment capacity. ANCD research paper 10. Canberra: Australian National Council on Drugs, 2005. Available at: (accessed Apr 2006).


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