Post on 29-Jan-2016
description
Hepatitis C and HIV/HCV Co-infection among Methadone
Clients in Dar es Salaam, Tanzania: Prevalence and
Predictors
Olivia Chang, MPHResearch and Program Manager
Pangaea Global AIDS
Presentation Outline
• Background• Methods• Results• Conclusions
Emergence of Injection Drug Use in East Africa
UNODC Data
Drivers of the Epidemic in Tanzania
• 30,000-50,000 PWID– 15,000-20,000 in Dar es Salaam
Reported Heroin Use in Tanzania
PWID General
HIV 35%-50% 6.9%
HCV 28%-76% 1.5%
Williams (2009) Nyandindi (2011), Lambdin (2013), Bowring (2013), Matee (2006), TACAIDS (2011), NACP (2014)
Prevalence Estimates (Dar)
Roll-out of Methadone in Dar es Salaam
* Community-based outreach begins (2010)
MNH Muhimbili National HospitalMRH Mwananyamala Regional HospitalTRH Temeke Regional Hospital
*
J an 2010 Aug 2014J an 2011 J an 2012 J an 2013 J an 2014
MNH TRH
1,100
MRH
1,600430
Methods: Prevalence and Predictors
• Study Design: Cross-sectional• Data Sources: Routine programmatic and
clinical monitoring data• Study Population: Clients enrolled in
methadone between February 2011 to January 2013 at Muhimbili National Hospital– Provider-initiated testing and counseling for HIV
and HCV is provided (rapid tests).
– Linkage to care and treatment for PLHIV; supportive care for PLHCV
Methods: Prevalence and Predictors
• Covariates: demographics, sexual risk factors, injection risk factors, mental health history, legal/criminal history and history of abuse
• Outcomes: 1) HCV+ and 2) HIV+/HCV+
• Prevalence Estimates: Percentages with 95% confidence intervals
• Statistical Analysis: Binomial regression to estimate adjusted risk ratios with 95% confidence intervals
Results
• Median Age (years) 33 (30,37)
• Female 7%
• Median Years of Heroin Use 10 (6, 15)
• Primary Education or Lower 67%
• Methadone clients enrolled: 629• Clients HCV-screened: 494 (79%)
Results
• Sexual Risk Behaviors (last 6 months)• Multiple Sex Partners 20%• No or Inconsistent Condom Use 40%
• Ever Practiced Flashblood* 7%• Share Needles and/or other
Equipment at Last Injection 17%
• Polysubstance Use (alcohol, cocaine, and/or benzodiazepine)
34%
• Injection-related Risk Behaviors
* Practice of injecting oneself with blood from another person who has recently injected heroin.
Results: Prevalence and Predictors of HCV
• HCV+: 57% (95% CI: 53%-61%)
Adjusted Risk Ratio (95% CI) p-value
Ever Practiced Flashblood 1.27 (1.13, 1.44) <0.001Share Needles and/or other Equipment at Last Injection
1.35 (1.17, 1.55) <0.001
Ever Been Arrested 1.21 (1.04, 1.41) <0.001
Adjusted Risk Ratios for HCV Seropositivity
Results: HIV/HCV Co-infection
Overall:
36% (95% CI: 31% – 40%)
Total HIV and HCV Screened: 413 (66%)
HIV+ HCV+
142 (34%)
24 (6%)
99(24%)
148(36% )
HIV- and HCV -
Results: HIV/HCV Co-infection
Overall:
36% (95% CI: 31% – 40%)
Among HIV+:
86% (95% CI: 81%-91%)
Total HIV and HCV Screened: 413 (66%)
HIV+ HCV+
142 (34%)
24 (6%)
99(24%)
148(36% )
HIV- and HCV -
86%
Results: Predictors of HIV/HCV Co-infection
Adjusted Risk Ratio (95% CI) p-value
Female 1.81 (1.60, 2.04) <0.001
Ever Practiced Flashblood 1.41 (1.25, 1.59) <0.001
Share Needles and/or other Equipment at Last Injection 1.36 (1.21, 1.53) <0.001
Adjusted Risk Ratios for HIV/HCV Co-infection
Results: Predictors of HIV/HCV Co-infection
Adjusted Risk Ratio (95% CI) p-value
Female 1.81 (1.60, 2.04) <0.001
Ever Practiced Flashblood 1.41 (1.25, 1.59) <0.001
Share Needles and/or other Equipment at Last Injection 1.36 (1.21, 1.53) <0.001
Adjusted Risk Ratios for HIV/HCV Co-infection
Conclusions
• Risky injection practices drive transmission.
• PWID, particularly women, have a disproportionate burden of disease and are also harder to reach.
• Current coverage is inadequate, scale-up of harm reduction is urgently needed.
How do we Respond?
How do we Respond?
Scale-up NSP and OST
Testing and counselingCondom distribution
IEC & BCC
Hep A/B immunization
HCV VL Monitoring
Care for PWID
Reach female PWID
How do we Respond?
Scale-up NSP and OST
Testing and counselingCondom distribution
IEC & BCC
Prevalence Estimates
Genotyping
Hep A/B immunization
HCV VL Monitoring
Simplify/optimize tx regimen
Research/ PolicyCare for PWID
Drug interaction studies
Affordable and equal access to tx
Reach female PWID
How do we Respond?
Scale-up NSP and OST
Testing and counselingCondom distribution
IEC & BCC
Prevalence Estimates
Genotyping
Hep A/B immunization
HCV VL Monitoring
Simplify/optimize tx regimen
Research/ PolicyCare for PWID
Drug interaction studies
Affordable and equal access to tx
Reach female PWID
Strengthen M&E systemsTrain Health Care Workers
Decentralize and Integrate ServicesAdvocacy
Systems
Acknowledgements