ABSTRACT:

Introduction:

Hepatitis C is one of the most neglected diseases by governments internationally.

Objective:

Identify the prevalence of hepatitis C and associated injection drug users in three cities of factors Colombia.

Methods:

Cross-sectional study of 668 injecting drug users recruited through respondent-driven sampling, inquired about demographic characteristics and risk behaviors. Laboratory testing was used on filter paper and cases of hepatitis C viral load tests with RNA were confirmed. Hepatitis C prevalence and associated factors was estimated with Chi-square test statistics and reasons for crude and adjusted prevalence were calculated using logistic regression.

Results:

The prevalence of hepatitis C was 17.5% and were found as factors that increase the prevalence of hepatitis: having HIV, injecting another person carrying the virus dose used was sharing a syringe, injected with a syringe and consume marijuana. As a factor that reduces the prevalence, purchase syringes in drug stores or other stores.

Conclusion:

This research evidence established consumption of drugs by injection , and the presence of hepatitis C in social networks of IDUs and highlights the importance of developing interventions for harm reduction and prevention of hepatitis C in this population these three cities.

Keywords:
Hepatitis C; Epidemiology; Prevalence; Cross-Sectional Studies; Heroin Dependence; Colombia

INTRODUCTION

The hepatitis C virus (HCV) is one of the greatest public health problems worldwide, transmitted through parenteral route, and is an important reason for chronic liver disease, cirrhosis and hepatocellular carcinoma¹1. Perz JF, Armstrong GL, Farrington LA, Hutin YJF, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol. 2006;45(4):529-38.. The World Health Organization (WHO) reports a prevalence of 3% of HCV infections world wide²2. World Health Organization. Viral hepatitis: WHA63.18. Ginebra: Sixty-third World Health Assembly; 2010.. Their geographic distribution is not homogeneous, with the most people infected by hepatitis C virus residing in Asia and Africa, which is equivalent to 70.6% of the total reported cases. Recent estimates for South America indicate a prevalence of HCV between 1.5 and 3.5%³3. Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology. 2013;57(4):1333-42..

In 1990, the main forms of HCV transmission were through hemoderivative products, hemodialysis and organ transplants⁴4. Bastie A, Pawlotsky JM, Roudot-Thoraval F, Dhumeaux D. Hepatitis C virus infection. Epidemiology. Pathol Biol (Paris). 1995;43(8):674-80.^,55. Kaldor JM, Dore GJ, Correll PK. Public health challenges in hepatitis C virus infection. J Gastroenterol Hepatol. 2000;15(Suppl.):E83-90., which were later minimized with the advances in biosecurity, though in the last few years, most people presenting as new cases in developed countries are injection drugs users⁶6. Smith DJ, Combellick J, Jordan AE, Hagan H. Hepatitis C virus (HCV) disease progression in people who inject drugs (PWID): A systematic review and meta-analysis. Int J Drug Policy. 2015;26(10):911-21. and people involved in high risk sexual activities, such as men who have sex with men⁷7. van de Laar TJ, Matthews GV, Prins M, Danta M. Acute hepatitis C in HIV-infected men who have sex with men: an emerging sexually transmitted infection. AIDS. 2010;24(12):1799-812..

