Injecting Risk Behaviors And HCV Genotypes Distribution Among People Who Inject Drugs Attending A Syringe Service Program In Tunis, Tunisia

Background: People who inject drugs (PWID) frequently engage in high risk behaviors exposing them to hepatitis C virus (HCV) infection. Research on HCV genotypes distribution among PWID is rare in the Middle East and North Africa region. This study investigates injecting risk behaviors and HCV genotypes distribution among PWID in Tunisia. Methods: A cross-sectional sample of 159 active PWID attending a syringe service program (SSP) in Tunis was selected from September 2017 through May 2018. All consenting participants completed a questionnaire-based interview followed with rapid anti-HCV test. HCV-RNA testing was performed for 62 PWID and HCV genotype was determined for 38 PWID. Results: Mean age was 40 years (IQR 33-53) and mean duration of injection drug use was 12,5 years (IQR 7–17). During the past 12 months, 47% reported receptive syringe sharing and 72% reported reusing syringes. The prevalence of HCV infection was 85%. PWID with longer duration of injection drug use (>5 years) were more likely to be HCV-infected (90% vs. 59%; p=0.0003). HCV-infected PWID were more likely to engage in receptive syringe sharing compared with uninfected PWID (51% vs. 21%; p=0.06). HCV-RNA testing was performed among 62 HCV-infected PWID (46%) and 52 PWID (84%) had a positive viral load. HCV-genotyping was performed among 38 PWID (73%). HCV genotype 1 occurred in 17 patients (45%), genotype 3 in 15 patients (39%) and genotype 4 in 6 patients (16%). For the HCV genotype 1, subtype 1a was predominant (16/17), followed by subtype 1b (1/17). Conclusions: Injecting risk behaviors are very frequent among HCV-infected PWID attending SSP in Tunisia. The distribution of HCV genotypes in this high risk group was distinct from the Tunisian general population. These results highlight the need for improved HCV prevention strategies and increased access to HCV treatment for PWID in Tunisia. Disclosure of interest: The authors declare that they have no competing interest.

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