New study confirms high hepatitis and HIV infection among people who inject drugs

A new study confirms high hepatitis C prevalence among people who inject drugs in the country. The recent findings from TB HIV Care’s latest bio-behavioural survey, conducted between May and September 2023, reveal a high prevalence of hepatitis C infection and high levels of HIV co-infection among people who inject drugs (PWID) in eThekwini, Ehlanzeni (Lydenburg and Mbombela) and Tshwane.

According to the World Health Organization, hepatitis is an inflammation of the liver that is caused by a variety of infectious viruses and non-infectious agents leading to a range of health problems, some of which can be fatal. There are five main strains of the hepatitis virus, referred to as types A, B, C, D, and E.

TB HIV Care strategic information and business development director Dr Joel Steingo said hepatitis B and hepatitis C infections are typically higher in key populations than the general population, but data is limited.

He further said the bio-behavioural surveys are critical because they allow us to estimate the population size of marginalised groups like PWID in sites across South Africa.

“The surveys allow us to estimate the prevalence of infections like HIV and viral hepatitis, assess health-seeking behaviour, gauge injecting practices and other risk factors, and examine the intersectionality between injecting drug use with behavioural, social, and structural factors – including the ability to access healthcare services,” he said.

Steingo said the survey, which is also aimed at estimating the prevalence of HIV among PWID populations in each city, shows the following:

• In eThekwini, an estimated 49.3% HIV prevalence; 5.8% prevalence for hepatitis B; an anti-HCV prevalence of 75.2%; and an HIV and anti-HCV co-infection prevalence of 43.2% among the PWID population.

• In Lydenburg, an estimated 45.4% HIV prevalence; 0.9% prevalence for hepatitis B; an anti-HCV prevalence of 40.8% and an HIV and anti-HCV co-infection prevalence of 26.7% among the PWID population.

• In Mbombela, an estimated 30.3% HIV prevalence; 1.6% prevalence for hepatitis B; an anti-HCV prevalence of 90.5%; and an HIV and anti-HCV co-infection prevalence of 28.1% among the PWID population.

• In Tshwane, an estimated 72.1% HIV prevalence; 2.8% prevalence for hepatitis B; an anti-HCV prevalence of 89.1%, and an HIV and anti-HCV co-infection prevalence of 69.2% among the PWID population.

Andrew Scheibe, technical adviser at TB HIV Care, said the high prevalence of HIV and hepatitis C highlights the need for increased prevention, testing, and treatment with direct-acting antivirals.

“Hepatitis C is often called the silent killer because many people remain completely asymptomatic until the infection progresses, causing serious liver damage and life-threatening health issues,” said Scheibe.

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