There are differences regarding age and geographic distribution of the infection, in the United States and Australia, for example, it is more often observed among young adults due to use of intravenous drugs⁸8. CircularHep_ByC.pdf [Internet]. [cited on 2014 July 3]. Available from: http://epi.minsal.cl/wp-content/uploads/2015/11/CircularHep_ByC.pdf
http://epi.minsal.cl/wp-content/uploads/... . In addition to that, this virus is the main cause for liver transplantation in countries such as the United States (USA) with 30% of occurrence, and up to 50% in Europe⁹9. Lingala S, Ghany MG. Natural History of Hepatitis C. Gastroenterol Clin North Am. 2015;44(4):717-34.^,1010. Moradpour D, Müllhaupt B. Hepatitis C: epidemiology natural course and diagnosis. Rev Med Suisse. 2015;11(471):896-901.. Although the topic has been widely discussed in many countries¹¹11. di Filippo D, Cortes-Mancera F, Beltran M, Arbelaez MP, Jaramillo S, Restrepo JC, et al. Molecular characterization of hepatitis c virus in multi-transfused Colombian patients. Virol J. 2012;9:242.^,1212. Nokhodian Z, Meshkati M, Adibi P, Ataei B, Kassaian N, Yaran M, et al. Hepatitis C among Intravenous Drug Users in Isfahan, Iran: a Study of Seroprevalence and Risk Factors. Int J Prev Med. 2012;3(Suppl 1):S131-138.^,1313. Alvarado-Mora MV, Fernandez MFG, Gomes-Gouvêa MS, de Azevedo Neto RS, Carrilho FJ, Pinho JRR. Hepatitis B (HBV), hepatitis C (HCV) and hepatitis delta (HDV) viruses in the Colombian population--how is the epidemiological situation? PLoS One. 2011;6(4):e18888.^,1414. Garfein RS, Rondinelli A, Barnes RFW, Cuevas J, Metzner M, Velasquez M, et al. HCV infection prevalence lower than expected among 18-40-year-old injection drug users in San Diego, CA. J Urban Health Bull N Y Acad Med. 2013;90(3):516-28.^,1515. Harris RJ, Ramsay M, Hope VD, Brant L, Hickman M, Foster GR, et al. Hepatitis C prevalence in England remains low and varies by ethnicity: an updated evidence synthesis. Eur J Public Health. 2012;22(2):187-92.^,1616. Klevens RM, Hu DJ, Jiles R, Holmberg SD. Evolving epidemiology of hepatitis C virus in the United States. Clin Infect Dis Off Publ Infect Dis Soc Am. 2012;55(Suppl. 1):S3-9.^,1717. Day CA, White B, Thein HH, Doab A, Dore GJ, Bates A, et al. Experience of hepatitis C testing among injecting drug users in Sydney, Australia. AIDS Care. 2008;20(1):116-23.^,1818. Kassaian N, Adibi P, Kafashaian A, Yaran M, Nokhodian Z, Shoaei P, et al. Hepatitis C Virus and Associated Risk Factors among Prison Inmates with History of Drug Injection in Isfahan, Iran. Int J Prev Med. 2012;3(Suppl. 1):S156-61.^,1919. Waheed Y, Shafi T, Safi SZ, Qadri I. Hepatitis C virus in Pakistan: a systematic review of prevalence, genotypes and risk factors. World J Gastroenterol WJG. 2009;15(45):5647-53., hepatitis C has been little studied in Colombia¹¹11. di Filippo D, Cortes-Mancera F, Beltran M, Arbelaez MP, Jaramillo S, Restrepo JC, et al. Molecular characterization of hepatitis c virus in multi-transfused Colombian patients. Virol J. 2012;9:242.^,2020. Navas M-C, Suarez I, Carreño A, Uribe D, Rios WA, Cortes-Mancera F, et al. Hepatitis B and Hepatitis C Infection Biomarkers and TP53 Mutations in Hepatocellular Carcinomas from Colombia. Hepat Res Treat. 2011;1-10.^,2121. Beltrán M, Navas MC, Arbeláez MP, Donado J, Jaramillo S, De la Hoz F, et al. Seroprevalence of hepatitis B virus and human immunodeficiency virus infection in a population of multiply-transfused patients in Colombia. Bioméd Rev Inst Nac Salud. 2009;29(2):232-43.^,2222. Cortes-Mancera F, Loureiro CL, Hoyos S, Restrepo J-C, Correa G, Jaramillo S, et al. Etiology and Viral Genotype in Patients with End-Stage Liver Diseases admitted to a Hepatology Unit in Colombia. Hepat Res Treat. 2011;1-10.^,2323. Beltrân M, Navas M-C, De la Hoz F, Mercedes Muñoz M, Jaramillo S, Estrada C, et al. Hepatitis C virus seroprevalence in multi-transfused patients in Colombia. J Clin Virol Off Publ Pan Am Soc Clin Virol. 2005;34(Suppl. 2):S33-8.^,2424. Alvarado-Mora MV, Botelho L, Nishiya A, Neto RA, Gomes-Gouvêa MS, Gutierrez MF, et al. Frequency and genotypic distribution of GB virus C (GBV-C) among Colombian population with Hepatitis B (HBV) or Hepatitis C (HCV) infection. Virol J. 2011;8:345..

