Prevalence Of Blood-borne Viruses Research Articles

P-1321. The Infectious Disease Needs of Adult Ukrainian Refugees in a Tertiary Centre in the West of Ireland

Abstract Background Since February 2022 6.5 million have fled Ukraine; 104’ 870 to Ireland (2% of Irish population) [1, 2] The surge in those seeking temporary protection, coupled with infectious disease epidemiology in Ukraine; high prevalence of blood borne viruses and TB has placed strain on host countries' health services. [3, 4] 18 ‘840 (18% of National total, 0.37% of Irish population) are accommodated within our catchment area. The objective of this study was to evaluate case complexity, barriers to access and impact on service by this population. HIV, HCV and HBV prevalence, control and management Methods We performed a retrospective chart review using our electronic patient record, compiled data on a protected spreadsheet and results were collated. Tuberculosis prevalence, susceptibility, site and management Results 123 adult Ukrainian refugees have newly attended our service since February 2022 - April 2024, 2.03 new patients weekly; 63/123 (51.2%) are female. The mean age is 44.7 years (18 - 79). 76 (61.8%) have HIV (PLWH); 68 (89.5%) known diagnoses; 39 (57.3%) of whom were virally suppressed on ART and 27 (40%) were viraemic as a result of treatment interruption, 2 (2.9%) had no blood testing with us. 7 (5.7%) were newly diagnosed following arrival to Ireland; 4 (57%) with advanced disease (mean CD4 Count 285 IU/mL [28 - 753]). Thirty two (42%) PLWH are co-infected with HCV, 4 (5.3%) with HBV. 37 (30%) attended with HCV mono-infection, 9 (7.3%) with HBV mono-infection. 17 PLWH (22.4%) report previously treated TB. We have seen 4 (3.25%) cases of active TB; three of MDR pulmonary disease and results are pending for the fourth case. 4, 10.5% of women living with HIV in this cohort have had pregnancies; 2 (5.3% of WLH) are currently pregnant (both live in Donegal; average 165.6 miles from clinic). The average distance traveled to our clinic is 64.6 miles (Range 0.62 - 189); based on current geographic distribution of the group 50.4% (62/123) can access public transport that would allow them to reach our clinic within 2 hours. There was no significant association between access to public transport and missed clinic appointments (p = 0.64). 115/123 (93.5%) have a need for an interpreter. Since February 2022 26 (21%) have required hospital admission with an average length of stay of 22.9 days and a total of 597 bed days used. Conclusion We have identified significant case complexity and ongoing high ID service need for this cohort. Cohort Demographics Disclosures All Authors: No reported disclosures

Community prevalence of blood-borne viruses (hepatitis B and HIV) in Ireland.

Chronic infection with hepatitis B virus and HIV causes significant morbidity and mortality. Effective antiviral treatment is available for both. Ireland has historically been considered a low prevalence country. However, with increasing inward migration and diversity, this may be changing. The aim of this study was to measure the community prevalence of hepatitis B virus and HIV infections in Irish residents born between the years 1965 and 1985. Anonymised residual serum samples from blood tests ordered by community general practitioners and tested in eight general hospital laboratories, spread across Ireland, were analysed for the presence of Hepatitis B surface antigen and antibodies to HIV. A total of 6080 samples were analysed for hepatitis B surface antigen including 2993 males, 2807 females and 280 samples for which gender was not recorded. HBsAg was detected in 28/6067 samples giving an estimated prevalence of 0.46% (95% CI 0.32-0.67%). Antibodies to HIV were identified in 18/6064 giving an estimated prevalence of 0.33% (95% CI 0.19-0.47%). The prevalence of both hepatitis B and HIV was significantly higher in Cork (Southwest Ireland) than other centres: hepatitis B (12/1050 vs 16/5017, p = 0.014) and HIV (11/1049 vs 7/5015, p < 0.001). The prevalence of hepatitis B virus and HIV infections in this cohort appear to be higher than previously estimated. In addition, their prevalence in the Cork area appears particularly high. Whether this represents a true prevalence or a chance finding will require confirmatory studies.

