Hepatitis C and HIV co-infection among people who use drugs and other key populations in South Africa: findings from a seven-city cross-sectional survey

Author: Scheibe A, Young K, Moses L, Basson RL, Versfeld A, Spearman CW, Sonderup M, Rebe K, Prabdial-Sing N, Puren A, Nel D, Medeiros N, Hausler H

Theme: Epidemiology & Public Health Research Year: 2019

Background: Key populations (KP), including people who inject or use drugs (PWID/PWUD), men who
have sex with men (MSM) and sex workers (SWs) are at increased risk for HIV and hepatitis C (HCV)
infection. Few South African KP programmes include hepatitis services, largely due to data limitations.
We assessed HIV-HCV co-infection prevalence and risks among KP accessing HIV services across seven
Methods: We recruited 3 443 KP (941 PWID, 224 PWUD, 747 MSM and 1 531 SWs) in 2016/17. Our
cross-sectional survey assessed socio-demographic characteristics and risks using an interviewer
administered tool. We tested for HIV and HCV using rapid diagnostic tests. Associations with coinfection were identified through multivariate analyses.
Results: HCV prevalence was 15% (51% among PWID, 8% among PWUD, 3% among MSM and <1% among SWs). HIV prevalence was 37% (16% among PWID, 2% among PWUD, 25% among MSM and 57% among SWs). HCV-HIV co-infection was 4% (14% among PWID, 3% among PWUD and 1% among MSM). Among those co-infected (n=145), the median age was 29, most were male (85%), black African (62%), and 92% had injected in the previous month. Of the 134 who had injected in the last month, 72% used a new needle and 20% shared a needle at their last injection. 37% (54/145) reported sexual activity in the previous month, among whom 11% reported transactional sex. 48% (21/44) of PWID and 50% (1/2) of PWUD reported condom use during last sex. In multivariate analysis, HIV-HCV co-infection was positively associated with recent injecting (last month) (adjusted odds ratio (aOR) 63.1, 95% CI 18.0 – 220.9) and being black African (aOR) 2.3, 95% CI 1.2-2.8). Conclusions: PWID have higher risks of HCV-HIV co-infection than other KPs. PWID programmes should routinely offer HIV and HCV testing. Other KPs found to use drugs should be screened for HCV. Disclosure statement: This study was funded by the Bristol-Myers Squibb Foundation. Andrew Scheibe is a member of the Bristol-Myers Squibb Foundation Technical Assistance Programme. No other disclosures to note

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