Prevalence Rates Of HCV Research Articles

Modelling the Impact and Cost-effectiveness of Extended Hepatitis C Virus Screening and Treatment with Direct-acting Antivirals in a Swiss Custodial Setting.

Hepatitis C virus (HCV) among people living in detention (PLD) is typically high in many countries including Switzerland, where it is estimated that the HCV prevalence rate is between 5.7% and 6.2%. In Switzerland, the existing screening strategy involves routine screening of PLD who indicate they are from HCV high-risk populations based on questionnaire responses upon entry to the detention center, rather than an offer to screen all PLD. A cost-effectiveness analysis from a Swiss healthcare provider perspective was conducted by combining a 5-year decision tree screening model with results from a Markov model of HCV treatment outcomes. This model explored the cost-effectiveness of increased HCV screening to cover all PLD compared to the current approach, using a standard test package and subsequent treatment with a single-tablet regimen in Swiss custodial settings. Sensitivity and scenario analyses examined the uncertainty of results. At the willingness-to-pay threshold of 100 000 Swiss Francs (CHF) per quality-adjusted life-year (QALY), comprehensive general screening was cost-effective compared to current risk-based screening, with a base case incremental cost-effectiveness ratio of CHF 14 312 per QALY. The net monetary benefit of screening the whole PLD population was CHF 23 298 046 and CHF 4298 per person. The proportion of PLD tested was predicted to increase from 13.6% to 67.0% under comprehensive screening. The results showed that comprehensive screening strategies in detention centers in Switzerland can be cost-effective, with the probabilistic sensitivity analysis estimating an 82.3% probability of cost-effectiveness.

Thalassaemia in Iran: Thalassaemia prevention and blood adequacy for thalassaemia treatment

Thalassaemia major is a hereditary disease mostly prevalent in the region called ‘thalassaemia belt’. Iran is one of the countries situated in thalassaemia belt. Four per cent of Iranian population is the carriers of beta‐thalassaemia gene. So far 18 783 major thalassaemics have been registered in Iran, and this number is the highest registered figure for thalassaemia among the world countries. The thalassaemia prevention program has started since 1995 in Iran that has led to a significant decrease in newborn cases so that the downward rate of new thalassaemia births was estimated to be 82·3% in 2009; this is a considerable success among developing Islamic countries. Iran enjoys a national blood network that ensures blood adequacy for thalassaemics. All blood donations are donated by voluntary blood donors, and the rate of blood donations by regular voluntary blood donors reached 54·07% in 2016. In recent years, through the care provided and measures taken the prevalence rate of HCV and HIV has declined the lowest level and it makes blood safety in Iran abreast of that in developed countries. Given the success of thalassaemia prevention program in Iran and blood adequacy for thalassaemics, Iran can act as the role model for the countries located on thalassaemia belt particularly in the Middle East and the North Africa.

PREVALENCE OF HBV AND HCV; AND THEIR ASSOCIATED RISK FACTORS AMONG PUBLIC HEALTH CENTER CLEANERS AT SELECTED PUBLIC HEALTH CENTERS IN SANA'A CITY-YEMEN

Occupational exposure of public health center cleaners (PHCCs) to blood and body fluids after skin injury or mucous membrane contact constitutes a risk for transmission of blood-borne pathogens. In the industrialized world, occupational surveillance is performed to assess and monitor health hazards related to blood borne pathogens. In contrast, in developing countries as Yemen, exposure and health impacts are rarely monitored and much remains to be done to protect PHCCs. The objective of this study was to determine the prevalence of HBV and HCV and their potential risk factors among PHCCs. A cross sectional prospective study was conducted among 388 PHCCs. Data was collected using pre-tested and structured questions. Venous blood was collected and the sera were tested for HBV surface antigen and anti-hepatitis C antibodies using enzyme-linked immune sorbent assay technique. The data were analysis by EPI-Info. Chi square and Odds ratio tests were used to assess the association of risk factors with HBV and HCV positivity. Results revealed that among the total 388 PHCCs examined, HBV and HCV were detected in 32 (8.2%), and 4 (1.03%) of them respectively. There was significant risk factors of hepatitis viruses with age group 20-24 years (OR=2.8), exposure to patients blood (OR=3), accidental stick of used needles (OR=2.3), sharp injury (OR=5.6), history of blood transfusion (OR=2.5), and hospital admission (OR=2.7). Also significant protected roles for HBV vaccine was found with infection. In conclusion high prevalence rates of HBV and HCV occurred in PHCCs. Unfortunately; all workers did not take training on medical waste and few workers use protective measures consistently as vaccination. There is needed to make vaccination of health care workers against HBV infection a firm policy and ensure complete and consistent adherence to work standard safety measures.

