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Open Access 01-12-2020 | Hepatitis B | Research article

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)

Authors: Andrew Scheibe, Katherine Young, Anna Versfeld, C. Wendy Spearman, Mark W. Sonderup, Nishi Prabdial-Sing, Adrian Puren, Harry Hausler

Published in: BMC Infectious Diseases | Issue 1/2020

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.

Personal communication with Dr. Kgomotso Vilakazi Nhlapo, hepatitis lead at the South African National Department of Health on 29 April 2020.

At the time of study implementation TB HIV Care operated HIV prevention services for SWs (in Cape Town, Port Elizabeth, Durban, Pietermaritzburg) and PWUD/ID (in Cape Town and Durban) through mobile outreach and from community based health centres. OUT Wellbeing provided HIV prevention and treatment services to PWUD/ID and MSM in Pretoria through mobile outreach and from a community based health centre. Anova Health Institute provided HIV prevention and treatment services to MSM in Cape Town and Johannesburg from community based health centres.

The sites which recruited sex workers routinely provided services to people who accessed services tailored towards people who identify as sex workers, but no specific distinction was made between transactional sex and sex work.

This decision was made based on the acceptable safety profile and tolerance of HBV vaccination and insufficient funds for additional HBV testing.

Personal communication with Leora Casey, key population programme manager at NACOSA, 19 June 2019.

At the time of study implementation HIV prevention, sexual health and harm reduction services for KPs existed in several other locations that were not part of this study. Notably, SW services existed in major urban areas like Johannesburg, Ekurhuleni and Bloemfontein. MSM services existed in Durban, Pietermaritzburg, Bloemfontein, Kimberly and Ehlanzeni. PWUD/ID harm reduction services were started in Port Elizabeth and Johannesburg after the study started.

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Title: 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)
Authors: Andrew Scheibe
Katherine Young
Anna Versfeld
C. Wendy Spearman
Mark W. Sonderup
Nishi Prabdial-Sing
Adrian Puren
Harry Hausler
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Hepatitis B
Human Immunodeficiency Virus
Hepatitis C
Published in: BMC Infectious Diseases / Issue 1/2020
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-020-05359-y

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