Presenting author: Behzad Hajarizadeh
Presenting author biography:
Behzad is a clinical epidemiologist, and an Associate Professor in the Kirby Institute (UNSW Sydney). His main areas of research include epidemiology and clinical management of viral hepatitis, particularly in the prison setting, and among people who inject drugs.
Global, regional, and country-level coverage of testing and treatment for HIV and hepatitis C infection among people who inject drugs: a systematic review
Behzad Hajarizadeh, Abe Kairouz, Evan Cunningham, Sophie Ottaviano, Alexandra Willing, Jeremy Ireland, Paige Webb, Samantha Colledge-Frisby, Alice Wheeler, Janni Leung, Lucy Tran, Olivia Price, Peter Vickerman, Michael Farrell, Matthew Hickman, Gregory Dore, Louisa Degenhardt, Jason Grebely, Amy Peacock
Background: People who inject drugs (PWID) are disproportionately affected by HIV and HCV infections. We conducted a systematic review to evaluate country-, regional-, and global-level coverage of HIV and HCV testing and treatment among PWID.
Methods: We searched peer-reviewed databases (MEDLINE, Embase, PsycINFO) and grey literature for studies published until April 2022 that reported the proportion of PWID who received testing or treatment for HIV or HCV. For each country, we estimated the proportion of PWID receiving HIV antibody testing in the past 12 months (recent), and those ever receiving HCV antibody and HCV RNA testing. We also estimated the proportion of PWID with HIV currently receiving antiretroviral therapy, and those with HCV ever receiving HCV antiviral treatment. Population-weighted regional and global estimates were generated where sufficient data were available.
Findings: Overall, 510 studies were included. Globally, an estimated 52.9% of PWID (67 countries) recently received HIV antibody testing [uncertainty interval (UI): 48.1-57.7; range: 0.9-86.0], and 46.4% (47 countries) ever received HCV antibody testing (UI: 41-52.8; range: <0.1-93.3). HCV RNA testing data were available from three countries. Coverage of HIV and HCV antibody testing was >75% in five and 14 countries, respectively. Data on uptake of current HIV therapy were available from 18 countries, ranging from 2.6% to 81.9%. Data on ever receiving HCV therapy were available from 23 countries, ranging from 1.8% to 88.6%. Uptake of HIV and HCV therapy was >75% in two and one countries, respectively.
Conclusion: HIV and HCV testing and treatment uptake among PWID varied widely across countries, with sub-optimal levels of uptake in most countries. Country-level data were limited, particularly on HCV RNA testing and HIV and HCV treatment uptake. More investments and tailored strategies at national and international levels are required to provide equitable access to HIV and HCV testing and treatment.