Identifying Opportunity for Online Education to Address HIV/HCV Knowledge Gaps in Health Professionals and Students in Egypt

HCV prevalence rates in Egypt are high. While low, HIV prevalence rates may be underreported. Adequate solutions to address these public health challenges are lacking. Stigma, misperceptions, and lack of specialized skills to deal with infection are persistent impediments. To address these challenges, we propose a plan that incorporates the use of online education and hybrid formats to meet the needs in the field. Online education has been used with success elsewhere in the Mediterranean and Middle East. Given the difficult economic conditions in Egypt and physical challenges of traditional formats of education, we propose a plan, curricular elements, and education tracking process as a strategy to improve the knowledge capacity of health professionals and students.

Prevalence rates of HIV, HBsAg and HCV co-infections among tuberculosis patients in Sokoto Metropolis, Northwest Nigeria

Introduction and Objectives: Tuberculosis (TB) and viral hepatitis are global health problems which are common in developing and undeveloped countries. The current study was aimed at determining the prevalence and co-infections of HIV, HBsAg and HCV among patients with tuberculosis in Sokoto, Northwest Nigeria. Methods: A cross-sectional study was conducted on a total of 276 patients with tuberculosis, aged 19-60 years at Usmanu Danfodiyo University Teaching Hospital, Sokoto and Specialist Hospital, Sokoto between May and November 2015. Blood samples collected were screened for HIV, HBsAg and HCV using immunochromatographic techniques. Results: The prevalence rates of HIV, HBsAg and HCV among TB patients were 16.3%, 14.9% and 5.4%, respectively while the prevalence of co-infections HIV-HBsAg, HIV-HCV, HBsAg-HCV and HIV-HBsAg-HCV in TB patients were 50.7%, 1.81%, 2.9% and 1.45%, respectively. Prevalence of HIV and HCV showed no relationship with age (P=0.240 and 0.987, respectively) but prevalence of HBsAg was associated with age (P=0.0304). There were no relationships of frequencies of HIV, HBsAg and HCV with gender. Conclusion and Recommendations: The study showed high prevalence rates of HIV, HBsAg and HIV-HBsAg co-infections among patients with tuberculosis in Sokoto, while age and gender showed little or no association. HIV and HBsAg tests are recommended for every patient diagnosed with tuberculosis to guide therapeutic decisions.

Incidence of HCV infection amongst HIV positive men who had sex with men and prevalence data from patients followed at the Infectious Diseases Clinic of Modena, Italy

BackgroundMen who had sex with men (MSM) living with HIV are at higher risk of developing sexual transmitted diseases. This study reports two years incidence rate and prevalence of HCV in a cohort of HIV positive MSM. MethodsMSM HIV-positive outpatients negative to HCV-Ab at first observation entered a Kaplan–Meier model in order to assess the HCV infection incidence rate. Prevalence analysis was performed with MSM HIV-positive that were on follow-up at 2016. An MSM population HIV-negative served as control. Results421 patients entered the incidence analysis. The incidence rate of HCV infection among MSM-HIV people was 0.44 per 100 patients-years (19 events). 40 out of 442 (9%) patients were HCV-positive (prevalence analysis); they were mostly genotype 1a and 3 with APRI score <0.7 (87.5%). Univariate analysis between MSM HIV-positive patients and MSM HIV-negative showed significant differences in the prevalence rate (9.0% vs 0.6%, P < 0.001) and median age (39 vs 47, P < 0.001). ConclusionIncidence and prevalence rate of HCV amongst MSM HIV-positive patients is higher than in other settings. Annual HCV-Ab screening for MSM HIV-positive patients should be enforced and early treatment of HCV recommended.

Seroprevalence and diagnosis of HIV, HBV, HCV and syphilis infections among blood donors.

