An urgent need to scale-up injecting drug harm reduction services in Tanzania: Prevalence of blood-borne viruses among drug users in Temeke District, Dar-es-Salaam, 2011

Bowring, Anna L; Luhmann, Niklas; Pont, Sandrine; Debaulieu, Céline; Derozier, Stephanie; Asouab, Fatima; Toufik, Abdalla; Gemert, Caroline van; Dietze, Paul; Stoové, Mark

doi:10.1016/j.drugpo.2012.08.005

Cited by 41 publications

(63 citation statements)

References 12 publications

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“…There have been two previous studies estimating HCV seroprevalence among PWID in Tanzania, reporting a prevalence of 28% and 53%, respectively 10, 12. Both previous studies also confer our finding of a heavily predominant male population 10, 12.…”

Section: Discussionsupporting

confidence: 83%

“…In populations with escalating incidence of PWID, a failure to integrate harm reduction strategies into any proposed healthcare intervention can have a significant impact on HCV transmission, as evidenced by the recent “opioid crisis” in parts of North America 37, 38. In Tanzania, there are an estimated 50 000 PWID, with only 3000 engaging in a local OST programme 10. Despite the existence of NSP in Dar‐es‐Salaam,39 more than half of PWID surveyed admitted to a history of needle sharing.…”

Section: Discussionmentioning

confidence: 99%

“…A study in Sénégal reported a high prevalence of HCV infection in drug users, but did not analyse the severity of the liver disease and furthermore, the drug users were mainly noninjectors 9. In East Africa, there have been a handful of descriptive studies, restricted to assessing the seroprevalence of HCV infection, ranging from 28%‐53% in Tanzania to 42% in Kenya 10, 11, 12. Lack of access to HCV nucleic acid testing (NAT), is a major obstacle to identifying chronically‐infected individuals encountered across resource‐limited settings 13…”

Section: Introductionmentioning

confidence: 99%

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The hepatitis C cascade of care in people who inject drugs in Dar es Salaam, Tanzania

Mohamed

Rwegasha

Kim

et al. 2018

Journal of Viral Hepatitis

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SummaryThe World Health Organisation has recently called for hepatitis C virus (HCV) elimination and has identified people who inject drugs (PWID) as a key population to scale‐up screening and linkage to care. This study reports the cascade of care for HCV in PWID attending the largest opioid substitution treatment (OST) clinic in Dar‐es‐Salaam, Tanzania. Between February 2011 and March 2016, HCV serology for all PWID registered at the Muhimbili National Hospital OST clinic, Dar‐es‐Salaam were obtained from records. In 2015, consecutive HCV‐seropositive PWID were invited to undergo a clinical evaluation including epidemiological questionnaire, liver stiffness measurement (Fibroscan) and virological analysis (HCV RNA viral load and genotyping). During the study period, 1350 persons registered at the OST clinic: all had a HCV serology including 409 (30%) positive results. Among the HCV‐seropositive individuals, 207 (51%) were active attenders and 153 (37%) were enrolled for clinical assessment: 141 (92%) were male, median age: 38 years (IQR 34‐41), and 65 (44%) were co‐infected with HIV; 116 patients (76%) had detectable HCV RNA, with genotypes 1a (68%) and 4a (32%); 21 (17%) had clinically significant fibrosis (≥F2) and 6 (5%) had cirrhosis (F4). None were offered HCV treatment. Chronic hepatitis C among PWID enrolled in the OST centre in Dar‐es‐Salaam is frequent, but its continuum of care is insufficient; integration of HCV diagnosis and treatment should form a part of OST intervention in PWID in Tanzania.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The hepatitis C cascade of care in people who inject drugs in Dar es Salaam, Tanzania

Mohamed

Rwegasha

Kim

et al. 2018

Journal of Viral Hepatitis

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“…The HIV rate of over 30% for those tested in Dar es Salaam is very high, comparable to the 35% HIV rate of IDUs tested in Dar es Salaam 19. Syphilis infection rates, which could include evidence of previous or present infection, were low at 2.5% (consistent with Zanzibar MSM data, which also utilised an antibody detection test), and no hepatitis B infection was detected.…”