The objective of this article was to identify factors associated to the prevalence of HCV infection in injection drugs users in three Colombian cities (Armenia, Bogotá and Cucuta).

METHODS

A cross-sectional descriptive study was carried out using survey-guided sampling and the inclusion criteria were: to be active users of injection drugs (more than 6 months of being injected), to be between 18 and 59 years of age, to sign the Informed Consent and to have a valid respondent driven sampling (RDS), except the seeds.

Due to the type of population studied, it was not possible to count on a known sample framework which would allow designing a conventional probabilistic sample, hence the option for a referenced chain sample based on the interviewees, a method proven useful to reach populations of difficult access such as users of injection drugs and which consists of a sample based on chains, though incorporating social networks theories in order to obtain a sample that approaches the population studied²⁵25. Cornell. Respondent Driven Sampling [Internet]. [cited 2014 July 8]. Available from: http://www.respondentdrivensampling.org/
http://www.respondentdrivensampling.org/... ^,2626. McCreesh N, Copas A, Seeley J, Johnston LG, Sonnenberg P, Hayes RJ, et al. Respondent driven sampling: determinants of recruitment and a method to improve point estimation. PLoS One. 2013;8(10):e78402..

This sampling method allows evaluating the probabilities of inclusion in relation to population, with a mathematical model, derived from the theory of Markov chains. This calculation estimates the population and their corresponding confidence intervals. Those numbers derive from the information about interviewees regarding their relations both with their recruiters and the size of their own social networks. Thus, this sampling method inferences from the population’s social networks²⁷27. Paquette D, Bryant J, Wit J. Respondent-Driven Sampling and the Recruitment of People with Small Injecting Networks. AIDS Behav. 2012;16(4):890-9..

Recruitment begins with a group of “seeds” or non-random participants in the target population. In the case of the present survey, an initial amount of three seeds was determined, out of the possible ones for each city; The size of the sample was calculated by using the formula for one proportion, confidence level at 1-α 95%, absolute precision at 5%, the minimum sample size for each city was 196 people, 668 users of injection drugs were questioned in all three cities using the same methodological design.

An applied and reviewed instrument was used in an investigation from UDI in 2010²⁸28. Berbesi D, Montoya L, Segura A. Prevalencia de VIH y comportamientos de riesgo en UDI en Medellin y Pereira. Bogota: Ministerio de Proteccion Social; 2012., based on an instrument designed in 2000 by the WHO, in Bogotá²⁹29. Mejía IE, Gómez AP. La inyección de drogas en Bogotá: una amenaza creciente. Adicciones. 2005;17(3):251-60.. The form included questions regarding demographic and behavioral characteristics of risk and a laboratory testing on filter paper to detect hepatitis C (antibody test)³⁰30. Pérez Guevara MT, Rolo Gómez FM, Nibot Sánchez C, Cruz Sui O, Rodríguez O. Determinación de anticuerpos al virus de la inmunodeficiencia humana tipo 1 (VIH-1) en muestras de sangre seca en papel de filtro. Rev Cubana Med Trop. 1998;50(2):93-5., the cases were confirmed by RNA viral load tests (the viral load was performed by the m2000 real time HCV system of Abbott, based on the real-time polymerase chain reaction (PCR), with filter paper sensitivity samples of 400 UI/mL).