Hematological Profile and Prevalence of Bloodborne Viruses Among Pregnant Women Attending Antenatal Clinic in a Tertiary Military Hospital in Lagos, Southwest of Nigeria

Pregnancy outcome is determined by a host of factors, including the mother's hematological profile and the concurrent presence of blood-borne viral infections. This study aimed to determine the hematological profile and prevalence of blood-borne viruses among pregnant women who attended our facility's outpatient obstetrics department over four years. This was a retrospective cohort study using data from the clinical records of 499 pregnant women who attended the antenatal clinic at the 68 Nigerian Army Reference Hospital, Yaba, Lagos, Nigeria, over a four-year period. Demographic information, full blood count parameters and results of screening for blood-borne viruses were collected into a predesigned proforma. The Hematological parameters and demographic variables were analyzed using SPSS version 29.0, values expressed in mean, frequency and percentages. Categorical variables were compared using chi-square test with statistical significance at p &lt; 0.05. The results were presented in tables, pie and bar charts using percentages and mean ± standard deviation. The mean age of the study participants was 36±2.3 years, with the blood group O being the most prevalent (49.7%). Hematocrit was lowest in the third trimester 31.21±4.1%, p&lt;0.001). Anemia was significantly associated with one parous experience (p=0.04), the presence of HIV infection (p=0.03) and the AS genotype (p=0.01). The prevalence of HIV infection (6.0%) was the highest of the three blood-borne viruses tested. The findings from this cohort study contribute more evidence toward the creation of standardized hematological reference values for pregnant women in Nigeria. Proper supplementation and implementation of routine screening for blood-borne viruses can lead to better pregnancy outcomes for Nigerian women.

Prevalence of blood-borne virus infections and uptake of hepatitis C testing and treatment in Australian prisons: the AusHep study

Incarcerated people are at high risk of blood-borne virus infections, particularly HCV, and a priority population for elimination efforts. This national bio-behavioural survey evaluated blood-borne virus prevalence and HCV testing-and-treatment uptake amongst people in Australian prisons. Randomly-selected participants from 23 representative prisons nationally were offered point-of-care testing for HIV and HCV (anti-HCV) antibodies, hepatitis B surface antigen (HBsAg), and HCV RNA (if anti-HCV positive). Demographic data and previous HCV testing and treatment were collected by structured interview. 1599 individuals participated (98% participation; 89%male; median age 35 years; 49% ever injected drugs). Prevalence estimates were: 31.7% (95% CI:28.8-34.8) for anti-HCV; 8.0%for HCV RNA (95% CI:6.4-9.9); 0.5% (95% CI:0.2-1.1) for HBsAg, and 0.8% (95% CI: 0.4-1.7) for HIV antibody. Among participants who had ever injected drugs (n=787), HCV RNA prevalence was highest among those injecting and sharing needles/syringes within the past month [27.9%; adjusted odds ratio (aOR):4.54 (95% CI:2.65-7.77). Among participants (n=1599), 70.4% (95% CI: 67.4-73.2) had ever been tested for HCV (62.6% in prison). The highest likelihood of having had HCV testing was observed among participants who injected drugs in the past month (aOR=10.37, 95% CI:5.72-0.18.78). Among those eligible (n=318), 84.6% (95% CI:79.2-88.7) had ever received HCV treatment (75.0% in prison), and 67.8% (95% CI:61.7-73.4) were cured. The likelihood of HCV treatment was higher among those previously imprisoned, (aOR=2.67, 95% CI:1.20-5.93). Despite high overall HCV testing and treatment uptake, the lower uptake and substantial ongoing HCV disease burden in some sub-populations highlights the need for continued prison-based elimination efforts with population-specific interventions. The AusHep study was funded by the Australian GovernmentDepartment of Health and Aged Care.