Section: Discussionsupporting

confidence: 70%

High HIV seroprevalence, rectal STIs and risky sexual behaviour in men who have sex with men in Dar es Salaam and Tanga, Tanzania

et al. 2014

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ObjectivesTo assess HIV and sexually transmitted infection (STI) prevalence and associated risk factors in men who have sex with men (MSM) in two cities in mainland Tanzania.MethodsWe conducted respondent-driven sampling of 300 MSM in Dar es Salaam and Tanga.ResultsIn Dar es Salaam, 172 (86%) men (median age 23, IQR 21–28) consented to HIV/STI testing, and 30.2% were HIV seropositive. Only five reported a previous positive HIV test: >90% were new HIV detections. 2.5% were syphilis-exposed and none hepatitis B positive, but 21.4% had a curable STI. Over 90% of the gonorrhoea and chlamydia was rectal. In Tanga, 11.1% of MSM were HIV seropositive, 8% hepatitis B positive and 0% were syphilis-exposed, with 4.4% having a curable STI. Predictors of HIV infection were number of MSM known, city, identifying as gay and having first sex with a man. Predictors for STIs were recent unprotected receptive anal intercourse, and number of MSM seen in the last month. 30% of the sample reported that they sold sex. There was no significant association between HIV and STI infection.ConclusionsHIV and STI rates were substantially lower in MSM in a provincial city than in a large metropolis and rates appear to depend on larger numbers of MSM known. Most HIV detected were new cases, and there was a high burden of asymptomatic curable rectal STIs (>1 in 5 MSM). Owing to stigma, MSM may not report homosexuality and thus not have rectal STIs treated. High need for tailored HIV testing and STI screening and treatment of MSM in Tanzania is apparent.

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“…40 National key informants with expertise in PWID and HIV estimated that prevalence of HIV among PWID was 36%–43% in Kenya and 42% in Tanzania (Table 2). 41 In Dar es Salaam (Tanzania), PWID recruited through snowball and targeted sampling were found to have a prevalence of HIV (35%) 42 much higher than that recorded for non-injecting drug users (12%). Further, there is high overlap between female PWID and sex work in Dar es Salaam, with an estimated 31% of female PWID engaging in commercial sex work as compared to less than 1% for males.…”

Section: People Who Inject Drugs (Pwid)mentioning

confidence: 98%

Concentrated HIV subepidemics in generalized epidemic settings

Tanser

Oliveira

Maheu‐Giroux

et al. 2014

Current Opinion in HIV and AIDS

118

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Purpose of review A relatively neglected topic to date has been the occurrence of concentrated epidemics within generalized epidemic settings and the potential role of targeted interventions in such settings. We review recent studies in high-risk groups as well as findings relating to geographical heterogeneity and the potential for targeting ‘high-transmission zones’ in the ten highest HIV prevalence countries in sub-Saharan Africa and the world. Recent findings Recent studies have confirmed earlier findings that, even in the context of generalized epidemics, men who have sex with men (MSM) have a substantially higher prevalence than the general population. Estimates of prevalence of HIV among people who inject drugs (PWID) in sub-Saharan countries are rarely available and, when they are, often outdated. We identified recent studies of sex workers (SW) in Kenya and Uganda. In all three cases – MSM, PWID and SW – HIV prevalence estimates are mostly based on convenience. Moreover, good estimates of the total size of these populations are not available. Our review of recent studies of high-risk populations defined on the basis of geography showed very high levels of both new and existing infections in Kenya (slums), South Africa (peri-urban communities) and Uganda (fishing villages). Summary Recent empirical findings combined with evidence from phylogenetic studies and supported by mathematical models provide a clear rationale for testing the feasibility, acceptability, and effectiveness of targeted HIV prevention approaches in hyper-endemic populations to supplement measures aimed at the general population.

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An urgent need to scale-up injecting drug harm reduction services in Tanzania: Prevalence of blood-borne viruses among drug users in Temeke District, Dar-es-Salaam, 2011

Cited by 41 publications

References 12 publications

The hepatitis C cascade of care in people who inject drugs in Dar es Salaam, Tanzania

The hepatitis C cascade of care in people who inject drugs in Dar es Salaam, Tanzania

High HIV seroprevalence, rectal STIs and risky sexual behaviour in men who have sex with men in Dar es Salaam and Tanga, Tanzania

Concentrated HIV subepidemics in generalized epidemic settings

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