Hepatitis C & HIV Incidence & Harm Reduction Program Use in a Conflict Setting: An Observational Cohort of Injecting Drug Users in Kabul, Afghanistan

Armed conflict may increase the risk of HIV and other pathogens among injecting drug users (IDUs); however, there are few prospective studies. This study aimed to measure incidence and potential predictors, including environmental events and needle and syringe distribution and collection program (NSP) use, of hepatitis C virus (HCV) and HIV among IDUs in Kabul, Afghanistan.

Consenting adult IDUs completed interviews quarterly in year 1 and semi-annually in year 2 and HCV and HIV antibody testing semi-annually through the cohort period (November 2007–December 2009). Interviews detailed injecting and sexual risk behaviors, NSP service use, and conflict-associated displacement. Quarters with peak conflict or local displacement were identified based on literature review, and key events, including insurgent attacks and deaths, were reported with simple counts. Incidence and predictors of HCV and HIV were measured with Cox proportional hazards models.

Of 483 IDUs enrolled, 385 completed one or more follow-up visits. All participants were male with a median age of 28 years and a median duration of injecting of 2 years. Reported NSP use among the participants ranged from 59.9 to 70.5 % in the first year and was 48.4 and 55.4 % at 18 and 24 months, respectively. There were 41 confirmed deaths, with a crude death rate of 93.4/1000 p-y and overdose as the most common cause. HCV and HIV incidence were 35.6/100 p-y and 1.5/100 p-y, respectively. Changing from injecting to smoking was protective for HCV acquisition, while duration of injecting and sharing syringes independently predicted HIV infection.

There is high HCV incidence and high numbers of reported deaths among male Kabul IDUs despite relatively consistent levels of harm reduction program use; peak violence periods did not independently predict HCV and HIV risk. Programming should increase awareness of HCV transmission and overdose risks, prepare clients for harm reduction needs during conflict or other causes of displacement, and continue efforts to engage community and police force support.

Below:  Insurgent attacks and incident hepatitis C cases among male injecting drug users in Kabul, Afghanistan, June 2007–December 2009 (n = 191)

Full article at: http://goo.gl/Qnnsh2

By: Catherine S. Todd, Abdul Nasir, Mohammad Raza Stanekzai, Katja Fiekert, Heather L. Sipsma, David Vlahov, andSteffanie A. Strathdee

Department of Obstetrics & Gynecology, College of Physicians and Surgeons, and Heilbrunn Department of Population & Family Health, Columbia University, Mailman School of Public Health, PH 16-69, 622 West 168th Street, New York, NY 10032 USA

Health Protection and Research Organisation, Street 4, Taimani, Kabul, Afghanistan

Department of Epidemiology, Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520-8034 USA

Department of Community Health Systems, University of California, San Francisco School of Nursing, 2 Koret Way, #N-319X UCSF Box 0602, San Francisco, CA 94143-0602 USA

Division of Global Public Health, University of California San Diego School of Medicine, 9500 Gilman Drive, MC 0507, La Jolla, CA 92093-0507 USA

Asia Pacific Business Unit and Clinical Sciences Division, FHI 360, Sindhorn Building, 130-132 Wittayu Road, Bangkok, 10330 Thailand

  

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