TB HIV Care, 11 Adderley Street, Cape Town, South Africa.
Department of Family Medicine, University of Pretoria, Pretoria, South Africa.
BMC Infect Dis. 2020 Sep 7;20(1):655. doi: 10.1186/s12879-020-05359-y.
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.
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.
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%).
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.
包括吸毒者（吸毒者/ ID）、性工作者（SWs）和男男性接触者（MSM）在内的药物使用者面临艾滋病毒和病毒性肝炎感染的风险增加。南非关键人群（KPs）中有关这些感染的流行病学数据有限。我们调查了这些 KPs 中的乙型肝炎（HBV）、丙型肝炎（HCV）和 HIV 的流行率以及选定的危险因素，以为有效应对措施提供信息。
我们使用便利抽样法招募了来自开普敦（SWs、MSM、PWUD/ID）、德班（SWs、PWUD/ID）、彼得马里茨堡（SWs）、姆塔塔（SWs）、伊丽莎白港（SWs）、约翰内斯堡（MSM）和比勒陀利亚（MSM 和 PWUD/ID）的 3500 名接受 HIV 相关卫生服务的 KPs 进入横断面调查。使用访谈者问卷评估社会人口统计学特征、药物使用和性行为风险行为。进行了乙型肝炎表面抗原（HBsAg）；丙型肝炎抗体、病毒载量和基因型以及 HIV 抗体检测。
在纳入研究的 3439 人中（1528 名性工作者、746 名男男性接触者、1165 名吸毒者/ ID），中位年龄为 29 岁，大多数参与者为黑人非洲人（60%），24%报告无家可归。82%的人在过去一个月内使用过物质，包括酒精（46%）和海洛因（33%）。75%的人在上一个月有过性行为，最后一次性行为时避孕套使用率为 74%。HIV 流行率为 37%（性工作者中最高为 47%），HBsAg 流行率为 4%（各 KP 相似），HCV 流行率为 16%（吸毒者/ ID 中最高为 46%）。
乙型肝炎、丙型肝炎和 HIV 给南非的 KPs 带来了健康负担。虽然 HIV 对所有纳入的 KPs 都很重要，但 HCV 对吸毒者/ ID 尤为重要。对于 KPs，需要乙型肝炎疫苗接种和行为改变干预措施，以支持持续使用避孕套和润滑剂，并提供支持。需要扩大阿片类药物替代疗法和针具交换服务的覆盖面，并为吸毒者/ ID 提供 HCV 治疗。
