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The Unlinked Anonymous Monitoring (UAM) Survey of People who Inject Drugs (PWID) is an annual cross sectional survey run by the UK Health Security Agency (UKHSA, formerly PHE) across England, Wales and Northern Ireland. The UAM Survey aims to monitor the prevalence of blood borne viruses (BBVs) such as hepatitis B, hepatitis C and HIV among individuals who have ever injected drugs recruited through drug and alcohol services. In addition to prevalence, the UAM Survey monitors risk and protective behaviours among this group such as sharing of injecting equipment, hepatitis B vaccine uptake, bacterial wound infections, and experience of overdose. The UAM Survey is world leading as it has been running for over 30 years, making it the oldest survey among PWID in the world.
Drug and alcohol services that support the UAM survey agree a target number of participants they will recruit over the period of a year. The UKHSA provides drug services with all the supplies needed to support the UAM Survey. If the drug and alcohol service returns 30 or more eligible samples within the survey year they receive a report containing analyses of the data for their service. It is important for participating drug and alcohol services to stay in touch with UAM Survey team throughout the year to review progress towards their sampling target.
To be eligible to participate an individual must have injected a psychoactive drug (previously or currently) and can only participate once in a calendar year. They self-complete a questionnaire and provide a dry blood spot (DBS) sample (gained by a finger prick device), these are then sent via post back to UKHSA for processing. Each service user is given a Love2Shop voucher in acknowledgement of their participation. As no personal identifiers are collected in the survey, participation is completely anonymous and service users do not get their results back. It is therefore best practice to offer to complete a diagnostic (in-house) BBV test alongside the UAM DBS sample, so service users can receive their results.
Service users in drug and alcohol services who have a history of injecting drug use or those who are currently injecting drugs are eligible to participate. An individual must only take part once in a calendar year.
The data collected from the UAM Survey of PWID is analysed nationally and locally to inform organisations of where there may be a higher prevalence of a BBVs, any trends in risk behaviours which may be present or where there may be gaps in service provision. The data from the UAM Survey is published each year in a set of annual data tables and in the Shooting Up report of infections and other injection-related harms among PWID. Data from the UAM is also used to develop services, clinical guidelines, educational campaigns, and health protection strategies.
Once the data tables are published it is good practice for the data to be analysed locally in conjunction with commissioners.
The UAM Survey of PWID Preliminary 2021 report can be found here: Unlinked Anonymous Monitoring (UAM) Survey of HIV and viral hepatitis among PWID: 2021 report; Preliminary data; HPR 15 (publishing.service.gov.uk))
The Shooting Up report of infections and other injection-related harms among PWID can be found here: https://www.gov.uk/government/publications/shooting-up-infections-among-people-who-inject-drugs-in-the-uk. The 2021 report will be published on February 8th.
As well as obtaining data which can build an understanding of national prevalence estimates and where resources may be required, the UAM Survey data can also be localised. A localised report can be highly beneficial for drug and alcohol services who are keen to address specific drug related harm in their area and with the planning of service delivery.
“Having the ability to offer a voucher to incentivise additional testing, as well as the really valuable information that we can get from the localised report, is vital for knowing where to focus our resources.”
The UAM Survey is anonymous, therefore, results do not get passed onto the service users who take part; however, drug and alcohol services can complete their usual BBV testing alongside the testing required for the UAM survey. Participation also gives the service user the opportunity to have a say in what affects them. The Love2Shop voucher for the UAM Survey can further incentivise in-service BBV testing and some services have reported an increase in testing as a result.
“When we started using the survey alongside our normal hepatitis c testing our testing rates increased by about 60%. The voucher really motivated some people to get tested.”
The reduced footfall in drug and alcohol services as a result of the COVID-19 pandemic negatively impacted the number of UAM surveys and samples received in 2020 and 2021. To help support the integrity of the data collected, the national report which follows, and the valuable information contained within it, services are being asked to participate. Increased participation from drug and alcohol services across England will give a better indication of BBV prevalence, what resources we may need to address the risks associated with injecting drug use and how we can better approach the elimination of hepatitis C.
The next UAM Survey runs from February 2022 to December 2022.
Training can be given to teams if they require it.
To arrange to participate or have an initial discussion about the UAM Survey you can either:
With special thanks to Claire Edmundson and Sara Croxford for their input.