Testing for Hepatitis B and C virus and HIV in mental healthcare settings in England between 2015–2021

People living with severe mental illness have an increased prevalence of bloodborne viruses (BBVs) such as hepatitis B (HBV) and hepatitis C viruses (HCV), and HIV. To help improve the physical health of people living with severe mental illness, we aim to understand associations with BBV testing and treatment provision among those tested in mental healthcare settings in England. HBV surface antigen [HBsAg], antibody HCV [anti-HCV] and HIV testing and demographic information pertaining to people tested in mental health settings in England were extracted from a BBV testing dataset. Records pertaining to individuals diagnosed with HCV or HIV were linked to treatment datasets. Multivariable logistic regression analyses were used to understand demographic associations with test positivity for each BBV. Between 2015–2021, 18,221 people tested for a BBV in a mental health setting (56% male, 71% White ethnicity), 90% of whom were in inpatient care. Testing positive for HBsAg, anti-HCV and HIV was 1.1% (95%CI: 0.93–1.26%), 4.3% (4.00–4.63%) and 1.1% (0.92–1.25%) respectively. In multivariable analyses, women had reduced odds of testing positive for anti-HCV and HIV compared to men. Being of Asian, Black, or another ethnicity was associated with increased odds of testing HBsAg positive and Black ethnicity was associated with a positive HIV test result compared to White ethnicity. White ethnicity was associated with testing anti-HCV test positive compared to all other ethnicities. Half (344/708) of those who were anti-HCV positive would have benefitted from treatment (HCV-RNA positive), of which 58% received treatment. HIV treatment (96%) and viral suppression (94%) after testing in mental healthcare was high. To improve the physical health of people living with mental health conditions and to aid England’s hepatitis elimination and HIV transmission goals, opt-out testing for BBVs may be beneficial to reduce health inequalities among people experiencing mental illness.

Analysing HCV incidence trends in people who inject drugs using serial behavioural and seroprevalence data: A modelling study

IntroductionThe introduction of new direct-acting antivirals for hepatitis C virus (HCV) infection, has enabled the formulation of a HCV elimination strategy led by the World Health Organisation (WHO). Guidelines for elimination of HCV target a reduction in incidence, but this is difficult to measure and needs estimating. MethodsSerial cross-sectional bio-behavioural sero-surveys provide information on an individual's infection status and duration of exposure and how these change over time. These data can be used to estimate the rate of first infection through appropriate statistical models. This study utilised updated HCV seroprevalence information from the Unlinked Anonymous Monitoring survey, an annual survey of England, Wales and Northern Ireland monitoring the prevalence of blood borne viruses in people who inject drugs. Flexible parametric and semiparametric approaches, including fractional polynomials and splines, for estimating incidence rates by exposure time and survey year were implemented and compared. ResultsIncidence rates were shown to peak in those recently initiating injecting drug use at approximately 0.20 infections per person-year followed by a rapid reduction in the subsequent few years of injecting to approximately 0.05 infections per person-year. There was evidence of a rise in incidence rates for recent initiates between 2011 and 2020 from 0.17 infections per person-year (95 % CI, 0.16–0.19) to 0.26 infections per person-year (0.23–0.30). In those injecting for longer durations, incidence rates were stable over time. ConclusionsFractional polynomials provided an adequate fit with relatively few parameters, but splines may be preferable to ensure flexibility, in particular, to detect short-term changes in the rate of first infection over time that may be a result of treatment effects. Although chronic HCV prevalence has declined with treatment scale up over 2016–2020, there is no evidence yet of a corresponding fall in the rate of first infection. Seroprevalence and risk behaviour data can be used to estimate and monitor HCV incidence, providing insight into progress towards WHO defined elimination of HCV.

Adverse health outcomes among people who inject drugs who engaged in recent sex work: findings from a national survey

ObjectivesThis study explores trends in sex work among people who inject drugs (PWID) by gender and the relationship between sex work and adverse health outcomes including overdose, injection-site, and blood-borne virus (BBV) infections. Study designThe Unlinked Anonymous Monitoring Survey of PWID is an annual cross-sectional survey that monitors BBV prevalence and behaviours, including transactional sex, among PWID recruited through specialist services in England, Wales, and Northern Ireland. MethodsTrends in sex work among PWID (2011–2021) were described. Data were analysed to assess differences between PWID who engaged in sex work in the past year (sex workers [SWs]) and those who did not (non-SWs) by gender (Pearson Chi2 tests) (2018–2021). Associations between sex work in the past year and adverse health outcomes were investigated using logistic regression. ResultsBetween 2011 and 2021, sex work among PWID remained stable, with 31% of women and 6.3% of men who inject, reporting having ever engaged in sex work, and 14% of women and 2.2% of men engaging in sex work in the past year. Between 2018 and 2021, SWs had greater odds of reporting symptoms of an injection-site infection (adjusted odds ratio (aOR): 1.68 [95% confidence interval {CI}: 1.31–2.16], P < 0.001) and reporting overdose (aOR: 2.21 [CI: 1.74–2.80], P < 0.001) than non-SWs had in the past year. Among men, SWs had 243% greater odds of having HIV than non-SWs (aOR: 3.43 [CI: 1.03–11.33], P = 0.043). ConclusionsOur findings highlight disproportionate vulnerability and intersection of overlapping risk factors experienced by PWID SWs and a need for tailored interventions which are inclusive and low-threshold.

