Abstract
BackgroundThere is scare information about HIV co-infections with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) among People Who Inject Drugs (PWID) in Mozambique. This information is critical to ensure the treatment necessary to decrease the progression of liver disease and the transmission of both HIV and hepatitis. We assess the prevalence of HIV, HBV and HCV co-infections as well as associated risk factors among PWID.MethodsThe first Bio-Behavioral Surveillance Survey was conducted in 2013–2014 among persons who self-reported to have ever injected drugs. Using respondent-driven sampling, PWID aged 18 years and older were recruited in two cross-sectional samples in Maputo and Nampula/Nacala, two large urban centers of Mozambique. Rapid screening of HIV, HBV (HBsAg) and HCV was performed on site. Data from participants in both cities were pooled to conduct RDS-weighted bivariate analyses with HIV/HBV and HIV/HCV co-infections as separate outcomes. Unweighted bivariate and multivariate logistic regression analyses were conducted to assess correlates of co-infection.ResultsAmong 492 eligible PWID, 93.3% were male and median age was 32 years [IQR: 27–36]. HIV, HBV and HCV prevalence were respectively 44.9% (95% CI:37.6–52.3), 32.8% (95% CI:26.3–39.5) and 38.3 (95% CI:30.6–45.9). Co-infections of HIV/HBV, HIV/HCV and HIV/HBV/HCV were identified in 13.1% (95% CI:7.2–18.9), 29.5% (95% CI:22.2–36.8) and 9.2% (95% CI:3.7–14.7) of PWID, respectively. Older age, history of needle/syringe sharing and history of injection with used needle/syringe was associated with HIV/HBV co-infection. Living in Maputo city, have older age, history of needle/syringe sharing and history of injection with used needle/syringe was associated with HIV/HCV co-infection.ConclusionThere is a high burden of HBV and HCV among HIV-infected PWID in Mozambique. Our results highlight the need for targeted harm reduction interventions that include needle exchange programs and integrated services for the diagnosis and treatment of HIV, HBV and HCV to address these epidemics among PWID. Efforts should be made to strengthen ART coverage in the population as an important treatment strategy for both viruses.
Highlights
There is scare information about Human immunodeficiency virus (HIV) co-infections with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) among People Who Inject Drugs (PWID) in Mozambique
About half the participants (50.9, 95% confidence intervals (CI): 45.8–55.9) reported initiation of injection drug use when they were between the ages of 18–24 years and reported daily drug injection during the past year (51.9, 95%CI: 45.4–58.4)
Our data indicates that approximately one-third of PWID participants have serological evidence of HIV (44.9%), HBV (32.8%) or HCV (38.3%), which is substantially higher than prevalence rates estimated for PWID reported from sub-Saharan African region for the three infections at 18.3, 3.7, 21.8%, respectively [1]
Summary
There is scare information about HIV co-infections with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) among People Who Inject Drugs (PWID) in Mozambique This information is critical to ensure the treatment necessary to decrease the progression of liver disease and the transmission of both HIV and hepatitis. The 3rd National HIV Strategic Plan recognized PWID as a key population in 2010, there has been a lack of information about the population size, HIV prevalence and their utilization of health services [5]. To address this gap, the first Bio-Behavioral Surveillance (BBS) survey among PWID was conducted in two main urban cities between 2013 and 2014, using respondent-driven sampling (RDS). This study estimated HIV prevalence at 50.1% in Maputo (95% CI: 40.1–59.0) and 19.9% in Nampula/Nacala (95% CI: 10.9–29.2), where the greater burden of HIV observed in the southern region is consistent with the dynamics of the HIV epidemic in the country [6, 7],
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