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Prevalence of HIV, viral hepatitis B/C and tuberculosis and treatment outcomes among people who use drugs : results from the implementation of the first drop-in-center in Mozambique

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Abstract
Background: People who use drugs (PWUD) which includes both people who inject drugs (PWID) and non-injection drug users (NIDU) are marginalized, experience high levels of stigma and discrimination, and are likely to have challenges with accessing health services. Mozambique implemented the first drop-in center (DIC) for PWUD in Maputo City in 2018. This analysis aims to assess the prevalence of HIV, viral hepatitis B (HBV) and C (HCV) and tuberculosis (TB) among PWUD, and assess their linkage to care and associated correlates. Methods: We conducted a cross-sectional retrospective analysis of routine screening data collected from the first visit at the drop-in center (DIC) during the period of May 2018 to November 2019 (18 months). Descriptive and multivariable logistic regression analysis were conducted to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of HIV, HBV, HCV and TB infections among PWID and NIDU. Cox proportional hazards models of determinants were used to estimate time from HIV diagnosis to linkage to care for PWUD. Results: A total of 1,818 PWUD were screened at the DIC, of whom 92.6% were male. The median age was 27 years (range:14-63). Heroin was the most consumed drug (93.8%), and among people who used it, 15.5% injected it. Prevalence of HIV (43.9%), HCV (22.6%) and HBV (5.9%) was higher among PWID (p<0.001). Linkage to HIV care was observed in 40.5% of newly diagnosed PWID. Factors associated with shorter time to linkage to care included drug injection (aHR=1.6) and confirmed TB infection (aHR=2.9). Conclusion: This was the first analysis conducted on the implementation of the DIC in Mozambique and highlights the importance of targeted services for this high-risk population. Our analysis confirmed a high prevalence of HIV, HBV and HCV, and highlight the challenges with linkage to care among PWID. The expansion of DIC locations to other high-risk localities to enhance HIV testing, treatment services and linkage to care to reduce ongoing transmission of HIV, HBV, HCV and TB and improve health outcomes.
Keywords
Health Policy, Medicine (miscellaneous), Drug use, People who inject drugs, HIV, hepatitis B, Hepatitis C, Tuberculosis, Mozambique, SUB-SAHARAN AFRICA, INJECT DRUGS, ANTIRETROVIRAL THERAPY, CARE, HCV

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MLA
Semá Baltazar, Cynthia, et al. “Prevalence of HIV, Viral Hepatitis B/C and Tuberculosis and Treatment Outcomes among People Who Use Drugs : Results from the Implementation of the First Drop-in-Center in Mozambique.” INTERNATIONAL JOURNAL OF DRUG POLICY, vol. 90, 2021, doi:10.1016/j.drugpo.2020.103095.
APA
Semá Baltazar, C., Kellogg, T. A., Boothe, M., Loarec, A., de Abreu, E., Condula, M., … Lüchters, S. (2021). Prevalence of HIV, viral hepatitis B/C and tuberculosis and treatment outcomes among people who use drugs : results from the implementation of the first drop-in-center in Mozambique. INTERNATIONAL JOURNAL OF DRUG POLICY, 90. https://doi.org/10.1016/j.drugpo.2020.103095
Chicago author-date
Semá Baltazar, Cynthia, Timothy A. Kellogg, Makini Boothe, Anne Loarec, Ernesto de Abreu, Manuel Condula, Erika Fazito, Henry F. Raymond, Marleen Temmerman, and Stanley Lüchters. 2021. “Prevalence of HIV, Viral Hepatitis B/C and Tuberculosis and Treatment Outcomes among People Who Use Drugs : Results from the Implementation of the First Drop-in-Center in Mozambique.” INTERNATIONAL JOURNAL OF DRUG POLICY 90. https://doi.org/10.1016/j.drugpo.2020.103095.
Chicago author-date (all authors)
Semá Baltazar, Cynthia, Timothy A. Kellogg, Makini Boothe, Anne Loarec, Ernesto de Abreu, Manuel Condula, Erika Fazito, Henry F. Raymond, Marleen Temmerman, and Stanley Lüchters. 2021. “Prevalence of HIV, Viral Hepatitis B/C and Tuberculosis and Treatment Outcomes among People Who Use Drugs : Results from the Implementation of the First Drop-in-Center in Mozambique.” INTERNATIONAL JOURNAL OF DRUG POLICY 90. doi:10.1016/j.drugpo.2020.103095.
Vancouver
1.
Semá Baltazar C, Kellogg TA, Boothe M, Loarec A, de Abreu E, Condula M, et al. Prevalence of HIV, viral hepatitis B/C and tuberculosis and treatment outcomes among people who use drugs : results from the implementation of the first drop-in-center in Mozambique. INTERNATIONAL JOURNAL OF DRUG POLICY. 2021;90.
IEEE
[1]
C. Semá Baltazar et al., “Prevalence of HIV, viral hepatitis B/C and tuberculosis and treatment outcomes among people who use drugs : results from the implementation of the first drop-in-center in Mozambique,” INTERNATIONAL JOURNAL OF DRUG POLICY, vol. 90, 2021.
@article{8690995,
  abstract     = {{Background: People who use drugs (PWUD) which includes both people who inject drugs (PWID) and non-injection drug users (NIDU) are marginalized, experience high levels of stigma and discrimination, and are likely to have challenges with accessing health services. Mozambique implemented the first drop-in center (DIC) for PWUD in Maputo City in 2018. This analysis aims to assess the prevalence of HIV, viral hepatitis B (HBV) and C (HCV) and tuberculosis (TB) among PWUD, and assess their linkage to care and associated correlates.