Blood transfusion is one of the most important therapeutic options of life-saving intervention for recipients who are in diseased or non-diseased conditions with severe blood loss. However, it is associated with certain risks which can lead to adverse consequences that may cause acute or delayed complications and bring the risk of transfusion-transmissible infections including HIV, Hepatitis B & C and Syphilis. So, there might be a fatal risk instead of life saving. This paper aims to provide a comprehensive and reliable tabulation of available data on seroprevalence and diagnosis of HIV, HBV, HCV and Syphilis infections among blood donors. We searched studies reporting the prevalence rate of HIV, HBV, HCV and Syphilis infections among blood donors that were published between October 2009 and June 2016, using databases of PubMed, Scopus, MEDLINE, Elsevier, ScienceDirect, EBSCO, Google Scholar, EMBASE, and Web of Science with keywords: ``Hepatitis C Virus'', ``Hepatitis B Virus'', ``HIV'', ``Syphilis'', ``Seroprevalence'', and ``blood donor''. The seroprevalence of HBV and HCV was highest in African countries as compared to others continents, predominantly the West African region with a range of 10.0% to 14.96% and 1.5% to 8.69%, respectively, while the overall seropositivity of HIV and syphilis infection show a significant declining pattern through successive years globally, even though relatively higher prevalence rate was observed among older age and those with low level of education. There is a problem during selection, diagnoses and screening process in developing nations primarily due to shortage of sensitive screening test kits, highly qualified human resource and lack of proper standard operating procedures and hence, the safety of blood and blood products are the primary threats in the region. Proper clinical diagnosis and screening method should be applied during blood donation and therefore, all the donated blood should be screened properly for transfusion-transmitted infections.

Prevalence of Transfusion Transmissible Infections in a Nigerian Tertiary Hospital

Millions of lives are saved each year through blood transfusion. Nevertheless, blood unscreened for transfusion transmissible infections (TTI) is a major public health problem. The prevalence of HIV, HBsAg, HCV and syphilis among blood donors reflect the status in the community hence the need for this study. A total of 108 donors comprising 11 family replacement donors, 32 voluntary donors and 65 paid donors were tested for antibodies to HIV, HBsAg, HCV and, syphilis using rapid serological screening methods. Among the 108 blood donors screened at the Madonna University Teaching Hospital (MUTH) Elele, the prevalence rates of HIV, HBsAg and HCV were 5.6%, 4.6% and 2.8%, respectively. All of the subjects tested negative to syphilis. The percentage positive based on the donor source was 4.6%, 4.6% and 0.9% for HIV, HBsAg and HCV, respectively among the paid donors, 1% for HIV among the voluntary donor and 1.9% for HCV among the family replacement donors. The prevalence rate for HIV and HBsAg co-infection was 0.9% as only one donor tested positive to both. Blood donors in MUTH Elele are relatively safe but efforts should be intensified in ensuring maximum safety. This can be achieved by screen

Viral Hepatitis among HIV+ Patients in Northern Vietnam

BackgroundLiver disease due to hepatitis B (HBV) and hepatitis C (HCV) is becoming the largest cause of death in HIV+ individuals worldwide. Compared with its neighbors, Vietnam has been identified as a country where coinfection with viral hepatitis among HIV+ persons is especially high, concentrated in people who inject drugs (PWID). The goal of this project was to identify the prevalence of and extent of clinical services offered for HCV and HBV among HIV+ patients at four medical facilities in northern Vietnam.MethodsWe conducted a retrospective chart review among HIV+ patients beginning ART between 2012 and 2015 at Bach Mai Hospital and the National Hospital for Tropical Diseases (NHTD) in Hanoi, and the Pho Yen and Thai Nguyen City Health Centers in Thai Nguyen Province. Collected data included demographics, history of injection drug use, and testing and treatment status for HBV and HCV. A missing test result counted as a negative result for calculation of prevalence.Results979 patient charts were examined (Bach Mai, n = 522; NHTD, n = 200; Pho Yen, n = 91; Thai Nguyen, n = 166). Across all four sites, prevalence of HCV coinfection ranged from 26% to 36%, HBV coinfection ranged from 5% to 7%, and HBV/HCV coinfection ranged from 2% to 8%. At Bach Mai and NHTD, PWID were ~50% of the HCV coinfected group and nearly 60% of the HCV/HBV dually coinfected group. As first line treatment for HBV was the same as ART, all patients with HBV were already being treated for it. HCV treatment was limited, with Bach Mai Hospital being the only site that had evidence of treatment. At Bach Mai, 3% of HIV patients coinfected with HCV only and 2% of HIV patients with both HCV/HBV received treatment for their HCV. Pegylated interferon+ribavirin was the only regimen used.ConclusionCompared with the general Vietnamese population, HCV was more prevalent among our sample of HIV+ individuals. As missing results were counted as negatives, it is likely that the true prevalence rates of both HCV and HBV are higher than reported. The lack of treatment for HCV among coinfected HIV+ individuals was concerning, particularly given the morbidity of HCV coinfection, and is an area for future intervention. Given the large percentage of HCV coinfected patients that were PWID, future efforts for the prevention and treatment of HCV should be focused in this community.Disclosures All authors: No reported disclosures.

