Demographic and behavioral correlates of HIV/STI among Vietnamese female sex workers in southwest China

Previous literature has suggested high rates of HIV/STIs among Chinese FSWs. However, limited data were available regarding HIV-related risks among Vietnamese FSWs – a rapidly increasing, vulnerable population in southwest China. 

The current study examined the demographic and behavioral factors associated with the infection rates of HIV, syphilis, and Hepatitis C (HCV) among Vietnamese FSWs in Guangxi, China. We conducted a secondary data analysis of a cumulative sample of 1026 Vietnamese FSWs (aged 14–66) recruited over five years (2010–2014) from 35 National Sentinel Surveillance sites in Guangxi. 

Analyses included Fisher’s exact chi-square test, t-test, and binary logistic regression. The overall prevalence of HIV, syphilis, and HCV infections among the cross-border women were 3.2%, 6.9%, and 2.6%, respectively. 

Multivariate analysis showed that greater lengths of sex work and low paying work venues were significant risk factors for HIV infection; for syphilis infection, older age, drug use experience, and forgoing condom use were significant risk factors; for HCV infection, drug use experience was the only significant risk factor. 

Our findings suggest that elevated HIV-related risks among the Vietnamese FSWs are closely related to their financial disadvantages and that drug use is a prominent risk factor for cross-border women in the sex trade. 

Furthermore, culturally tailored and linguistically accessible HIV prevention and intervention initiatives that target cross-border FSWs, with a close international collaboration between China and Vietnam, are urgently needed.

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By: Yu YJ1, Li X1, Tam CC2, Zhou Y3, Chen Y3, Shen Z3.

• 1a Arnold School of Public Health, University of South Carolina , Columbia , SC , USA.
• 2b Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA.
• 3c Guangxi CDC, HIV&STD Prevention Center , Nanning , Guangxi , People's Republic of China.
• AIDS Care. 2016 May 30:1-6

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Blood-borne viral co-infections among HIV+ inmates

Via:  http://goo.gl/mbSFE5

Vancouver’s First Supervised Injection Site - Video

Via:  https://goo.gl/dFNMVW

HIV and hepatitis C prevalence, and related risk behaviours among people who inject drugs in three cities in Croatia: Findings from respondent-driven sampling surveys

Background

There are limited data on HIV and hepatitis C virus (HCV) epidemiology among people who inject drugs (PWID) in Croatia. This study aims to provide data on HIV and HCV prevalence and sexual and injecting risk behaviours among PWID in Zagreb, Split, and Rijeka.

Methods

Using respondent-driven sampling (RDS) we recruited from November 2014 to February 2015 a total of 176 PWID in Zagreb, 255 in Rijeka and 399 in Split. Participants provided biological specimens for HIV and HCV testing and completed a behavioural questionnaire.

Results

• The proportion of female PWID ranged from 19.5% in Zagreb to 26.0% in Split. 
• In the month before the survey, 2.5% of PWID in Split, 5.6% in Rijeka and 8.0% in Zagreb reported sharing non-sterile needles and syringes. 
• Many PWID injected opioid substitution therapy (OST) in the month before the survey (57.0% in Zagreb and 57.5% in Split and Rijeka, respectively). 
• Among PWID who had a casual sexual partner in the past 12 months (ranging from 39.2% in Split to 44.4% in Rijeka) condom use was low. 
• Although HIV prevalence was low (0.2% in Rijeka and Zagreb, 0.3% in Split), 
• HCV antibody prevalence was considerable (29.1% in Zagreb, 31.5% in Rijeka, 38.3% in Split). 
• HIV and HCV testing coverage in the past 12 months was insufficient (6.8% and 7.0% in Split; 13.2% and 13.5% in Zagreb; 20.2% and 21.5% in Rijeka, respectively).

Conclusion

We found a low-level HIV epidemic and a sizable HCV epidemic among PWID in Zagreb, Split and Rijeka. Presence of high-risk injecting and sexual behaviours together with inadequate HIV and HCV testing coverage call for development of a comprehensive approach to harm reduction and introduction of needle and syringe exchange programmes in prisons, as well as strengthening sexual health interventions.

