Abstract
BackgroundPeople who inject drugs (PWID) are at high risk for hepatitis C (HCV), hepatitis B (HBV) and HIV without accessible harm reduction programmes. Coverage of needle and syringe and opioid substitution therapy (OST) services in South Africa is below global recommendations and no hepatitis services exist for PWID. We assessed HCV, HBV and HIV prevalence and risk factors among PWID accessing harm reduction services in Cape Town, Durban and Pretoria to inform policy and programming.MethodsWe conducted a cross-sectional survey among PWID in these cities between August 2016 and October 2017. Participants were opportunistically sampled while accessing services. Study team members administered a questionnaire that assessed sociodemographic characteristics, drug use and sexual risk practices. We tested for HCV (antibody, viral load and genotype), HBV surface antigen (HBsAg) and HIV. Bivariate and multivariate analyses assessed associations with HCV serostatus.ResultsNine hundred and forty-three PWID were included in the per protocol analysis. The majority (87%, 819/943) were male, the overall median age was 29 and most lived on the street (66%, 626/943). At last injection, 77% (722/943) reported using a new needle and syringe and 17% (163/943) shared equipment. HIV prevalence was 21% (196/926), HBsAg positivity 5% (47/936), HCV seroprevalence 55% (513/937), HCV viraemic prevalence (proportion tested with detectable HCV) 43% (404/937) and HCV viraemic rate (proportion HCV antibody positive with detectable HCV) 79% (404/513). HCV genotype 1a (73%, 270/368) was the most prevalent. In multivariate analysis, HCV infection was positively associated with residing in Pretoria (adjusted odds ratio (aOR) 1.27, 95% CI 1.21–1.34), living on the street (aOR 1.90, 95% CI 1.38–2.60), frequent injecting (aOR 1.58, 95% CI 1.15–2.16) and HIV infection (aOR 1.69, 95% CI 1.15–2.47), and negatively associated with black race (aOR 0.52, 95% CI 0.36–0.74) and sexual activity in the previous month (aOR 0.61, 95% CI 0.42–0.88).ConclusionsHCV and HIV are major health threats affecting PWID in these cities. Access to OST and needle and syringe services needs to be increased and integrated with HCV services. Social and structural factors affecting PWID who live on the street need to be addressed.
Highlights
People who inject drugs (PWID) are at high risk for hepatitis C (HCV), hepatitis B (HBV) and Human immunodeficiency virus (HIV) without accessible harm reduction programmes
In sub-Saharan Africa, approximately 60 million people are chronically infected with the hepatitis B virus (HBV) and 10.2 million people are chronically infected with hepatitis C virus (HCV) [1]
Demographic characteristics among PWID participants were similar across the three cities, apart from proportionately more people of mixed ancestry and fewer black participants in Cape Town than in the other sites, and a higher proportion of PWID living on the street in Durban (Table 1)
Summary
People who inject drugs (PWID) are at high risk for hepatitis C (HCV), hepatitis B (HBV) and HIV without accessible harm reduction programmes. Coverage of needle and syringe and opioid substitution therapy (OST) services in South Africa is below global recommendations and no hepatitis services exist for PWID. People who inject drugs (PWID) who cannot access harm reduction services, needle and syringe programmes and opioid substitution therapy (OST), are at high risk of HCV, HIV and if non-immune, for HBV infection [7, 8]. Many current PWID in South Africa were born before this vaccine was introduced and a pool of chronic HBV remains, with HCV and HIV providing the bulk of new blood borne infections among PWID [9]
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