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Epidemiology of HIV and hepatitis C infection among women who inject drugs in Northeast India: A respondent-driven sampling study.

Epidemiology of HIV and hepatitis C infection among women who inject drugs in Northeast India: A respondent-driven sampling study.
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Mcfall AM, Solomon SS, Lucas GM, Celentano DD, Srikrishnan AK, Kumar MS, Mehta SH,


Mcfall AM, Solomon SS, Lucas GM, Celentano DD, Srikrishnan AK, Kumar MS, Mehta SH, (click to view)

Mcfall AM, Solomon SS, Lucas GM, Celentano DD, Srikrishnan AK, Kumar MS, Mehta SH,

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Addiction (Abingdon, England) 2017 03 20() doi 10.1111/add.13821

Abstract
BACKGROUND AND AIMS
Despite extensive research on HIV and hepatitis C (HCV) among people who inject drugs (PWID), there remains a gap in knowledge on the burden among women who inject drugs and their unique contexts and risk factors. This analysis compares HIV and HCV prevalence in female and male PWID and estimates injection and sexual risk correlates of prevalent HIV and HCV infection among women in Northeast India.

DESIGN
Cross-sectional sample accrued using respondent-driven sampling.

SETTING
Seven cities in Northeast India, 2013.

PARTICIPANTS
6,457 adult PWID.

MEASUREMENTS
Participants completed an interviewer-administered survey. HIV infection was diagnosed onsite and HCV antibody testing was done on stored specimens. HIV and HCV prevalence estimates were stratified by gender. Among women, the association of risk correlates with HIV and HCV were estimated using multi-level logistic regression models.

FINDINGS
796 (16%) of the PWID were women, of whom 53% (95% confidence interval [CI]: 49-57%) were HIV-infected and 22% (CI: 20-25%) were HCV-infected. HIV and HCV prevalence among men was 17% (CI: 17-18%) and 32% (CI: 31-32%), respectively. Among women, correlates of HIV were widowhood (adjusted odds ratio [aOR] vs. currently married: 4.0, CI: 2.1-7.6) and a higher number of lifetime sexual partners (aOR ≥8 vs. none: 3.1, CI: 1.1-8.9). Correlates of HCV were longer injection duration (aOR per 10 years: 1.7, CI: 1.3-2.3), injecting only heroin and a combination of drugs (aOR vs. pharmaceuticals only: 5.6, CI: 1.7-18.9 and aOR: 2.6, CI: 1.6-4.2, respectively), sharing needles/syringes (aOR: 2.5, CI: 1.3-4.6) and a larger PWID network (aOR ≥51 vs. 1-5: 4.2, CI: 2.4-7.2).

CONCLUSIONS
Women who inject drugs in Northeast India have a high HIV prevalence which was more than double their hepatitis C (HCV) prevalence, an opposite pattern than is typically observed among male PWID. HIV infection is associated with sexual risk factors while injection-related behaviors appear to drive HCV infection.

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