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By:  Senad Handanagic, Ivana Bozicevic, Marta Civljak, Zoran Dominkovic, Sandra Sevic, Jelena Barbaric, Tatjana Nemeth Blazic, Oktavija Dakovic Rode, Josip Begovac

WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia

Correspondence

Corresponding author. Tel.: +385 1 4590 147; fax: +385 1 4684 212. 

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A Budget Impact Analysis of Newly Available Hepatitis C Therapeutics and the Financial Burden on a State Correctional System

Hepatitis C virus (HCV) infection continues to disproportionately affect incarcerated populations. New HCV drugs present opportunities and challenges to address HCV in corrections. 

The goal of this study was to evaluate the impact of the treatment costs for HCV infection in a state correctional population through a budget impact analysis comparing differing treatment strategies. Electronic and paper medical records were reviewed to estimate the prevalence of hepatitis C within the Rhode Island Department of Corrections. 

Three treatment strategies were evaluated as follows: 

1. treating all chronically infected persons, 
2. treating only patients with demonstrated fibrosis, and 
3. treating only patients with advanced fibrosis. 

Budget impact was computed as the percentage of pharmacy and overall healthcare expenditures accrued by total drug costs assuming entirely interferon-free therapy. Sensitivity analyses assessed potential variance in costs related to variability in HCV prevalence, genotype, estimated variation in market pricing, length of stay for the sentenced population, and uptake of newly available regimens. 

Chronic HCV prevalence was estimated at 17% of the total population. Treating all sentenced inmates with at least 6 months remaining of their sentence would cost about $34 million-13 times the pharmacy budget and almost twice the overall healthcare budget. Treating inmates with advanced fibrosis would cost about $15 million. A hypothetical 50% reduction in total drug costs for future therapies could cost $17 million to treat all eligible inmates. 

With immense costs projected with new treatment, it is unlikely that correctional facilities will have the capacity to treat all those afflicted with HCV. Alternative payment strategies in collaboration with outside programs may be necessary to curb this epidemic. In order to improve care and treatment delivery, drug costs also need to be seriously reevaluated to be more accessible and equitable now that HCV is more curable.

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By:  Nguyen JT1, Rich JD, Brockmann BW, Vohr F, Spaulding A, Montague BT.

• 1Brown University School of Public Health, Providence, RI, USA. 
• J Urban Health. 2015 Aug;92(4):635-49. doi: 10.1007/s11524-015-9953-4.

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Prevalence of Hepatitis C Virus in Brazil's Inmate Population: A Systematic Review

OBJECTIVE

To estimate the prevalence of hepatitis C virus infection in Brazil's inmate population.

METHODS

Systematic review on hepatitis C virus infection in the inmate population. Brazilian studies published from January 1, 1989 to February 20, 2014 were evaluated. The methodological quality of the studies was assessed using a scale of 0 to 8 points.

RESULTS

Eleven eligible studies were analyzed and provided data on hepatitis C virus infection among 4,375 inmates from seven states of Brazil, with a mean quality classification of 7.4. The overall hepatitis C virus prevalence among Brazilian inmates was 13.6% (ranging from 1.0% to 41.0%, depending on the study). The chances of inmates being seropositive for hepatitis C virus in the states of Minas Gerais (MG), Sergipe (SE), Mato Grosso do Sul (MS), Rio Grande do Sul (RS), Goiás (GO) and Espirito Santo (ES) were 84.0% (95%CI 0.06;0.45), 92.0% (95%CI 0.04;0.13), 88.0% (95%CI 0.09;0.18), 74.0% (95%CI 0.16;0.42), 84.0% (95%CI 0.08;0.31) and 89.0% (95%CI 0.01;0.05) respectively, lower than that observed in the Sao Paulo state (seroprevalence of 29.3%). The four studies conducted in the city of Sao Paulo revealed a lower prevalence in more recent studies compared to older ones.

CONCLUSIONS

The highest prevalence of hepatitis C virus infection in Brazil's inmate population was found in Sao Paulo, which may reflect the urban diversity of the country. Despite Brazilian studies having good methodological quality to evaluate the prevalence of the hepatitis C virus, they are scarce and lack data on risk factors associated with this infection, which could support decisions on prevention and implementation of public health policies for Brazilian prisons.