Prevalence of blood-borne viruses and hepatitis B vaccination status among haemodialysis patients in Central Australia

A cross-sectional study to determine the prevalence of blood-borne viruses and hepatitis B vaccination status in haemodialysis patients in Central Australia. Our study comprised 366 Aboriginal and 1 non-Indigenous Australian in Central Australia who had commenced haemodialysis between January 1996 and December 2019. Chronic hepatitis B infection was seen in 8.4% of patients, and serological evidence of human T-lymphotropic virus 1 in 28.3% of patients. The prevalence of HIV and hepatitis C was less than 1%. The vaccine status of all 182 patients who had received the hepatitis B vaccine was reviewed. Vaccine response was seen in 72.2% of patients who had received the vaccine at birth or in early childhood. There were 99 patients aged 20 years and older who had received hepatitis B vaccines before their haemodialysis commenced. Vaccine response was observed in 88.9% of these patients. A seroconversion rate of 78.5% was achieved in vaccine naïve patients who received the hepatitis B vaccine after their haemodialysis commenced. The response to the hepatitis B vaccine among haemodialysis patients in Central Australia was suboptimal and variable. The prevalence of chronic hepatitis B infection declined after the universal hepatitis B vaccination was introduced in 2000.

Prevalence of Blood-Borne Viruses and Predictors of Risk in Potential Organ Donors in Australia.

Internationally, the designation of a patient as an increased viral risk organ donor has been associated with lower utilisation rates. The actual prevalence of blood borne viruses in Australian potential organ donors, and the predictive performance of questionnaires administered to stratify this risk, remains unknown. We conducted a retrospective review of all patients who commenced workup for donation on the national database between 2014–2020. The prevalence of HIV, Active HBV and Active HCV in 3650 potential organ donors was 0.16%, 0.9%, and 2.2%, respectively. The behavioural risk profile was assessed in a subset of 3633 patients. Next-of-kin reported increased risk behaviours were associated with an increased prevalence of HCV but not of HIV or HBV (OR 13.8, p < 0.01, OR 0.3. p = 0.42, OR 1.5, p = 0.14). Furthermore, the majority of HIV and HBV infections occurred in potential donors without a disclosed history of increased risk behaviours. In this series, donors had a higher prevalence of HCV, and similar rates of HBV and HIV to the broader community. Behavioural transmission risks were poorly predictive of HIV and HBV. Rather than pre-transplantation behavioural risk screening, routine post-transplant recipient screening may provide a more powerful tool in mitigating the consequences of unexpected viral transmission.

Nucleic acid testing identifies high prevalence of blood borne viruses among approved blood donors in Mozambique.