As a control measure for information bias among interviewers, a training was conducted prior to the collection of information; confidentiality of the information provided by the population was ensured. The project was approved by the Research Ethics Committee of Universidad CES.

The statistical analysis and result tables were built in RDSAT^® and SPSS^® 21.0. They present the description of UDI characteristics and the estimated prevalence of hepatitis C with confidence interval (CI) of 95%. In order to establish the association between exposure factors and the prevalence of hepatitis C, the statistical χ ² and Fisher’s exact tests were performed, with significance level of 5%; Likewise, gross prevalence ratios (PR) with values of p < 0.25 in the bivariate were adjusted through logistic regression.

RESULTS

The total users of injection drugs included was 668, of which 265 (39.7%) were from Armenia, 193 (28.9%) from Bogotá and 210 (31.4%) from Cucuta; with mean age of 26 years old (minimum 18 and maximum 59 years of age); 82.2% (549) were men; 73.7% (492) did not have stable partners; 50% had complete secondary education; the socioeconomic level of living, before starting to use drugs decreased 68.7% and right after using drugs, it increased by 16%. As for drug consumption, the mean time of drug consumption was 5.74 (DS: 5.2) years (Table 1).

The estimated prevalence for HCV infection in the total study population was 17.5% and for HIV infection was 4.2%. The highest HCV prevalence population were the users from the city in Armenia with 22.3% (95%CI 12.3% - 23.5%) previously published data³¹31. Berbesi-Fernández D, Segura-Cardona Á, Montoya-Vélez L, Castaño-Perez GA. Hepatitis C y VIH en usuarios de drogas inyectables en Armenia-Colombia. Adicciones. 2015;27(4):246-52., followed by Cucuta with 21.4% (95%CI 15.7% - 26.4%) and finally Bogotá with 7.6% (95%CI 3.2% - 13.3%).

Fifty-four percent (14/26) of injection drugs users with HIV infection had HCV infection; it was observed, in all three cities, that having HCV infection increased by six times the risk of having HIV (PRaj 6.87; 95%CI 2.86 - 16.06); the population with the highest frequency of HIV/HCV co-infections was the group of users from Cucuta, 75%, followed by Armenia with 42.9% and Bogotá with 28.6%.

Three times the risk of having HCV was observed in people who at any given time in their lives injected themselves along with other users who reported having HCV (PRaj 2.45; 95%CI 1.33 - 4.53). Another associated factor observed was taking doses of a drug mixture shared by other people (PR 1.9; 95%CI 1.12 - 3.21); likewise, not purchasing needles and syringes in pharmacies increased twice the risk of having HCV (PR 1.86; 95%CI 0.94 - 3.69) (Table 2).

Other more frequent factors in people with hepatitis C were the consumption of marijuana (PR 1.54; 95%CI 0.15 - 15.43) and the consumption of basuco (PR 1.47; 95%CI 0.42 - 5.13). On the other hand, the consumption of cocaine (62.2%) and alcohol (95.6%) did not report differences in the proportions.