Prevalence of hepatitis C virus among inmate populations grouped into seven different states of Brazil.

State	Positive samples	Sample size	HCV sero-prevalence (%)	95%CI		OR	95%CI		p
				Lower	Upper		Lower	Upper
Sao Paulo	624	2,131	29.3	27.3	31.2	Ref.	–	–	< 0.001
Minas Gerais	4	63	6.3	0.3	12.4	0.16	0.06	0.45
Sergipe	13	422	3.1	1.4	4.7	0.08	0.04	0.13
Mato Grosso do Sul	33	686	4.8	3.2	6.4	0.12	0.09	0.18
Rio Grande do Sul	19	195	9.7	5.6	13.9	0.26	0.16	0.42
Goias	9	148	6.1	2.2	9.9	0.16	0.08	0.31
Espirito Santo	7	730	1.0	0.3	1.7	0.02	0.01	0.05
Total	709	4,375	16.2	15.1	17.3	–	–	–

Full article at:   http://goo.gl/tgGDws

By:  Magri MC1, Ibrahim KY2, Pinto WP2, França FO2, Bernardo WM3, Tengan FM2.

• 1Laboratório de Investigação Médica em Hepatologia por Vírus, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
• 2Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
• 3Centro de Desenvolvimento de Educação Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. 
• Rev Saude Publica. 2015;49:36. doi: 10.1590/S0034-8910.2015049005886. Epub 2015 Jul 31.

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High-Impact Hepatitis C Virus Testing for Injection Drug Users in an Urban ED

OBJECTIVES:

We implemented the "High-Impact Testing for Injection Drug Users", or the "HIT IDU" initiative, an emergency physician (EP)-based hepatitis C virus (HCV) testing program. The objective of this study was to evaluate the outcomes of this clinical protocol.

METHODS:

This was a prospective observational pilot study. The HIT IDU initiative encouraged EPs to integrate targeted HCV testing into care, with an emphasis on screening all people who inject drugs (PWID). Physicians selected the primary indication for HCV testing from a drop-down menu integrated into the electronic ordering process. The primary outcome was the absolute number and overall proportion of EP-based HCV antibody positive tests, further stratified by the indication for testing.

RESULTS:

Over the 3-month study period, 14,253 unique patients were evaluated, and EPs tested 155 patients for HCV (1.1%; 95% confidence interval [CI], 0.9%-1.2%), of which 40 (26%, 95% CI, 19%-33%) were HCV antibody positive. The proportion of HCV antibody positivity by testing indication was as follows: PWID 47% (34/73; 95% CI, 35%-59%), patient requested test 10% (4/40; 95% CI, 3%-24%), confirm patient report 67% (2/3; 95% CI, 9%-99%), liver disease of uncertain etiology 0% (0/3; 95% CI, 0%-71%), and other 0% (0/36; 95% CI, 0%-10%). There were 22 patients chronically infected, 19 had a follow-up appointment arranged, 3 attended their follow-up appointment, and 1 patient was treated at 1 year of follow-up.

CONCLUSIONS:

Although the overall number of EP-based HCV tests performed was low, high rates of infection were identified, particularly among PWID. There were significant challenges with linkage to care.

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By:  Anderson ES1, Pfeil SK2, Deering LJ2, Todorovic T2, Lippert S3, White DA2.

• 1Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA; Department of Emergency Medicine, Stanford University, Palo Alto, CA. Electronic address: esoremanderson@gmail.com.
• 2Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA.
• 3Department of Emergency Medicine, Stanford University, Palo Alto, CA. 
• Am J Emerg Med. 2016 Mar 3. pii: S0735-6757(16)00186-8. doi: 10.1016/j.ajem.2016.03.004. 

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Understanding differences in HIV/HCV prevalence according to differentiated risk behaviors in a sample of PWID in rural Puerto Rico

BACKGROUND:

Blood contained in needles and injection equipment has been identified as a vector for HIV and HCV transmission among people who inject drugs (PWID). Yet, there is often a wide discrepancy in prevalence for both viruses. While microbiological differences between viruses influence prevalence, other variables associated with the way drugs are acquired and used, also play a role.