Shewhart Charts and Two-Monthly Screening Interval to Monitor Hepatitis C and Hepatitis B Virus Infections in Two-Year Prospective Cohort Study of Hemodialysis Patients in Vietnam

Background : Early detection of an increase in the rate of hepatitis C (HCV) and hepatitis B (HBV) acquired during healthcare in hemodialysis setting allows rapid assessment and intervention to prevent subsequent sero-conversions. We retrospectively examined the application of the Shewhart chart to our two-year cohort study to early detect temporal change in HCV and HBV sero-conversions among hemodialysis patients in low-resourced setting provided that there was a known investigated outbreak of HCV occurring in this study period. We also reported our findings of the incidence density, prevalence, genotype and subtype of HCV and HBV infections and their associated risk factors. Methods : All 201 patients treated at the District-6 Hospital in Ho Chi Minh City, Vietnam participated in a prospective cohort study between 2012 and 2014. Patients consented to be tested for HBV surface antigen (HBsAg) and HCV core antigen (HCV-coreAg) and provided information on demographics, lifestyle risk factors and treatment related risk factors two-monthly through an administered questionnaire. Positive patients were tested for viral genotypes. Sero-conversions were plotted retrospectively on a P-control chart. Results : HCV and HBV prevalence rates were 12% (95%CI 8% – 18%) and 8% (95%CI 5% – 12%) respectively. HCV and HBV incidence density rates were 5 (95%CI 3-9) and 2 (95% CI 1-4) new cases per 1,000 person-months. These incidence and prevalence rates of HCV and HBV were not statistically different (P>0.05) except in follow-up months 13 and 14 when HCV outbreak occurred (P = 0.0008). An alarming increase in both HBV (months 11 and 12) and HCV (months 13 and 14) infection was demonstrated by Shewhart chart. Infection control lapses were identified as the cause of these increases. Among typable patients, 5 had HCV genotype 1b, 3 (genotype 1a) and 2 (genotype 6a). Two patients tested HBV genotype B. Conclusion : The applicable Shewhart control chart and two-monthly screening interval should be routinely utilized to detect potential HCV and HBV outbreak in low-resourced hemodialysis settings so that improvement interventions can be in place timely to prevent the spread of diseases. Strict adherence to infection control measures and routine infection control improvement strategies are vital in preventing these healthcare associated infections.

Epidemiology of hepatitis C virus in Ghana: a systematic review and meta-analysis.