DISCUSION

There are few studies on hepatitis C in Colombia³²32. Alvarado-Mora MV, Fernandez MFG, Gomes-Gouvêa MS, de Azevedo Neto RS, Carrilho FJ, Pinho JRR. Hepatitis B (HBV), hepatitis C (HCV) and hepatitis delta (HDV) viruses in the Colombian population--how is the epidemiological situation? PLoS One. 2011;6(4):e18888., and this investigation identified a significant number of injection drugs users who share and reuse injection equipment, similarly to what was observed in other cities of Colombia in 2010³³33. Berbesi D, Segura A, Montoya L. Cross-sectional study of HIV prevalence and the characteristics of injecting drug users in Colombia. J Subst Use. 2013;364-7.^,3434. Mateu-Gelabert P, Harris S, Berbesi D, Cardona ÁMS, Vélez LPM, Motta IEM, et al. Heroin Use and Injection Risk Behaviors in Colombia: Implications for HIV/AIDS Prevention. Subst Use Misuse. 2016;51(2):230-40.^,3535. Berbesi D, Segura-Cardona A, Montoya-Vélez L, Mateu-Gelabert P. Consumo de heroína inyectada en Colombia y comportamientos de riesgo. Salud Ment. 2013;36(1):27-31.; widely documented and discussed factors in other countries, though for Colombia, represent the first step toward intervention strategies³⁶36. Sepúlveda-Arias JC, Isaza C, Vélez JP. Hepatitis B and C prevalence among heroin addicts in methadone maintenance treatment (MMT) and not in MMT in Pereira, Colombia. J Infect Dev Ctries [Internet]. 2014 [cited 2015 July 13];8(09). Available from: http://www.jidc.org/index.php/journal/article/view/4525
http://www.jidc.org/index.php/journal/ar... .

Co-infections of HIV and HCV have been reported among drug users in different countries. In Tijuana, a seven times higher risk of hepatitis C was observed³⁷37. Cruz I de A, Aguilar MR, Badillo LOC. Sexo transaccional en usuarios de drogas como factor de riesgo para infecciones de transmisión sexual. Rev Sexol Soc [Internet]. 2014 [cited 2015 Oct 8];20(2). Available from: http://www.revsexologiaysociedad.sld.cu/index.php/sexologiaysociedad/article/view/484
http://www.revsexologiaysociedad.sld.cu/... and in Ireland, 62% of people with hepatitis had HIV; in Hong Kong, the co-infection was between 46% and 74% and in Thailand, up to 90% of UDI had these infections³⁸38. Lee SS. Prevalence of hepatitis C infection in injection drug users in Hong Kong. Hong Kong Med J. 2009;15(Suppl. 8):45-6.. The present study also observed that UDI with HIV had six times the risk of contracting hepatitis C infection.

An UDI study was carried out in San Diego, California, with a sample of 510 people³⁹39. Page K, Hahn JA, Evans J, Shiboski S, Lum P, Delwart E, et al. Acute hepatitis C virus infection in young adult injection drug users: a prospective study of incident infection, resolution, and reinfection. J Infect Dis. 2009;200(8):1216-26., mostly men (74%), finding prevalences of hepatitis C at 26.9% (95%CI 23.0 - 30.7%) and HIV at 4.2% (95%CI 2.4 - 5.9%)¹⁴14. Garfein RS, Rondinelli A, Barnes RFW, Cuevas J, Metzner M, Velasquez M, et al. HCV infection prevalence lower than expected among 18-40-year-old injection drug users in San Diego, CA. J Urban Health Bull N Y Acad Med. 2013;90(3):516-28..

In all three cities in Colombia, the UDI population behaved similarly to what was reported in California, obtaining a sample of 668 people, of which 82.2% were men, with prevalence of 17.5% (95%CI 14.55 - 20.47) for HCV and 3.9% (95%CI 2.35 - 5.43) for HIV. Likewise, this study and others in the world on UDI have observed that men have greater prevalence of HCV infection; in Colombia, 18,2% of men had hepatitis C in comparison to 12.6% of women, without statistically significant differences.

A study carried out in Iran found that injection drugs users who shared syringes had three times higher probability of getting infected than the ones who did not share needles¹²12. Nokhodian Z, Meshkati M, Adibi P, Ataei B, Kassaian N, Yaran M, et al. Hepatitis C among Intravenous Drug Users in Isfahan, Iran: a Study of Seroprevalence and Risk Factors. Int J Prev Med. 2012;3(Suppl 1):S131-138.. Differences between the cities were found in Colombia, considering the one who shared syringes the most: Bogota (58.5%), followed by Armenia (37.2%) and finally Cucuta (26.8%), justifying the need to install damage reduction and control programs.