BackgroundAlthough blood transfusion is an intervention that saves lives, it poses significant risks to the blood receivers, including the transmission of bloodborne pathogens. We aimed at determining the prevalence of Human Immunodeficiency Virus (HIV), Hepatitis B virus (HBV), and Hepatitis C virus (HCV) in candidates approved for blood donation, and in samples considered to be negative in reference blood banks in Mozambique.MethodsA cross-sectional study was performed between November 2014 and October 2015 in Maputo and Beira cities. Demographic information was obtained from all consenting blood donors using a structured questionnaire. Plasma samples were screened for HIVAb/Ag combinations, HBsAg and Anti-HCV. Blood donors considered to be negative by serological testing were re-tested in pools of six plasma samples using nucleic acid testing (NAT).ResultsMost blood donors were male 2,320 (83.4%) with an age range of 18 to 34 years. The overall seroprevalence of HIV, HBV and HCV infections among blood donors approved for donation was 4.6% (127; 95% CI 3.8–5.4), 4.5% (124; 95% CI 3.7–5.3) and 0.4% (11; 95% CI 0.2–0.7), respectively. The overall frequency by NAT of HIV RNA, HBV DNA, and HCV RNA in serologically negative blood donor samples was 2.6 per 1000 blood donors (7; 95% CI 1.1–5.4); 12.5 per 1000 blood donors (33; 95% CI 8.6–17.5) and 2.6 per 1000 blood donors (6; 95% CI 1.0–5.7), respectively.ConclusionOur results show high seroprevalence of HIV and HBV infections in blood donors approved for donation, and high frequency of molecular biomarkers of HIV, HBV, and HCV in blood considered to be safe. These results suggest the need for a new blood screening policy in Mozambique, including the use of NAT to detect infectious blood donations during the immunologically negative window.

\u201cI always prefer to withdraw than use a condom\u201d: contextualising condomless sex among East Asian and sub-Saharan African international students in Sydney

BackgroundIncidence and prevalence of blood-borne viruses and sexually transmissible infections among young people continue to necessitate population-based studies to understand how contextualised sexual health services can be developed and implemented to promote protective behaviours such as consistent condom use. This study examined condomless sexual practice among a sample of East Asian and sub-Saharan African international university students in Sydney, Australia.MethodsThis qualitative study was methodologically guided by interpretative phenomenological analysis. Data was provided by 20 international students sampled from five universities in Sydney, who participated in either face-to-face or telephone semi-structured in-depth interviews. The interview sessions were audio-recorded, transcribed verbatim, coded in NVivo and analysed using reflexive thematic analysis.ResultsCondomless sexual practices appear to be common among the study group based on participants’ self-reports of their own practices and the practices of friends and peers. Three themes contextualising condomless among the study participants were generated from the interview transcripts: (1) unanticipated sex, condom related stigma and alcohol use (2) pleasure-seeking, curiosity and intimacy (3) condomless sex as a gendered practice.ConclusionsThe result of this study has implications for public health research, practice and policy around design, implementation and evaluation of multi-layered and population-specific sexual health services that are tailored to addressing the needs of international students, who migrate from traditional sexual cultures to Australia, where sexual norms are more liberal.

Viral Coinfection among COVID-19 Patient Groups: An Update Systematic Review and Meta-Analysis.

Background Coinfections have a potential role in increased morbidity and mortality rates during pandemics. Our investigation is aimed at evaluating the viral coinfection prevalence in COVID-19 patients. Methods We systematically searched scientific databases, including Medline, Scopus, WOS, and Embase, from December 1, 2019, to December 30, 2020. Preprint servers such as medRxiv were also scanned to find other related preprint papers. All types of studies evaluating the viral coinfection prevalence in COVID-19 patients were considered. We applied the random effects model to pool all of the related studies. Results Thirty-three studies including 10484 patients were identified. The viral coinfection estimated pooled prevalence was 12.58%; 95% CI: 7.31 to 18.96). Blood viruses (pooled prevalence: 12.48%; 95% CI: 8.57 to 16.93) had the most frequent viral coinfection, and respiratory viruses (pooled prevalence: 4.32%; 95% CI: 2.78 to 6.15) had less frequent viral coinfection. The herpesvirus pooled prevalence was 11.71% (95% CI: 3.02 to 24.80). Also, the maximum and minimum of viral coinfection pooled prevalence were in AMRO and EMRO with 15.63% (95% CI: 3.78 to 33.31) and 7.05% (95% CI: 3.84 to 11.07), respectively. Conclusion The lowest rate of coinfection belonged to respiratory viruses. Blood-borne viruses had the highest coinfection rate. Our results provide important data about the prevalence of blood-borne viruses among COVID-19 patients which can be critical when it comes to their treatment procedure.

Could 30 years of political controversy on needle exchange programmes in Sweden contribute to scaling-up harm reduction services in the world?