BackgroundTo fully understand the burden of hepatitis C (HCV) infection in Ghana towards informing appropriate preventive measures, accurate prevalence estimates are needed. In this study, we estimate the prevalence of chronic HCV infection by systematically reviewing primary studies published between 1995 and 2015.MethodsA systematic review and meta-analysis was conducted as per the PRISMA guidelines. Comprehensive searches for hepatitis C prevalence studies for the years 1995–2015 were conducted in PubMed, ScienceDirect, Google Scholar, Africa Journals Online (AJOL) and the WHO African Index Medicus databases. We also searched the websites of the ministry of health and Ghana Health service for non-indexed studies or reports on the subject. Further systematic reference screening of published reviews and retrieved studies were also conducted to identify additional publications not captured through the online searches.ResultsTwenty-Four (24) studies from nine regions of Ghana with a combined sample size of 100,782 were analyzed. No study involving participants from Upper West region was retrieved. The national prevalence of chronic HCV was estimated as 3.0 % (95 % CI = 2.6 % to 3.5 %; I2 = 97.61 %, p < 0. 001). Prevalence rates of chronic HCV infection among blood donors was 2.6 % (95 % CI = 2.1 % to 3.1 %; I2 = 98.33 %, p < 0.001) with higher prevalence rate estimated for replacement blood donors (RBDs) than voluntary blood donors (RBDs). Among pregnant women and parturients, anti-HCV seroprevalence was estimated as 4.6 % (95 % CI = 1.8 % to 7.5 %; I2 = 75.74 %, p = 0.016). The national prevalence of HIV/HCV co-infection was also estimated as 2.8 % (95 % CI = 0.4-6 %; I2 = 65.86 %, p = 0.0053). Regional prevalence of chronic HCV infection were determined for Ashanti (1.5 %, 95 % CI = 1.2 % to 1.9 %; I2 = 96.24 %, p < 0.001) and Greater Accra (6.4 %, 95 % CI = 4.2 % to 8.6 %; I2 = I2 = 88.5 %, P < 0. 001) regions but no estimates were available for the other eight regions. The ascending order of HCV prevalence rates according to years in which studies were conducted was 2006–2010 < 2011–2015 < 1995–2002 < 2001–2005. Higher prevalence of chronic HCV infection was estimated for rural (5.7; 95 % CI 5.0–6.3 %; I2 = 0, p = 0.804) than urban (2.6 %, 95 % CI = 2.1 % to 3.0 %; I2 = 97.3 %, p = 0.0001) settings.ConclusionOur study demonstrates a high prevalence of chronic hepatitis C infection in Ghana. This highlights the urgent need for stronger commitments from government and all stakeholders within the country to outline efficient preventive and curative measures towards reducing the overall burden of the disease.

Implementation of rapid HIV and HCV testing within harm reduction programmes for people who inject drugs: a pilot study

ABSTRACTIncluding HCV and HIV rapid tests in harm reduction programmes (HRP) for people who inject drugs (PWID) can increase detection of these infections in high-risk populations who do not seek conventional health care. Aims: To assess acceptability and feasibility of rapid HIV and HCV tests in HRP; to identify HIV and HCV prevalence rates in HRP; to identify the percentage of PWID with a reactive test that attend hospital for confirmation and follow-up. Rapid oral tests for HCV and HIV were offered to users of 13 HRP from both mobile units and facility-based centres. A total of 172 HCV and 198 HIV tests were performed, with a refusal rate of 1.7% and 10.4%, respectively. Injectors made up 64.9% of all drug users and 35.1% did not inject drugs. Overall, 20.3% of HCV tests and 2.5% of HIV test were reactive. Only 24 of the 35 reactive HCV could be confirmed (68.6%) and one was false-negative. Of the five HIV reactive cases, only two could be confirmed (40%) with 1 false-positive case. Acceptability of rapid HIV and HCV tests among HRP users was high. The usefulness of oral rapid tests in HRP has been demonstrated, especially in mobile HRP.

Five years of experience with ID‐NAT at a tertiary care centre in North India: An interdictory step in preventing the transfusion‐transmitted Infections

IntroductionTechnological advancements in transfusion medicine have led to safer blood supply to the community like never before. However, blood safety is a daunting task in India with ~1.25 billion population and high prevalence rate of HIV (0.29%), HBV (2–8%) and HCV (2%) in donor population. This study aims at evaluating the impact of ID‐NAT as an add‐on test on safe blood supply in the current Indian scenario.Materials and MethodA retrospective observational study was conducted to analyse the data of 5 years of add‐on NAT at Main Blood Bank, AIIMS, New Delhi.Results1.84% (3556 of 193 167) units were initially NAT reactive. A total of 3495 units were further tested, of which 79.25% were discriminated (193 HIV, 421 HCV, 2060 HBV and 96 co‐infections). The remaining 13% (456) were repeat non‐reactive and 7.7% (269) could not be discriminated. Overall, NAT yield rate was one in 847, whereas virus‐specific NAT yield rates were one in 96 584, one in 2683, one in 1370 and one in 14 859 for HIV, HCV, HBV and HBV/HCV Co‐infections, respectively.ConclusionFive‐years of ID‐NAT screening interdicted 228 probable TTIs to 684 (assuming 100% component separation) transfusion recipients. Implementation of NAT along with routine serological tests for screening of the blood donations definitely improves the transfusion safety. However, interpretation of NAT reactive results should be adjudged cautiously keeping in mind, the chance occurrence of false‐positive reactivity.