METHODS:

Respondent-driven sampling (RDS) methods recruited a sample of 315 current intravenous drug users in rural Puerto Rico. Information about type and frequency of use, HIV and HVC risk behaviors (sharing needles, cookers, cotton, and water), sexual behaviors, and alcohol use was collected. HIV and HCV statuses were assessed via rapid antibody tests. T tests compare means of participants who tested positive (reactive) to those who tested negative. Logistic regression analyses were used to validate the association of the risk factors involved.

RESULTS:

Tests showed a significant difference in HIV (6 %) and HCV (78.4 %) prevalence among a population of current PWID. The main riskbehaviors in HCV transmission are the sharing of injection "works", (e.g., cookers, cotton, and water). Sharing works occurred more than twice as often as the sharing of needles, and HCV+ and HCV- individuals reported the same needle sharing habits.

CONCLUSIONS:

Washing and rinsing injection works with water seems to prevent HIV transmission, but it is unable to prevent HCV infection. While education about the need to clean injection equipment with bleach might be beneficial, equipment sharing-and the subsequent risk of HVC-might be unavoidable in a context where participants are forced to pool resources to acquire and use intravenous drugs.

Descriptive statistics

	Mean/%	SD	N
% HIV positive (INSTI Rapid Test)	6.0 %		315
% HCV positive (OraQuick Rapid Test)	78.4 %		315
% Male	90.5 %		315
% Born in Puerto Rico	93.0 %		315
Age (years)	41.8	(10.07)	315
Annual per capita income	$4452	($3200)	311
% Unemployed	85.4 %		314
% Currently homeless	21.9 %		314
% Graduate high school (or higher)	52.4 %		315
% Married or living together as married	22.2 %		315
% Injected 4 or more times per day	39.7 %		315
% Injected 2–3 times per day	39.7 %		315

Full article at:   http://goo.gl/xAXsqk

By:  Abadie R1, Welch-Lazoritz M2, Gelpi-Acosta C3, Reyes JC4, Dombrowski K5.

• 1Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE, 68588, USA. rabadie2@unl.edu.
• 2Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE, 68588, USA. mwelch2@unl.edu.
• 3Social Science Department, LaGuardia Community College, 31-10 Thomson Ave., Long Island City, NY, 11101, USA. camilagelpi@gmail.com.
• 4Department of Biostatistics and Epidemiology, University of Puerto Rico, 365067, San Juan, PR, 00936, USA. juan.reyes5@upr.edu.
• 5Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE, 68588, USA. kdombrowski2@unl.edu.
• Harm Reduct J. 2016 Mar 8;13(1):10. doi: 10.1186/s12954-016-0099-9. 

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Pre-Donation Screening of Volunteer Prisoner Blood Donors for Hepatitis B & C in Prisons of Punjab, Pakistan

BACKGROUND:

Prisoners as a high risk group are never recommended for blood donations. In Pakistan, prisoners are legally allowed to donate blood and get thirty days extra remission. Inspectorate of prisons allowed Alizaib Foundation for blood donation camps subject to predonation screening of volunteer prisoner blood donor against infectious diseases. This study was conducted to identify the potential benefits of pre-donation screening.

METHODS:

This cross sectional study was conducted in October, 2009 in Punjab. Intending volunteer prisoner blood donors from January, 2007 to September, 2009 from prisons of Punjab were included. Physically fit were tested for Hepatitis C Virus (HCV) and B Virus (HBV) by Rapid test kit before bleeding. Data was analysed by Epi-Info.

RESULTS:

A total of 5894 male volunteer prisoner donors were screened and 1038 (17.6%) were rejected. The mean age was 28 years (range: 17-70 years). Of 5894, 857 (14.5%) were HCV positive and 222 (3.8%) were HBV positive. HCV & HBV co-infection was present among 41 (0.7%). Being convicted prisoner blood donor is significantly associated with higher seroprevalence for HCV (OR 1.35, 95% C.I. 1.17-1.57) and being under trial prisoner is significantly associated with higher seroprevalence for HBV (OR 1.40, 95% C.I. 1.06-1.85).