High incidence and rapid increase in the prevalence of hepatitis C was found in young populations, with recent drug consumption, family instability, with partners who were also injection drugs users, and with a history of having injected themselves along with people with HCV⁴⁰40. Grebely J, Dore GJ. Prevention of hepatitis C virus in injecting drug users: a narrow window of opportunity. J Infect Dis. 2011;203(5):571-4.^,4141. Dalgard O, Egeland A, Ervik R, Vilimas K, Skaug K, Steen TW. Risk factors for hepatitis C among injecting drug users in Oslo. Tidsskr Nor Lægeforen. 2009;129(2):101-4..

This was similar to what was observed in Colombia, where the associated factors to hepatitis C were: being HIV positive, single, male, injecting along with other people with hepatitis, using doses from a shared syringe and injecting with a homemade syringe.

A high prevalence of hepatitis C was found in Brazil, associated to drug consumption, increasing the progress into chronic diseases with low response to antiviral therapy; hence the authors’ proposing the use of intervention strategies as soon as possible⁴⁰40. Grebely J, Dore GJ. Prevention of hepatitis C virus in injecting drug users: a narrow window of opportunity. J Infect Dis. 2011;203(5):571-4.^,4242. Lopes CLR, Teles SA, Espírito-Santo MP, Lampe E, Rodrigues FP, Motta-Castro ARC, et al. Prevalence, risk factors and genotypes of hepatitis C virus infection among drug users, Central-Western Brazil. Rev Saúde Pública. 2009;43(Suppl. 1):43-50.. The present investigation of hepatitis C in UDI is mainly associated to the consumption of marijuana (OR 1.54) and basuco (OR 1.47); high consumptions of cocaine and alcohol was also observed.

Basuco and crack are smokable forms of cocaine, which differ in that the first is obtained through the extraction of alkaloids from the coca leaf and which are not process until they become cocaine hydrochloride, while crack is obtained by mixing cocaine hydrochloride with sodium bicarbonate and water or ammonia. Basuco is predominant in countries of the Andean region of Latin America, whilst crack is more widely spread in North America and the rest of the world⁴³43. Castaño G. Cocaínas fumables en Latinoamérica. Adicciones. 2000;12(4):541-50..

Basuco and crack have similar neurobiological and social deterioration effects in addition to a great addictive potential, reason why basuco is considered “equivalent” to crack in less resourceful Latin American countries such as Colombia⁴⁴44. Berbesi Fernandez D, Fernandez DYB, Segura-Cardona A, Montoya-Velez L, Hernández-Rendón M. Consumo de basuco en usuarios de drogas inyectables de Colombia. Rev Cuba Salud Pública [Internet]. 2016;42(2). Available from: http://www.revsaludpublica.sld.cu/index.php/spu/article/view/393
http://www.revsaludpublica.sld.cu/index.... . Studies evaluating crack consumption in UDI and their associated higher risk behaviors have documented that this group is more prone to promiscuity and sexual exchange for drugs⁴⁵45. Booth RE, Kwiatkowski CF, Chitwood DD. Sex related HIV risk behaviors: differential risks among injection drug users, crack smokers, and injection drug users who smoke crack. Drug Alcohol Depend. 2000;58(3):219-26., as well as increased seroconversion for HCV and HIV⁴⁶46. DeBeck K, Kerr T, Li K, Fischer B, Buxton J, Montaner J, et al. Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs. Can Med Assoc J. 2009;181(9):585-9..

In Pakistan, an increased prevalence of hepatitis C in drug users was identified, once they prefer injecting over inhaling the drug due to the decreased availability and quality of the heroin which was often consumed inhaled; thus, new drug users prefer to initiate their consumption intravenously in order to obtain the greatest satisfactory effect from the very beginning¹⁹19. Waheed Y, Shafi T, Safi SZ, Qadri I. Hepatitis C virus in Pakistan: a systematic review of prevalence, genotypes and risk factors. World J Gastroenterol WJG. 2009;15(45):5647-53.; The present study found that 83.6% of the studied population injected heroin at their first time, followed by cocaine and a smaller portion began with ketamine injections.