A new decision model for economic evaluation of novel therapies for HCV

In 2014, the European Medicines Agency (EMA) has given the license to two new direct-acting antiviral: sofosbuvir and simeprevir. The evidence provided by the studies, reported a high rate of SVR even in patients with decompensated cirrhosis. This and other innovative elements are potentially adept at changing the entire natural course of HCV. However, the dramatic prevalence rates of HCV observed in Italy, and the high prices that are expected to be required by the pharmaceutical industry, raises some critical issues about how to regulate access to such drugs. The objective of this article is to present a new decision model for the evaluation of novel therapies for HCV. This model is intended to provide a tool for the decision-maker that seeks to address the main issues related to the introduction of HCV new treatments. The model that we have structured follows the classic Bayesian approach, using data from reference literature for staging the action of treatments depending on the level of fibrosis (F0, F1, F2, F3, F4). The model is designed to consider patients with all genotypes and allows to make comparisons between innovative and traditional therapies (dual, triple, IFN free, PI combinations, etc.), for both experienced and naïve patients. In addition, the model is used to simulate mixed cohorts of patients, representing a population with HCV with different levels of fibrosis and different genotypes. To show the potential of the model, we created some simple scenarios assuming different levels of SVR and pricing. The results of our model show that, even assuming an SVR rate of 100%, the administration of new treatments for HCV subjects F1 / 2 has an incremental cost-effectiveness ratio not sustainable. In contrast, for the subjects F3 and F4, low incremental SVR rates and an incremental cost of the innovative therapy of € 40,000 would be cost effective. The added value of this model is its versatility and applicability to diverse assessment needs. In addition, the model offers an opportunity for reflection even to the industry, which in the years to come will have to develop strategies for entering the market and offer sustainable prices for decision-makers and at the same time remunerate the investment in research and development consistently with the expectations of the shareholders.

Trends in Prevalence of Hepatitis B (HBV) and Hepatitis C (HCV) virus infection among blood donors in Apollo Hospital, Dhaka, Bangladesh, 2007-2011

Transfusion transmitted infection (TTIs) is still a concern associated with blood transfusion as hepatitis B and hepatitis C remains a major public health problem in a country like Bangladesh. The trends of the prevalence of HBsAg and HCV infection among the healthy blood donors even in a tertiary level hospital could be a guide for planning and implementing programs for preventive measures. All samples of a total 18,381 unit of blood were screened for hepatitis B surface antigen and anti-hepatitis C virus antibodies at Apollo Hospitals Dhaka over a period of 5 years (2007-2011). The prevalence of HBV and HCV infection was calculated by year to demonstrate the trends. The overall sero prevalence rate of HBV and HCV among all blood donors at Apollo Hospitals, Dhaka during 2007 to 2011 was 1.42% and 0.10% respectively. There was decreasing trend observed in sero prevalence of HBV (1.77% vs 1.64%) and HCV (0.13% vs 0.02%) over five years of time, although this change was not statistically significant (p=0.16 for HBV and p=0.20 for HCV). However, a significant decreasing trend was observed in the sero prevalence of HBV among blood donors aged 30 years and above, which was 1.04% in 2011 against 1.73% in 2007 (p=0.04). The decreasing trend in the prevalence of HBV and HCV infection might be the result of improvement in donor recruitment and selection, replacement donation exclusion in transfusion services, and possibly decreasing HBV infection prevalence in general population. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20330 Pulse Vol.6 January-December 2013 p.27-32

PTH-087 Perceptions Of Liver Disease Amongst The Nepali Community; Designing Effective Case-finding Strategies To Test Uk Migrant Groups For Hbv And Hcv

IntroductionIdentifying at-risk migrant groups for Hepatitis B and C (HBV and HCV) is well established. The UK Nepali community has grown rapidly since 2004, when settlement rights were given for...

