Abstract
BackgroundFew countries in sub-Saharan Africa know the magnitude of their HIV epidemic among people who inject drugs (PWID). This was the first study in Mozambique to measure prevalence of HIV, HBV, and HCV, and to assess demographic characteristics and risk behaviors in this key population.MethodsWe used respondent-driven sampling (RDS) to conduct a cross-sectional behavioral surveillance survey of PWID in two cities of Mozambique lasting six months. Participants were persons who had ever injected drugs without a prescription. Participants completed a behavioral questionnaire and provided blood specimens for HIV, hepatitis B surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) testing. We performed RDS-adjusted analysis in R 3.2 using RDSAT 7.1 weights.ResultsWe enrolled 353 PWID in Maputo and 139 in Nampula/Nacala; approximately 95% of participants were men. Disease prevalence in Maputo and Nampula/Nacala, respectively, was 50.1 and 19.9% for HIV, 32.1 and 36.4% for HBsAg positivity, and 44.6 and 7.0% for anti-HCV positivity. Additionally, 8% (Maputo) and 28.6% (Nampula/Nacala) of PWID reported having a genital sore or ulcer in the 12 months preceding the survey. Among PWID who injected drugs in the last month, 50.3% (Maputo) and 49.6% (Nampula/Nacala) shared a needle at least once that month. Condomless sex in the last 12 months was reported by 52.4% of PWID in Maputo and 29.1% in Nampula/Nacala. Among PWID, 31.6% (Maputo) and 41.0% (Nampula/Nacala) had never tested for HIV. In multivariable analysis, PWID who used heroin had 4.3 (Maputo; 95% confidence interval [CI]: 1.2, 18.2) and 2.3 (Nampula/Nacala; 95% CI: 1.2, 4.9) greater odds of having HIV.ConclusionUnsafe sexual behaviors and injection practices are frequent among PWID in Mozambique, and likely contribute to the disproportionate burden of disease we found. Intensified efforts in prevention, care, and treatment specific for PWID have the potential to limit disease transmission.
Highlights
Few countries in sub-Saharan Africa know the magnitude of their Human immunodeficiency virus (HIV) epidemic among people who inject drugs (PWID)
Formative assessment Prior to conducing the PWID biological and behavioral survey (BBS), we conducted formative assessments consisting of 7 focus groups and 22 key informant interviews with 86 participants in Maputo and Nampula/Nacala in July 2013 to identify the feasibility of using respondent-driven sampling for reaching PWID in the survey cities
In terms of study operation, formative assessment determined that incentives to help cover cost of transport and time would be helpful, fingerprick was preferable to venous blood draw, participants would be willing to test for HIV, Hepatitis B virus (HBV) and Hepatitis C virus (HCV) [21]
Summary
Few countries in sub-Saharan Africa know the magnitude of their HIV epidemic among people who inject drugs (PWID). This was the first study in Mozambique to measure prevalence of HIV, HBV, and HCV, and to assess demographic characteristics and risk behaviors in this key population. A systematic review determined that HIV prevalence among PWID in subSaharan Africa was 56% [3], but estimates in the region vary widely [3]. Few harm reduction programs and PWID-specific HIV prevention, care and treatment services are available in sub-Saharan Africa [8,9,10]. In Mozambique, publicly funded harm reduction and HIV care and treatment programs for PWID did not exist prior to this study
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