COINFECTION WITH HIV AND HEPATITIS C VIRUS AMONG IDUS IN NORTH-EASTERN STATES OF INDIA Santosh Kumar Sharma International Institute for Population Sciences Mumbai

INTRODUCTION  Coinfection with HIV and hepatitis C virus (HCV) is a significant problem, especially among injection drug users (IDUs).  Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are the two pathogens most commonly transmitted by drug users through the multi-person use (“sharing”) of drug injection equipment.  Hepatitis C virus infection is less known to public health community than HIV in terms of health and social crisis, but it is also concern. HCV is transmitted by exposure to infected blood, and it is predominantly found in IDUs.

Cont.…  Several studies have documented high prevalence of infection with hepatitis C virus among injecting drug users, both in industrialised and developing countries.  Moreover, co-infection with HCV and HIV is not uncommon and has become a global public health problem, causing an increased rate of progression to cirrhosis, decompensated liver disease, hepatocellular carcinoma, and death  Global estimates indicate that there are 15.9 million (range million) people who inject drugs (PWID) across 151 countries

Cont…  In Southeast Asia, 70% to 86% of IDUs in the Philippines, southern China and Thailand were infected with HCV.  In India the prevalence of hepatitis C infection was very high in Manipur (56% in Bishnupur and 78% in Churachandpur), but lower in Nagaland (5.4% in Phek and 16.7% in Wokha).  India is estimated to have 168, million IDUs with HCV antibody prevalence ranging from 5 to 93 per cent among HIV+ IDUs.

 To understand the risk factor associated with Co-infection with HIV and Hepatitis C Virus among Injecting drug users of North-East States of India OBJECTIVES

 A cross sectional bio-behavioural survey, Integrated Behavioural and Biological Assessment round 2 (IBBA) 2010 data has been used to study the risk factor for coinfection with HIV and HCV.  IBBA round 2survey collect the information among Injecting drug users from Maharashtra (Mumbai/Thane combined) and the north-Eastern states (Churachandpur & Bishnupur from Manipur and Phek & Wokha from Nagaland). METHODS AND MATERIALS

Integrated Behavioral and Biological Assessment: A Sexually Transmitted and Blood-borne Infection Prevalence Assessment in High Risk Populations in India  IBBA Round 2( ) The sample size for Injecting drug users was 1650 and respondent driven sampling was the method used to sample eligible respondents  IBBA populations Female Sex Workers Brothel Based (FSW-­ ‐ BB) Female Sex Workers Non-­ ‐ Brothel Based (FSW-­ ‐ NBB) Male Who Have Sex With Men (MSM)/Male Sex Workers (MSW) Male clients of Female Sex Workers Male Injecting Drug Users (IDU) Truckers Drivers and helper (TD/H) Female Sex Workers Highway-­ ‐ Based (FSW-­ ‐ HB)  National Highway Truckers Drivers and helper (TD/H) Female Sex Workers Highway-­ ‐ Based (FSW-­ ‐ HB)

In this study only IDUs of North-East states of Manipur and Nagaland has taken. IDUs were selected on the criteria of those who were 18 years or older, who injected addictive substances/drugs for non-medical purposes at least once in past six month A sample size of 400 was estimated for each survey district. The sample size for Injecting drug users for North-Eastern sates was As a result of the clandestine nature of IDU, respondent driven sampling (RDS), a social network-based sampling technique was used. Chi square statistics and to identify the factor associated with coinfection with HIV and HCV Binary logistics regression was used to estimate odds ratios.

RESULTS AND DISCUSSION  The prevalence of co-infection with HIV and HCV was found 15 percent of Injecting drug users.  HCV was present in 93% of HIV positive and 34.4% of HIV negative IDUs.  The prevalence of HIV in HCV positive and in HCV negative was 34.3% and 1.7% respectively  Overall HIV prevalence among Injecting drug users in North-eastern states of India is 16 percent and HCV prevalence is 44 %.

Prevalence of coinfection with HIV and HCV by their background Characteristics

Prevalence of co-infection with HIV and Hepatitis C virus by their Injecting behaviour

Prevalence of co-infection with HIV and Hepatitis C virus by their Injecting sharing behaviour

Factor associated with coinfection with HIV and Hepatitis C virus  Older IDUs, 6-10 years of schooling and divorced/separated/widowed are 14 times, 2.9 times and 3.6 times more likely to have co-infected with HIV and HCV respectively  IDUs started drug use at the age of 26 and above are 2.28 times more likely to have co-infected with HIV and HCV  One important finding of the study is those IDUs started first injecting drug after 6 and above years of first drug use, are approximately 4 times more likely to have Co- infection with HIV and HCV

Cont.…..  IDUs, co-infected with HIV and HCV are 1.7 times more likely among those IDUs who draw up drug solutions from a common container.  The behaviour of Cleaning needle/syringes by IDUs are also 3 times more probable to co-infected with HIV and HCV.

Summery of findings and Conclusions  The prevalence of Hepatitis C Virus is very high among HIV seropositive Injecting drug users  Older IDUs and having less year of schooling are significantly higher prevalence of coinfection with HIV and HCV  One important finding is that widowed/divorced/separated IDUs are more likely to co-infected with HIV and HCV  It was also found that those IDUs started drug use at the age of 26 and above and longer duration between first drug use to first injecting drugs are more probable to have co-infected with HIV and HCV.

Cont.….  IDUs, co-infected with HIV and HCV are more likely among those IDUs who draw up drug solutions from a common container.  The behaviour of Cleaning needle/syringes by IDUs are also 3 times more probable to co-infected with HIV and HCV.

 The study emphasize that there should be a preventive strategies to control the coinfection with HIV and hepatitis C infection among IDUs.  Services for drug users need to be improved and increased, guided by harm reduction principles. Hepatitis C prevention and access to hepatitis C treatment is urgent.