HIV risks among injecting and non-injecting female partners of men who inject drugs in Almaty, Kazakhstan: Implications for HIV prevention, research, and policy

BackgroundKazakhstan and other countries in Central Asia are experiencing a rapidly growing HIV epidemic, which has historically been driven by injection drug use, but is more recently being fueled by heterosexual transmission. MethodsThis paper examines HIV and HCV infection, as well as sexual and drug-related risks among female partners of men who inject drugs (MWID), comparing females who inject drugs (FWID) to non-injecting female partners on socio-demographic, relationship context, and structural characteristics. ResultsThe prevalence rate of HIV was 30.1% among FWID and 10.4% among non-IDU female partners of MWID. The prevalence rate of HCV was 89.8% among FWID and 14.8% among female non-IDUs. Less than one-fifth of all female participants had access to HIV education and services or harm reduction programs. Although high rates of non-injection drug use and sexual risk behaviors were found among both FWID and non-injecting female partners of MWID, we found that FWID were more likely to be HIV seropositive (aRR=3.03; 95% CI=1.78, 5.18) and HCV seropositive than non-IDU females (aRR=6.05; 95% CI=4.05, 9.04), were more likely to have used alcohol or drugs before sex (aRR=1.67; 95% CI=1.40, 2.00), and were more likely to have used sedatives, barbiturates, tranquilizers, sleeping pills, or painkillers that were not prescribed by a physician (aRR=17.45; 95% CI=8.01, 38.01). ConclusionGiven the spread of the HIV epidemic to heterosexual partners in Kazakhstan, more attention is needed in research, prevention, and policies regarding female partners of male injection drug users.

Economic Recession and Emergence of an HIV-1 Outbreak among Drug Injectors in Athens Metropolitan Area: A Longitudinal Study

BackgroundDuring 2011, a dramatic increase (1600%) of reported HIV-1 infections among injecting drug users (IDUs) was noted in Athens, Greece. We herein assess the potential causal pathways associated with this outbreak.MethodsOur study employed high resolution HIV-1 phylogenetic and phylogeographic analyses. We examined also longitudinal data of ecological variables such as the annual growth of gross domestic product (GDP) of Greece in association with HIV-1 and HCV sentinel prevalence in IDUs, unemployment and homelessness rates and HIV transmission networks in Athens IDUs before and during economic recession (2008–2012).ResultsIDU isolates sampled in 2011 and 2012 suggested transmission networks in 94.6% and 92.7% of the cases in striking contrast with the sporadic networking (5%) during 1998–2009. The geographic origin of most HIV-1 isolates was consistent with the recently documented migratory waves in Greece. The decline in GDP was inversely correlated with annual prevalence rates of HIV and HCV and with unemployment and homelessness rates in IDUs (all p<0.001). The slope of anti-HCV prevalence in the sentinel populations of IDUs and in “new” drug injectors was found 120 and 1.9-fold (p = 0.007, p = 0.08 respectively) higher in 2008–2012 (economic recession) compared with 2002–2006. The median (25th, 75th) size of transmission networks were 34 (12, 58) and 2 (2, 2) (p = 0.057) in 2008–2012 and 1998–2007, respectively. The coverage of harm reduction services was low throughout the study period.ConclusionsScaling-up harm reduction services and addressing social and structural factors related to the current economic crisis should be urgently considered in environments where HIV-1 outbreaks may occur.

Psychiatric co-morbidity among subjects with heroin and cocaine use disorders and its association with HCV infection

Aim: This study aims to determine whether psychiatric co-morbidity is associated with HCV infection in a substance misuse population.Methods: We identified all subjects in the National Drug Treatment Monitoring System (NDTMS) during the period January 2007–December 2010 for whom information was recorded which identified their psychiatric co-morbidity status and their HCV status. Multivariate analysis was used to identify risk factors that could predict HCV infection.Results and conclusions: The HCV prevalence rate was 32%. HCV infected subjects were younger (21.4% versus 23.1%) when they first started to use drugs, they were more likely to be white (85.1% versus 13.1%) and male (74% versus 72.6%), to have urgent housing problems (13.0% versus 9.7%), to inject (42.8% versus 18.8%), and to share injecting paraphernalia (35.4% versus 9.2%). After adjusting for demographics and drug and alcohol use behaviours, the Odds Ratio of psychiatric co-morbidity for HCV infection was 1.33 (95% CI 1.01–1.75). The results suggest that psychiatric co-morbidity is associated of HCV infection.Clinical implications: It is important to take psychiatric co-morbidity into account when treating these patients and designing intervention strategies.

P3.123 Hepatitis C Testing and Incidence in HIV-Positive Men Who Have Sex with Men in Melbourne, Victoria. A Retrospective Cohort Study

BackgroundOver the past five years there have been increasing reports of HCV transmission in HIV-positive men who have sex with men (MSM) globally. It is unclear whether this increase is...