Prevalence Of Hepatitis C, B And HIV Among People Who Use Drugs In Three South African Cities

Author: Basson RL, Moses L, Scheibe A, Young K, Versfeld A, Booyens L, Spearman CW, Sonderup M, Rebe K, Prabdial-Singh N, Puren A, Nel D, Medeiros N, Schneider A,Andrews Y, Padayachee K, McBride A, Hausler H

Theme: Epidemiology & Public Health Research Year: 2018

Epidemiological data on HCV among injecting and non-injecting people who use drugs
(PWID and PWUD respectively) in South Africa is limited. Comprehensive HCV responses
are not widely available. We investigated the HBV, HCV and HIV prevalence among PWUD
and PWID who access HIV services in Cape Town, Durban and Pretoria.
We performed a cross-sectional study among people aged ≥18 years who self-reported
having used heroin, cocaine or methamphetamine in the last 12 months. We recruited 960
PWID and 240 non-injecting PWUD who accessed HIV prevention services between August
2016 and October 2017. We administered a standardized health assessment that enquired
about demographics and substance use, and performed point-of-care testing for HIV, HBV
and HCV.
Participants were predominantly male (87% for PWID, 81% for PWUD), African (42% for
PWID, 54% for PWUD) with a median age of 31 years. Overall HCV sero-prevalence was
54% among PWID (Pretoria (84%), Cape Town (42%), Durban (35%)) and 10% among
PWUD (Pretoria (20%), Cape Town (9%), Durban (1%)). HBV surface antigen prevalence
was 5% for PWID and 3% for PWUD (Pretoria 5 and 3%, Cape Town 6 and 4%, Durban 4
and 3%, respectively). HIV prevalence was 21% for PWID and 13% for PWUD (Pretoria 38
and 21%, Cape Town 6 and 3%, Durban 19 and 13%, respectively). HCV/HIV co-infection
was higher among PWID than PWUD (15% and 2%, respectively).
High HCV sero-prevalence among PWID supports the expansion of comprehensive HCV
responses including testing, treatment, and prevention activities like needle and syringe
programmes and opiate substitution therapy (OST). Higher than expected HCV seroprevalence among PWUD warrants further investigation and supports their inclusion in
appropriate services. The geographic distribution of HCV disease burden should inform
relative allocation of resources to treatment and prevention.
Disclosure of Interest Statement:
This study was made possible through funding from the Bristol-Myers Squibb Foundation.

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