Objectives: To measure the prevalence of hepatitis C virus (HCV), HIV and sexually transmitted infections (STI) among injecting drug users (IDUs) in Rawalpindi and Abbottabad and to examine risk factors associated with HIV and HCV.
Methods: Two cross-sectional surveys were performed of community-recruited IDUs with collection of clinical specimens for testing of HCV, HIV and other STIs. Behavioural data were collected through interviewer-administered questionnaires. Characteristics and risk behaviours were compared across cities. Univariate and multivariate analyses explored risk factors associated with HIV and HCV.
Results: The prevalence of HIV was 2.6% (95% CI 0.83% to 4.5%) in Rawalpindi (n = 302) and zero in Abbottabad (n = 102). The prevalence of HCV was significantly higher in Rawalpindi at 17.3% (95% CI 13.0% to 21.6%) than in Abbottabad at 8% (95% CI 2.6% to 13.4%). The prevalence of other STIs was low in both cities, with <2% of participants having current gonorrhoea or Chlamydia and <3% with active syphilis. Injecting risk behaviours were greater in Rawalpindi. An increased risk of HCV was associated with using informal sources as a main source of new needles/syringes (OR 2.8, 95% CI 1.3 to 6.0) compared with pharmacies and a history of drug treatment (OR 3.7, 95% CI 0.9 to 11.6). Reporting symptoms of an STI was associated with decreased odds of HIV in Rawalpindi (OR 0.02, 95% CI 0.03 to 0.9).
Conclusions: The findings suggest recent transmission of HIV and HCV and point to the urgent need for the provision of clean needles/syringes to IDUs and a review of how needles/syringes are currently provided via healthcare establishments.
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Contributors: LP cleaned and coded all the datasets, interpreted the data and led the writing of the paper. PV contributed to the design of the survey and survey instruments and contributed to the writing. MC contributed to the design of the survey instrument and contributed to several drafts. SH contributed to the survey design and implementation of the project in Rawalpindi and Abbottabad. NL contributed to the design of the survey instrument, was responsible for project implementation in Pakistan and contributed to paper writing. SM contributed to the design of the survey instrument and to paper writing. RM was responsible for laboratory inputs. AA contributed to the development of the laboratory methods and the writing of the paper. SH, principal investigator, contributed to the design of the survey and survey instruments, coordinated survey implementation, interpreted data and is the lead author on the paper.
Funding: UK Department for International Development.
Competing interests: None.
Ethics approval: Ethical approval was obtained from the London School of Hygiene ethics board and from the Nai Zindagi Institutional Review Board.