1. High HIV, HBV and HCV Prevalence among People Who Inject Drugs: Results from the First Integrated Bio-behavioral Survey of PWID in Mozambique Authors: Cynthia SEMÁ-BALTAZAR 3, Isabel SATHANE 5, Makini BOOTHE 2, Liliana DENGO-BALOI 3, Helena RICARDO 3, Denise LANGA 3, Jennifer PEREGOY 4, Heidi FRANK 2, Lídia GOUVEIA 1, Roberta HORTH 2

2. Introduction Literature review shows that certain groups enganging in higher risk behavior, such as people who inject drugs (PWID), may have higher rates of infection than the general population. National Strategic Response Plan to HIV and AIDS in Mozambique (PEN III 2010- 2015) recognizes the need for further evidence regarding PWID as a high risk population for HIV in Mozambique. In 2014, Mozambique carried out the first Integrated Biological Behavioral Survey (IBBS) among PWID with the following main objectives: Estimate prevalences of HIV, HBV and HCV and Identify associated risk factors among PWID in Maputo and Nampula Estimate the population size of PWID in maputo and Nampula Assess use and access to drug dependency health and care programs in Maputo and Nampula

3. MOZAMBIQUE High burden of HIV - prevalence 11.5% (INSIDA 2009) Malaria ~ 40% children (DHS, 2011) Under nutrition (50% 6-59 mo Age) Malaria, HIV, Diarrhea and Respiratory Infection leading causes of child deaths Maternal Mortality ~400/100.000 LB Increasing Burden of Trauma: *traffic and violence* and Chronic disease Hypertension -30% (STEPS 2009) Cyclic Epidemics: e.g. Cholera

4. Methodology Survey sites: Maputo and Nampula Eligibility criteria a.Age ≥ 18 years b.Lived, worked or socialized in the survey area in the last 12 months c.Ever injected drugs at any point in their lives d.In a possession of a valid coupon e.Abiity and willingness to provide written informed consent to participate

5. Methodology Recruitment methodology Respondent-Driven Sampling (“RDS”) Behavioral data collection Pre and post test counselling for: HIV HBV (HBsAg) HCV (anti-HCV) Collection of dried blood spot (DBS) sample for central laboratorial testing

6. Recruitment Duration: October 2013 to March 2014 Sample: 353 in Maputo 139 in Nampula/Nacala

7. Results: Sex and Age The majority of PWID are men: Maputo=92.9% Nampula/Nacala=97.0% As per age group, PWID are young: Maputo=22 [19-56] Nampula/Nacala=28 [18-60])

8. Results: Contact with peer educators or HIV/AIDS activists <12 months

9. Results: Free condoms <12 months

10. Results: Previous HIV testing

11. Results: Participants who injected drugs in the last 30 days

12. Results: Needle sharing in the month preceding the survey

13. Results: Number of female sexual partners among man who inject drugs in the 12 months preceding the survey

14. Results: Use of condoms at the last sexual intercourse among PWID who had sex in the last 12 months preceding the survey

15. Results: Demand for services and difficulty in obtaining services in the last 12 months preceding the survey

16. Results: Treatment seeking behavior among PWID with STI symptoms in the 12 months preceding the survey

17. Results: HIV Prevalence

18. Results: HIV prevalence among PWID by age group

19. Results: Prevalence of HIV, HBV and HCV or any coinfeccion among PWID

20. Results: Proportion of HIV-positive PWID who are aware of own HIV status

21. Results: Testing, care and treatment Cascade among HIV-positive participants

22. Conclusions Main Findings: High burden of disease A diverse, extensive and highly-discriminated population With high level of risk behaviors With limited access to healthcare and prevention services

23. Recommendations Interventions focused on Damage reduction and provision of healthcare services: Harm reduction interventions focused on policies, programs and interventions HIV preventions and treatment activities targeting PWID the need to implement Hepatitis B vaccination campaigns for this population Healthcare services with the same level of attention of that of general population Continuous surveillance of epidemiologic data

24. Aknowledgment & Warning Aknowledgement: The authors would like to thank the contribution of every institution involved in the preparation and execution of these activity, the participants of the survey, field workers, provincial health directorates of Maputo and Nampula, members of IBBS technical group, for it’s valuable contributions and this surveys success. Warning: This presentation shows survey results funded by the Presidents Emergency Plan for AIDS Relief (PEPFAR), through Health and Human Services Department and Center for Disease Prevention and Control (CDC) representation in Mozambique, under cooperation agreement # U2GPS001468. Opinions expressed in this presentation doesn’t reflect necessarly opinions from CDC and USA government.

25. PARTNERS

26. OBRIGADA! KANIMAMBO! THANK YOU!