Aims:To end the hepatitis and AIDS epidemics in the world by 2030, countries are encouraged to scale-up harm reduction services and target people who inject drugs (PWID). Blood-borne viruses (BBV) among PWID spread via unsterile injection equipment sharing and to combat this, many countries have introduced needle and syringe exchange programmes (NEP), though not without controversy. Sweden’s long, complicated harm reduction policy transition has been deviant compared to the Nordic countries. After launch in 1986, no NEP were started in Sweden for 23 years, the reasons for which are analysed in this study.Methods:Policy documents, grey literature and research mainly published in 2000–2017 were collected and analysed using a hierarchical framework, to understand how continuous build-up of evidence, decisions and key events, over time influenced NEP development.Results:Sweden’s first NEP opened in a repressive-control drug policy era with a drug-free society goal. Despite high prevalence of BBV among PWID with recurring outbreaks, growing research and key-actor support including a NEP law, no NEP were launched. Political disagreements, fluctuating actor-coalitions, questioning of research, and a municipality veto against NEP, played critical roles. With an individual-centred perspective being brought into the drug policy domain, the manifestation of a dual drug and health policy track, a revised NEP law in 2017 and removal of the veto, Sweden would see fast expansion of new NEP.Conclusions:Lessons from the Swedish case could provide valuable insight for countries about to scale-up harm reduction services including how to circumvent costly time- and resource-intensive obstacles and processes involving ideological and individual moral dimensions.

Prevalence of hepatitis B virus infection and its associated factors among 15,461 pregnant women in Yunnan province, China

PurposeChina has the world's largest burden of hepatitis B virus (HBV) infection. However, there are few studies reported on the latest prevalence of hepatitis B surface antigen (HBsAg) among pregnant women in China. We aimed to assess the prevalence of HBV infection and its associated risk factors among pregnant women in Yunnan, which is a province with relatively high prevalence of blood-borne viruses. MethodsWe conducted a cross-sectional study of 15,641 pregnant women who underwent routine antenatal screening for HBsAg in Yunnan between 2013 and 2016. Logistic regression analyses were used to examine the associations between HBV infection and risk factors. ResultsOverall, 7.89% (95% confidence interval (CI), 7.47%–8.31%) of the 15,641 pregnant women tested positive for HBsAg. Multivariable logistic regression analysis showed that advanced age (≥35 years old; adjusted odds ratio [aOR], 2.43–2.59), Hani ethnicity (aOR, 1.97; 95% CI, 1.22–3.17), unemployed women (aOR, 1.88; 95% CI, 1.30–2.72), multigravidas (aOR, 1.21; 95% CI, 1.05–1.40), and multiparas (aOR, 1.28; 95% CI, 1.10–1.49) were more likely to be infected with HBV. HBV infection was associated with cesarean section and preterm birth, with aORs of 1.31 (1.17–1.48) and 1.23 (1.00–1.51), respectively. In the subgroup analysis, the association between Hani ethnicity and HBV infection was significantly higher in women aged 35 years or older (aOR = 5.15; 95% CI, 1.51–17.55) than in women younger than 35 years of age (aOR = 1.69; 95% CI, 1.00–2.86). ConclusionsHBV infection among 15,641 pregnant women was of high-intermediate endemicity in Yunnan, China. Advanced age, Hani ethnicity, unemployment, and multigravid and multiparous statuses were associated with an increased prevalence of HBV infection. High-risk pregnant women should be paid more attention during routine antenatal examination.

Frequency of injecting among people who inject drugs: A systematic review and meta-analysis

