1. Hepatitis C and HIV Incidence Among Injecting Drug Users in Kabul, Afghanistan Catherine Todd, Abdul Nasir, M. Raza Stanekzai, M. Zafar Rasuli, Katja Fiekert, Mark Orr, Steffanie Strathdee, & David Vlahov

2. BACKGROUND & DESIGN Opiate production & use in Afghanistan at high levels with injecting use concentrated in urban areas. 1 Kabul has population of 4 million with estimated 1251 injecting drug users in 2006-2007. 2 Study was longitudinal cohort assessing trends in risk behaviors & HIV, syphilis, & hepatitis B & C infection over a 24 month period. Participants completed questionnaire at baseline, quarterly in 1 st year, & semi-annually in 2 nd year. Serologic testing performed with whole blood rapid testing & serum-based confirmatory tests at baseline & every 6 months. References: 1.UNODC. Drug Use in Afghanistan: 2009 Survey. Executive summary. UNODC, 2010, Vienna, Austria. 2.SAR AIDS Human Development Sector, South Asia Region, The World Bank. Mapping and Situation Assessment of Key Populations at High Risk of HIV in Three Cities of Afghanistan. Available at: http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/EXTSAREGTO PHEANUT/EXTSAREGTOPHIVAIDS/0,,contentMDK:21763929~pagePK:34004173~piPK:340 03707~theSitePK:496967,00.html

3. FEATURES/KEY EVENTS OF COHORT

4. INCIDENCE & RISK FACTORS - At 6 months, HIV acquisition associated with sharing syringes in last 6 months & duration of injecting; HCV seroconversion not associated with any variable. - At 12 months, HIV acquisition remained associated with duration of injecting & sharing syringe sharing. HCV acquisition was associated with age while younger age at initiation of injecting was protective.

5. LIMITATIONS 97 participants presented only at enrollment; those with no follow-up had lower HCV prevalence at baseline (18.8% vs. 40.4%, p<0.001) and were more likely to be new initiates (<1 year) of injecting drug use (29.7% vs. 17.2, p=0.04). Deaths likely under-reported as no official reporting system.

6. CLOSING THOUGHTS Two years ago the services were same but their services were very weak. Two years ago, you had wait for hours for one syringe. Now they expanded their services a lot and also have improved a lot. Now they have fixed times for distribution of syringes. The drug users can take syringes on time. They provide the service of taking a bath for drug users and also they give food for drug users. When they (drug users) leave, they are given one week supply of syringes which is 30 syringes. IDI 006 Yes, of course HR program has reduced risk. Before these programs, drug users shared syringes. Now everyone uses one syringe one time. Besides harm reduction programs help with the treatment of different diseases such as: HIV, Hepatitis, syphilis etc. IDI 209

7. ACKNOWLEDGEMENTS We wish to thank the Ministries of Public Health and Counter-Narcotics of the Islamic Republic of Afghanistan and our harm reduction partners, Medicins du Monde, Nejat Center, and OTCD, for their assistance; and, especially, our participants for their time and trust. This study was funded by the Doris Duke Charitable Foundation with confirmatory testing support provided by the U.S. Military HIV Research Program. CT also appreciates support from the Fogarty International Center of the National Institutes of Health (K01TW007408).