CONCLUSION:

Hepatitis B & C viruses were responsible for almost 18% prisoner blood donor rejection. Pre-donation screening of blood donors is an effective intervention to improve the safety and limit the cost of blood. Treatment of identified cases may contribute to public health. In the international scenario this study findings necessitate the amendments in the relevant prison rules.

Article at:   http://goo.gl/mU8HbM  Abstract:  http://goo.gl/8U8ovZ

By:  Pervaiz A, Sipra FS, Rana TH, Qadeer I.

J Ayub Med Coll Abbottabad. 2015 Oct-Dec;27(4):794-7.

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Seroprevalence of HCV Markers among HIV Infected Patients from Curitiba & Metropolitan Region, Brazil

OBJECTIVE:

to determine the prevalence and epidemiological factors associated with hepatitis (HCV) coinfection in human immunodeficiency virus (HIV) patients from Curitiba and the metropolitan region.

METHODS:

a study with 303 HIV+ patients, mean age 41.2 years (18-73); 50.5% men, followed at the Hospital de Clínicas, Universidade Federal do Paraná, between April 2008 and March 2009. Clinical and epidemiological data were obtained through questionnaires and retrospective analysis of medical records. Anti-HCV antibodies were detected by chemiluminescence immunoassay.

RESULTS:

a total of 12.9% of HIV+ patients were positive for anti-HCV antibodies, 64.1% were men and 35.9% women, with mean age of 44.5 years (24-66). The frequency of HCV among men was 16.7% and among women 9.1%. HCV prevalence was associated to HIV infection when compared to the general population. The parenteral route of transmission was the most frequent among coinfected patients (46.1%), and the sexual transmission among HIV+/HCV- (71.8%). The frequency of intravenous drug users was higher among the coinfected patients (61.5%) compared to the non coinfected (12.6%).

CONCLUSION:

the prevalence of coinfection with HCV in HIV+ patients is 12.9%, 88 times higher than in the general population in Curitiba. The most frequent route of transmission in the coinfected patients is parenteral, but the sexual route is also representative (34.6%).

Prevalence of HCV/HIV co-infection in different Brazilian geographical regions 

Geographical regions	N	HCV-HIV prevalence (Anti-HCV)	References
Florianópolis, SC	99	53.8%	Treitinger et al., 199934
São Paulo, SP	1,457	17.7%	Mendes-Corrêa et al., 200141
Rio de Janeiro, RJ	238	8.9%	Ferraz et al., 200242
Campinas, SP	232	53.8%	Pavan et al., 200335
Santos, SP	495	36.2%	Segurado et al., 200421
Londrina, PR	784	21.0%	Morimoto et al., 200522
Manaus, AM	704	5.0%	Braga et al., 200623
Porto Alegre, RS	330	38.2%	Tovo et al., 200625
Cuiabá, MT	1,008	10.9%	Mussi et al., 200726
Botucatu, SP	150	14.7%	Corvino et al., 200743
Belo Horizonte, MG	824	9.2%	Carmo et al., 200844
Belo Horizonte, MG	300	15.7%	Rodrigues et al., 200845
Londrina, PR	778	21.0%	Reiche et al., 200829
São Paulo, SP	8,019	12.9%	Farias et al., 200828
Recife, PE	343	4.1%	Carvalho et al., 200946
São Paulo, SP	2,024	16.7%	Mendes-Corrêa et al., 201040
Santa Maria, RS	250	31.2%	Santos et al., 201030
CE	1,291	25.4%	Távora et al., 201332
Curitiba, PR	303	12.9%	Present study

Full article at:   http://goo.gl/LlHsVX

By:  Tizzot MR¹, Grisbach C², Beltrame MH³, Messias-Reason IJ⁴.

¹Pharmacy Course, UNIBRASIL, Curitiba, PR, Brazil.

²Universidade Federal do paraná, Curitiba, PR, Brazil.

³Hospital das Clínicas, UFPR, Curitiba, PR, Brazil.

⁴Pathology Department, UFPR, Curitiba, PR, Brazil.

Rev Assoc Med Bras. 2016 Feb;62(1):65-71. doi: 10.1590/1806-9282.62.01.65.

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