BackgroundPeople who inject drugs (PWID) do so at varying frequencies. More frequent injecting is associated with skin and soft tissue infection, blood borne viruses, and overdose. The aims of this review are to estimate the prevalence of injecting frequency among PWID and compare these estimates to current needle–syringe distribution coverage estimates, and identify socio-demographic and risk characteristics, and harms associated with daily or more injecting. MethodsWe conducted a systematic review of the peer-reviewed and grey literature from 2008 to 2018 and extracted needle–syringe distribution coverage data from a recent systematic review. We generated country-, region-, and global-level estimates of daily or more injecting. We also ran meta-regression analyses to determine associations between daily or more injecting and socio-demographic characteristics, injecting risk behaviour, non-fatal overdose, injection site skin infection, and blood borne virus prevalence. ResultsOur search resulted in 61,077 sources, from which 198 studies were eligible for inclusion in this review. There were 74 countries with estimates for injecting frequency. Globally, we estimated that 68.1% (95%CI 64.5-71.6%) of PWID, equating to approximately 10.5 (95% UI 6.8–15.0) million people, inject daily or more frequently. There was a higher percentage of participants reporting daily or more injecting among samples with shorter injecting careers, more male participants and higher reporting of opioids as their main drug injected. Daily or more injecting was also associated with samples reporting a higher prevalence of HIV and hepatitis C antibody (anti-HCV), non-fatal overdose, and receptive needle sharing in the previous month. ImplicationsWHO recently recommended a needle–syringe distribution target of 300 needles per PWID per year which is unlikely to be sufficient for the majority of PWID injecting daily or more who are out of drug treatment. FundingThe Australian National Drug and Alcohol Research Centre, Australian National Health and Medical Research Council, University of New South Wales

First Report of Prevalence of Blood-Borne Viruses (HBV, HCV, HIV, HTLV-1 and Parvovirus B19) Among Hemophilia Patients in Afghanistan

Blood-borne viruses including Hepatitis B and C, HIV, HTLV-1 and parvovirus B19 are still a factor of concern, especially for hemophilia patients. Although the safety of the blood supply continues to improve worldwide, the blood supply system in Afghanistan was damaged by many years of conflict and political instability. To date, there are few studies focused on the prevalence of blood-borne viruses in hemophilia patients. This study is first to investigate the prevalence of five blood-borne viruses in Afghanistan hemophilia patients in four cities including Kabul, Herat, Mazar-i-Sharif and Jalal Abad. A total of 80 hemophilia male patients were screening for the presence of five transfusion-transmitted viruses using ELISA and PCR. Data obtained showed 2.5% seropositivity for HBV, 8.75% seropositivity for HCV, and 91.25% seropositivity for parvovirus B19. None of the patients were positive for HIV and HTLV-1 and the prevalence of HCV was higher in older patients rather than younger patients. This finding, the first to report in Afghanistan, shows a high prevalence of parvovirus B19 in Afghanistan hemophilia patients and implementation of highly sensitive screening is necessary.

Exploring HIV infection in a UK vulnerable prisoner population in response to newly identified cases.

Prison populations are considered at elevated risk of blood borne virus (BBV) transmission. Between December 2015 and February 2016, four new cases of HIV infection were diagnosed across two male vulnerable prisoner (VP) custodial units in Wales, UK. Cases were identified through routine BBV testing. The paper aims to discuss these issues. As a result of identifying four new HIV cases, targeted BBV testing across the VP units using dried blood spot testing for HIV, Hepatitis C (HCV) and Hepatitis B was undertaken. A total of 617 men were offered testing, 256 (41 per cent) were tested. No further cases of HIV were identified. Eight men were identified as HCV antibody positive. There was no evidence to suggest the four original cases of HIV were linked. Embedding universal BBV screening within prison health provision will ensure timely identification of cases. Further research is needed to better understand BBV transmission risks within subsets of the prison population such as the VP and sex offending groups. Little is known about the prevalence of BBVs in vulnerable prison populations. The findings add to the knowledge available for practitioners in the field.

A Global Meta-analysis of the Prevalence of HIV, Hepatitis C Virus, and Hepatitis B Virus Among People Who Inject Drugs-Do Gender-Based Differences Vary by Country-Level Indicators?

Women-specific factors exist that increases vulnerability to drug-related harms from injection drug use, including blood-borne viruses (BBVs), but gender-based differences in BBV prevalence have not been systematically examined. We conducted meta-analyses to estimate country, regional, and global prevalence of serologically confirmed human immunodeficiency virus (HIV), hepatitis C virus (HCV; based on detection of anti-HCV antibody), and hepatitis B virus (HBV; based on detection of HBV surface antigen) in people who inject drugs (PWID), by gender. Gender-based differences in the BBV prevalence (calculated as the risk among women relative to the risk among men) were regressed on country-level prevalence and inequality measures (Gender inequality index, Human development index, Gini coefficient, and high, low or middle income of the country). Gender-based differences varied by countries and regions. HIV prevalence was higher among women than men in sub-Saharan Africa (relative risk [RR], 2.8; 95% confidence interval [CI], 1.8-4.4) and South Asia (RR, 1.7; 95% CI, 1.1-2.7); anti-HCV was lower among women in the Middle East and North Africa (RR, 0.6; 95% CI, .5-.7) and East and Southeast Asia (RR, 0.8; 95% CI, .7-.9). Gender-based differences varied with country-levels of the BBV prevalence in the general population, human development, and income distribution. HIV was more prevalent in women who inject drugs as compared to their male counterparts in some countries, but there is variation between and within regions. In countries where women are at higher risks, there is a need to develop gender-sensitive harm-reduction services for the particularly marginalized population of women who inject drugs.