It has been proposed that HIV and HCV prevention is achieved by reducing the risk behaviors leading to the infections, such as injecting drugs, sharing syringes, using homemade syringes and the number of times a syringe is used, considering the three later ones are the factors more strongly associated to these infections; though despite the available evidence, current coverage of intervention strategies to decrease UDI damage are limited in the world⁴⁰40. Grebely J, Dore GJ. Prevention of hepatitis C virus in injecting drug users: a narrow window of opportunity. J Infect Dis. 2011;203(5):571-4.. There are no restrictions in Colombia for the purchase of syringes, but the high reuse of syringes by users injected with drugs, and the use of homemade syringes, suggest low availability and access to clean and new syringes³³33. Berbesi D, Segura A, Montoya L. Cross-sectional study of HIV prevalence and the characteristics of injecting drug users in Colombia. J Subst Use. 2013;364-7..

A study carried out in 2012 concluded the prevalence rates of hepatitis C worldwide are increasing, reason the primary prevention guided by “safe injection practices” are important, once that the mortality caused by this infection will double in the next few decades, significantly increasing direct and indirect costs, as well as the total costs for the treatment of this disease¹⁸18. Kassaian N, Adibi P, Kafashaian A, Yaran M, Nokhodian Z, Shoaei P, et al. Hepatitis C Virus and Associated Risk Factors among Prison Inmates with History of Drug Injection in Isfahan, Iran. Int J Prev Med. 2012;3(Suppl. 1):S156-61.. Thus, programs targeting illicit drugs users are imperative, in addition to an exchange program for syringes and contaminated injection objects and reinforcing education for UDIs about possible diseases transmitted by blood⁴⁷47. Hassannejad R, Kassaian N, Ataei B, Adibi P. High risky behaviors among intravenous drug users in Isfahan, Iran: A study for hepatitis C harm reduction programs. Int J Prev Med. 2012;3(Suppl. 1):S73-8..

Drug consumption requires thinking of damage reduction strategies between active consumers who are not willing to refrain from using them. The programs emphasized to be implemented are syringe Exchange, injection workshops and safe sex programs, especially among beginners and young injectors, once that some authors suggest that the circumstances, behaviors and practices observed in the first injection are critical and may be reproduced throughout their “drug injection career” ⁴⁸48. Centers for Disease Control. Prevention of acquired immune deficiency syndrome (AIDS): report of inter-agency recommendations. MMWR Morb Mortal Wkly Rep. 1983;32(8):101-3.^,4949. Bruggmann P, Grebely J. Prevention, treatment and care of hepatitis C virus infection among people who inject drugs. Int J Drug Policy. 2015;26(Suppl. 1):S22-6..

It could be noted this investigation had limitations such as its sample being interview-based and thus being considered a non-random type of selection which must fulfill a series of assumptions to be considered a sample dependent of the social network; the information about the provision of homemade syringes was not investigated in depth; furthermore, these data result from a survey which collected self-reports of drug consumption practices, and may have inaccuracies based on the honesty of the response.

CONCLUSIONS

This investigation shows an established consumption of injection drugs and the presence of hepatitis C virus in the social networks of UDIs; it was not expected that, despite the lack of intervention strategies or a plan to reduce HCV and HIV transmission, the prevalence of these infections was not as high when compared to other countries⁵⁰50. Aceijas C, Rhodes T. Global estimates of prevalence of HCV infection among injecting drug users. Int J Drug Policy. 2007;18(5):352-8.. It is not considered that high prevalences of these diseases should be expected in order to onset damage control programs.

The prevalence of hepatitis C and the high reuse of syringes represent an alert in the Colombian cities, indicating the presence of infection in injection networks and emphasizing the importance of generating new and specific interventions for the reduction of damage and the prevention of hepatitis C in this population.

References

Publication Dates

History