High rates HCV, HIV, and associated risk behaviors among criminal legal system involved people who inject drugs in Kenya

Author: Matthew Akiyama, Lindsey Riback, Mercy Nyakowa, Chenshu Zhang, Sarah Masyuko, Rose Wafula, Nazila Ganatra

Theme: Epidemiology & Public Health Research Year: 2023

Background: Globally, criminal legal system (CLS)-involved individuals are disproportionately affected by HCV and HIV due to criminalization of substance use and limited access to testing, treatment, and harm reduction in prisons and the community. Our goal is to understand baseline HCV and HIV prevalence, and associated risk factors among CLS-involved people who inject drugs (PWID) in Kenya.

Methods: We are recruiting 3,500 PWID from needle and syringe programs sites in Kenya. Participants are recruited using respondent driven sampling, complete biobehavioral surveys, and receive HIV, HCV, and HBV testing. We conducted this analysis using chi-square tests for categorical variables and t-tests for continuous variables.

Results: Of the 1526 participants enrolled thus far, most are male (89.9%) with an average age of 34.4 years old (SD=±8.6). Nearly half of participants report ever been incarcerated (n=697, 45.7%) with an average of 2.6 (SD=±1.6) lifetime incarcerations and an average of 10.4 (SD=±14.4) lifetime months. One-fifth (21.2%) report ever using drugs while incarcerated, among whom 88.5% reported using drugs during their last incarceration. CLS-involvement was significantly associated with HCV (23.8% vs. 17.9%, p=0.004) and HIV prevalence (14.8% vs. 9.1%, p<0.001), respectively. CLS-involved PWID were more likely to report injection drug use (84.7% vs 73.3%, p<0.001) and inject more times on average (64.9 vs 48.7, p<0.001) in the last 30 days, and have injected for more years on average (7.0 vs 5.6, p<0.001). At their last injection, CLS-involved PWID were more likely to have used a needle previously used by someone else (15.1% vs 5.4%, p<0.001).

Conclusion: HCV and HIV prevalence are significantly higher among CLS-involved PWID in Kenya which may be attributed to higher risk behaviors in prisons and the community. Our findings highlight the need for increased testing, treatment, harm reduction among CLS-involved PWID both in prisons and after return to the community.

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