HIV among People Who Inject Drugs in the Middle East and North Africa: Systematic Review and Data Synthesis

Mumtaz, Ghina R.; Weiss, Helen A.; Thomas, Sara L; Riome, Suzanne; Setayesh, Hamidreza; Riedner, Gabriele; Semini, Iris; Tawil, Oussama; Akala, Francisca Ayodeji; Wilson, David J.; Abu‐Raddad, Laith J.

doi:10.1371/journal.pmed.1001663

Cited by 150 publications

(192 citation statements)

References 96 publications

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“…From 13 MENA countries that have published evidencebased data on PWIDs, epidemics are reported as being concentrated in Pakistan, Iran, Afghanistan, Egypt, Morocco and Libya [26] . While increasing trends are reported in Pakistan, Iran and Egypt, Libya has recently been facing the highest HIV prevalence (87%) among PWIDs in the region [27] .…”

Section: Pwidsmentioning

confidence: 99%

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Early initiation of antiretroviral treatment: Challenges in the Middle East and North Africa

Sardashti

Samaei

Firouzeh

et al. 2015

WJV

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New World Health Organization guidelines recommend the initiation of antiretroviral treatment (ART) for asymptomatic patients with CD4+ T-cell counts of ≤ 500 cells/mm 3 . Substantial reduction of human immunodeficiency virus (HIV) transmission is addressed as a major public health outcome of this new approach. Middle East and North Africa (MENA), known as the area of controversies in terms of availability of comprehensive data, has shown concentrated epidemics among most of it's at risk population groups. Serious challenges impede the applicability of new guidelines in the MENA Region. Insufficient resources restrict ART coverage to less than 14%, while only one fourth of the countries had reportable data on patients' CD4 counts at the time of diagnosis. Clinical guidelines need to be significantly modified to reach practical utility, and surveillance systems have not yet been developed in many countries of MENA. Based on available evidence in several countries people who inject drugs and men who have sex with men are increasingly vulnerable to HIV and viral hepatitis, while their sexual partners -either female sex workers or women in monogamous relationships with high-risk men -are potential bridging populations that are not appropriately addressed by regional programs. Research to monitor the response to ART among the mentioned groups are seriously lacking, while drug resistant HIV strains and limited information on adherence patterns to treatment regimens require urgent recognition by health policymakers. Commitment to defined goals in the fight against HIV, development of innovative methods to improve registration and reporting systems, monitoring and evaluation of current programs followed by costeffective modifications are proposed as effective steps to be acknowledged by National AIDS Programs of the countries of MENA Region. 134 MINIREVIEWSSubmit a

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Section: Pwidsmentioning

confidence: 99%

“…The MENA region is no exception, and expansion of harm reduction programs is essential for effectively fighting HIV. HCV and HBV are also not targeted appropriately despite higher transmission rates compared to HIV [26] . Management of HBV or HCV co-infections in HIV patients has been a matter of controversy for years [20] .…”

Section: Pwidsmentioning

confidence: 99%

Early initiation of antiretroviral treatment: Challenges in the Middle East and North Africa

Sardashti

Samaei

Firouzeh

et al. 2015

WJV

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“…People who inject drugs are at a higher risk of HIV and hepatitis C virus (HCV) transmission by sharing of injecting equipments (2)(3)(4)(5). Injecting drug users now account for one in 10 new HIV infections worldwide (6).…”

mentioning

confidence: 99%

“…For example, the prevalence rate of HIV/AIDS was upwards of 75% -89% among the Chinese injection drug users (3). Similarly, studies show that HIV/AIDS and HCV infection epidemics among people who inject drugs are high (3)(4)(5) with a range of 10% -15% for HIV and 31% -64% for HCV prevalence (4). Additionally, data come from the Middle East and North Africa suggest a high prevalence of sharing needles and syringes in the last injection (18% -28%), low levels of condom that ever used with (20% -54%), and sexual activities (15% -30%) among injection drug users (4).…”

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confidence: 99%

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The Necessity of Enhanced Harm Reduction Programs to Prevent Blood-Borne Infections Amongst Injection Drug Users

2016

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HIV Spreading in Middle East, North Africa Among People Who Inject Drugs

Friedrich¹

2014

JAMA

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Background and aims People who inject drugs (PWID) are a key population at high risk of hepatitis C virus (HCV) infection. The aim of this study was to delineate the epidemiology of HCV in PWID in the Middle East and North Africa (MENA). Methods Syntheses of data were conducted on the standardized and systematically assembled databases of the MENA HCV Epidemiology Synthesis Project, 1989-2018. Random-effects meta-analyses and meta-regressions were performed. Meta-regression variables included country, study site, year of data collection and year of publication [to assess trends in HCV antibody prevalence over time], sample size and sampling methodology. Numbers of chronically infected PWID across MENA were estimated. The Shannon Diversity Index was calculated to assess genotype diversity.Results Based on 118 HCV antibody prevalence measures, the pooled mean prevalence in PWID for all MENA was 49.3% [95% confidence interval (CI) = 44.4-54.1%]. The country-specific pooled mean ranged from 21.7% (95% CI = 4.9-38.6%) in Tunisia to 94.2% (95% CI = 90.8-96.7%) in Libya. An estimated 221 704 PWID were chronically infected, with the largest numbers found in Iran at 68 526 and in Pakistan at 46 554. There was no statistically significant evidence for a decline in HCVantibody prevalence over time. Genotype diversity was moderate (Shannon Diversity Index of 1.01 out of 1.95; 52.1%). The pooled mean percentage for each HCV genotype was highest in genotype 3 (42.7%) and in genotype 1 (35.9%). Conclusion Half of people who inject drugs in the Middle East and North Africa appear to have ever been infected with hepatitis C virus, but there are large variations in antibody prevalence among countries. In addition to > 200 000 chronically infected current people who inject drugs, there is an unknown number of people who no longer inject drugs who may have acquired hepatitis C virus during past injecting drug use. Harm reduction services must be expanded, and innovative strategies need to be employed to ensure accessibility to hepatitis C virus testing and treatment.

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HIV among People Who Inject Drugs in the Middle East and North Africa: Systematic Review and Data Synthesis

Abstract: Laith Abu-Raddad and colleagues assess the current state of knowledge of the HIV epidemic among people who inject drugs in the Middle East and North Africa. Please see later in the article for the Editors' Summary

Cited by 150 publications

References 96 publications

Early initiation of antiretroviral treatment: Challenges in the Middle East and North Africa

Early initiation of antiretroviral treatment: Challenges in the Middle East and North Africa

The Necessity of Enhanced Harm Reduction Programs to Prevent Blood-Borne Infections Amongst Injection Drug Users

HIV Spreading in Middle East, North Africa Among People Who Inject Drugs

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