Hepatitis B, hepatitis C and HIV prevalence and related sexual and substance use risk practices among key populations who access HIV prevention, treatment and related services in South Africa: findings from a seven-city cross-sectional survey (2017)

Abstract

Background People who use drugs including people who inject drugs (PWUD/ID), sex workers (SWs) and men who have sex with men (MSM) are at increased risk of HIV and viral hepatitis infection. Limited epidemiological data on the infections exists in key populations (KPs) in South Africa. We investigated the prevalence of hepatitis B (HBV), hepatitis C (HCV) and HIV and selected risk factors among these KPs to inform effective responses. Methods We used convenience sampling to recruit a targeted 3500 KPs accessing HIV-related health services across Cape Town (SWs, MSM, PWUD/ID), Durban (SWs, PWUD/ID), Pietermaritzburg (SWs), Mthatha (SWs), Port Elizabeth (SWs), Johannesburg (MSM) and Pretoria (MSM and PWUD/ID) into a cross-sectional survey. An interviewer questionnaire to assess socio-demographic characteristics, drug use and sexual risk practices, was administered. HBV surface antigen (HBsAg); HCV antibody, viral load and genotype, and HIV antibody, was tested. Results Among the 3439 people included in the study (1528 SWs, 746 MSM, 1165 PWUD/ID) the median age was 29 years, most participants were black African (60%), and 24% reported homelessness. 82% reported substance use in the last month, including alcohol (46%) and heroin (33%). 75% were sexually active in the previous month, with condom use at last sex at 74%. HIV prevalence was 37% (highest among SWs at 47%), HBsAg prevalence 4% (similar across KPs) and HCV prevalence was 16% (highest among PWUD/ID at 46%). Conclusions HBV, HCV and HIV pose a health burden for KPs in South Africa. While HIV is key for all included KPs, HCV is of particular importance to PWUD/ID. For KPs, HBV vaccination and behavioural change interventions that support consistent condom and lubricant access and use are needed. Coverage of opioid substitution therapy and needle and syringe services, and access to HCV treatment for PWUD/ID need to be expanded.

Seroprevalence of Hepatitis B Virus and Associated Factors Among Female Sex Workers Using Respondent-Driven Sampling in Hawassa City, Ethiopia

“…The prevalence of HBV among female sex workers in different studies conducted in African countries has been revealed as 4.2% in the Republic of Congo, 6 17.1% in Nigeria, 7 18.2% in Burkina Faso, 8 4% in South Africa, 9 and 2.5% in Ruanda. 10 From limited studies in Ethiopia, the highest prevalences were reported from Gondar (28.9%), 11 Mekelle (6%), 12 and Dessie (13.1%).…”

“…Different factors are associated with female sex workers acquiring HBV, like workplace associated factors, inconsistent condom use, substance, and drug use, 12 economic factors, marital interruption, low educational status, and unsafe alcohol use, and co-infection with other sexually transmitted infections, which are common factors associated with HBV infection. 9 …”

Expanding the epidemiological understanding of hepatitis C in South Africa: Perspectives from a patient cohort in a rural town

“…[9,20] GT5a has also not been detected in any key population studies to date -here GT1 and GT3a are prevalent. [5] Reviewing the patients' self-reported histories suggests a shared mode of HCV transmission. Most patients reported attending the local primary care clinic and receiving parenteral therapies at time points in their lives.…”

“…[3,4] Unsurprisingly, recent data from key populations in SA demonstrate a high prevalence of HCV and HIV-HCV co-infection. [5] HCV prevalence studies in men who have sex with men (MSM) have demonstrated rates of 6%, with genotype (GT) 1a and 3a the predominant genotypes identified. [6] Interestingly, to date no GT5a, an HCV genotype unique to SA, has been identified in any of the key population studies in SA.…”

“…[7] Key population patients tend to be younger, the median age being 29 years in SA, whereas the other HCV prevalence peak comprised people invariably >50 years of age. [5,6,8] In recent data from Cape Town looking at a general HCV patient cohort accessing treatment, 26% of patients had no identifiable risk factor, possibly pointing towards other parenteral exposure, e.g. through traditional or unsafe medical practices, as a likely means of transmission.…”