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Olivia Chang, MPH Research and Program Manager Pangaea Global AIDS

Hepatitis C and HIV/HCV Co-infection among Methadone Clients in Dar es Salaam, Tanzania: Prevalence and Predictors. Olivia Chang, MPH Research and Program Manager Pangaea Global AIDS. Presentation Outline. Background Methods Results Conclusions.

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Olivia Chang, MPH Research and Program Manager Pangaea Global AIDS

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  1. Hepatitis C and HIV/HCV Co-infection among Methadone Clients in Dar es Salaam, Tanzania: Prevalence and Predictors Olivia Chang, MPH Research and Program Manager Pangaea Global AIDS

  2. Presentation Outline • Background • Methods • Results • Conclusions

  3. Emergence of Injection Drug Use in East Africa UNODC Data

  4. Drivers of the Epidemic in Tanzania • 30,000-50,000 PWID • 15,000-20,000 in Dar es Salaam Prevalence Estimates (Dar) Reported Heroin Use in Tanzania Williams (2009) Nyandindi (2011), Lambdin (2013), Bowring (2013), Matee (2006), TACAIDS (2011), NACP (2014)

  5. Roll-out of Methadone in Dar es Salaam * * Community-based outreach begins (2010) MNH Muhimbili National Hospital MRH Mwananyamala Regional Hospital TRH Temeke Regional Hospital

  6. 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

  7. 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

  8. Results • Methadone clients enrolled: 629 • Clients HCV-screened: 494 (79%)

  9. Results • Sexual Risk Behaviors (last 6 months) • Injection-related Risk Behaviors * Practice of injecting oneself with blood from another person who has recently injected heroin.

  10. Results: Prevalence and Predictors of HCV • HCV+: 57% (95% CI: 53%-61%) Adjusted Risk Ratios for HCV Seropositivity

  11. Results: HIV/HCV Co-infection Overall: 36% (95% CI: 31% – 40%) Total HIV and HCV Screened: 413 (66%)

  12. 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%)

  13. Results: Predictors of HIV/HCV Co-infection Adjusted Risk Ratios for HIV/HCV Co-infection

  14. Results: Predictors of HIV/HCV Co-infection Adjusted Risk Ratios for HIV/HCV Co-infection

  15. 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.

  16. How do we Respond?

  17. How do we Respond? Care for PWID HCV VL Monitoring Hep A/B immunization Reach female PWID Scale-up NSP and OST Testing and counseling Condom distribution IEC & BCC

  18. How do we Respond? Care for PWID Research/ Policy Affordable and equal access to tx HCV VL Monitoring Hep A/B immunization Simplify/optimize tx regimen Drug interaction studies Reach female PWID Scale-up NSP and OST Testing and counseling Condom distribution IEC & BCC Genotyping Prevalence Estimates

  19. How do we Respond? Care for PWID Research/ Policy Affordable and equal access to tx HCV VL Monitoring Hep A/B immunization Simplify/optimize tx regimen Drug interaction studies Reach female PWID Scale-up NSP and OST Testing and counseling Condom distribution IEC & BCC Genotyping Prevalence Estimates Strengthen M&E systems Train Health Care Workers Decentralize and Integrate Services Advocacy Systems

  20. Acknowledgements

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