Methods: We conducted a cross-sectional retrospective analysis of routine screening data collected from the first visit at the drop-in center (DIC) during the period of May 2018 to November 2019 (18 months). Descriptive and multivariable logistic regression analysis were conducted to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of HIV, HBV, HCV and TB infections among PWID and NIDU. Cox proportional hazards models of determinants were used to estimate time from HIV diagnosis to linkage to care for PWUD.

Results: A total of 1,818 PWUD were screened at the DIC, of whom 92.6% were male. The median age was 27 years (range:14-63). Heroin was the most consumed drug (93.8%), and among people who used it, 15.5% injected it. Prevalence of HIV (43.9%), HCV (22.6%) and HBV (5.9%) was higher among PWID (p<0.001). Linkage to HIV care was observed in 40.5% of newly diagnosed PWID. Factors associated with shorter time to linkage to care included drug injection (aHR=1.6) and confirmed TB infection (aHR=2.9).

Conclusion: This was the first analysis conducted on the implementation of the DIC in Mozambique and highlights the importance of targeted services for this high-risk population. Our analysis confirmed a high prevalence of HIV, HBV and HCV, and highlight the challenges with linkage to care among PWID. The expansion of DIC locations to other high-risk localities to enhance HIV testing, treatment services and linkage to care to reduce ongoing transmission of HIV, HBV, HCV and TB and improve health outcomes.}},
  articleno    = {{103095}},
  author       = {{Semá Baltazar, Cynthia and Kellogg, Timothy A. and Boothe, Makini and Loarec, Anne and de Abreu, Ernesto and Condula, Manuel and Fazito, Erika and Raymond, Henry F. and Temmerman, Marleen and Lüchters, Stanley}},
  issn         = {{0955-3959}},
  journal      = {{INTERNATIONAL JOURNAL OF DRUG POLICY}},
  keywords     = {{Health Policy,Medicine (miscellaneous),Drug use,People who inject drugs,HIV,hepatitis B,Hepatitis C,Tuberculosis,Mozambique,SUB-SAHARAN AFRICA,INJECT DRUGS,ANTIRETROVIRAL THERAPY,CARE,HCV}},
  language     = {{eng}},
  pages        = {{8}},
  title        = {{Prevalence of HIV, viral hepatitis B/C and tuberculosis and treatment outcomes among people who use drugs : results from the implementation of the first drop-in-center in Mozambique}},
  url          = {{http://dx.doi.org/10.1016/j.drugpo.2020.103095}},
  volume       = {{90}},
  year         = {{2021}},
}

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