Hepcare europe: Hepcheck; reaching vulnerable populations

Introduction: HepCare Europe is a three year EU funded project involving collaboration with four member states. The vision for the project is to create an innovative, integrated system for Hepatitis C HCV testing & treatment among key ‘at-risk’ groups, including people who inject drugs PWID’s and the homeless, through outreach to the community and integration of primary and secondary care services. With clinical sites in Dublin, London, Seville and Bucharest, and economic evaluation in Bristol UK, the consortium has developed a number of work packages focused on operationalizing the multiple components of testing, care and cure that are key components of the strategy to eradicate HCV in the European Union. Consortium members include UCD Ireland SAS Spain SVB Romania University of Bristol UK and University College London UK Theory/Method: The HepCheck component of the project offered screening across the four clinical sites in Dublin, London, Seville and Bucharest. Point of care testing was offered to ‘at- risk’ groups who are frequently marginalized with respect to health service engagement. Screening was conducted in prisons, opioid substitution treatment clinics and in homeless services. Results: A total of 1,749 individuals were screened, 31.2 % n=559 tested HCV antibody positive. To date 40% n= 222 individuals have attended a specialist appointment for HCV treatment. In-depth analysis of the data is ongoing including identification of risk factors for HCV infection, levels of HCV related liver disease, prevalence of blood borne viruses and linkage to care. Discussion: In order to achieve World Health Organisation WHO HCV elimination targets by 2030 we need to identify and successfully treat the most vulnerable HCV individuals in the community. Conclusion: Community based screening intervention can enhance HCV diagnosis for at risk populations but referrals to/ attendance at secondary care remains a challenge for this cohort. Lessons Learned: The HepCheck data highlights the potential for developing interventions to enhance engagement with HCV screening and entry to the cascade of care required to cure HCV. Suggestions for future Research: Based on the findings of this study further research is required to develop community based interventions to ensure that the most vulnerable populations are engaged with the HCV care pathway and have the opportunity of treatment and cure.

Implementing routine blood-borne virus testing for HCV, HBV and HIV at a London Emergency Department - uncovering the iceberg?

UK guidelines recommend routine HIV testing in high prevalence emergency departments (ED) and targeted testing for HBV and HCV. The 'Going Viral' campaign implemented opt-out blood-borne virus (BBV) testing in adults in a high prevalence ED, to assess seroprevalence, uptake, linkage to care (LTC) rates and staff time taken to achieve LTC. Diagnosis status (new/known/unknown), current engagement in care, and severity of disease was established. LTC was defined as patient informed plus ⩾1 clinic visit. A total of 6211/24 981 ED attendees were tested (uptake 25%); 257 (4.1%) were BBV positive (15 co-infected), 84 (33%) required LTC. 100/147 (68%) HCV positives were viraemic; 44 (30%) required LTC (13 new, 16 disengaged). 26/54 (48%) HBV required LTC (seven new, 11 disengaged). 16/71 (23%) HIV required LTC (10 new, five disengaged). 26/84 (31%) patients requiring LTC had advanced disease (CD4 1, Fibroscan F3/F4 or liver cancer), including five with AIDS-defining conditions and three hepatocellular carcinomas. There were five BBV-related deaths. BBV prevalence was high (4.1%); most were HCV (2.4%). HIV patients were more successfully and quickly LTC than HBV or HCV patients. ED testing was valuable as one-third of those requiring LTC (new, disengaged or unknown status patients) had advanced disease.