National Association of People Living with HIV/AIDS in Nepal (NAP+N), Kathmandu, Bagmati, Nepal.
National Centre for AIDS and STD Control (NCASC), Kathmandu, Bagmati, Nepal.
PLoS One. 2021 May 28;16(5):e0252490. doi: 10.1371/journal.pone.0252490. eCollection 2021.
People who inject drugs (PWIDs) have sub-optimal HIV and HCV testing as the available testing services are inadequate in low and middle-income countries. We examined a model of Community-Led Testing (CLT) in Nepal, exploring the feasibility of HIV and HCV testing by trained lay service providers who had similar backgrounds to those of PWIDs. We also assessed the prevalence of HIV and HCV within this study population and the associated risk factors among PWIDs.
A mix-methods cross-sectional study was conducted among 1029 PWIDs in five major districts of Nepal from July 2019 to February 2020. Trained PWID peers performed the screening for HIV and HCV using Rapid Diagnostic Test (RDT) kits. Acceptability and feasibility of the testing was assessed. The participants' sociodemographic characteristics and injecting and non-injecting risk characteristics were determined. The association of risk and prevention characteristics with testing results were assessed using multiple logistic regression.
PWIDs shared that the test providers were friendly and competent in counseling and testing. Of total PWIDs (n = 1,029), 20.6% were HCV-positive and 0.2% were HIV-positive. HCV positivity was associated with needle sharing (AOR: 1.83, 95% CI: 1.27,2.64; p = 0.001) and reuse of syringe/needle (AOR: 2.26; 95% CI: 1.34, 3.79; p = 0.002). In addition, PWIDs were more likely to be HCV-positive who started opioid substitution therapy (OST) (AOR: 1.88, 95% CI: 1.26, 2.80, p = 0.002) and attended the rehabilitation center (AOR: 1.66, 95% CI: 1.10, 2.53, p = 0.017).
This CLT model was found to be a novel approach of testing of HIV and HCV which was acceptable to PWIDs in Nepal and showed the high prevalence of HCV and its association with injecting-related risk behaviors and being users of OST and rehabilitation. The findings highlight the need of community-led testing in hotspots, OST settings, and rehabilitation centers to screen new HIV and HCV infections.
在中低收入国家，由于现有检测服务不足，注射毒品者（PWID）的 HIV 和 HCV 检测率并不理想。我们在尼泊尔考察了一种社区主导的检测（CLT）模式，探索由与 PWID 背景相似的经过培训的非专业服务提供者进行 HIV 和 HCV 检测的可行性。我们还评估了该研究人群中 HIV 和 HCV 的流行率以及 PWID 中的相关风险因素。
2019 年 7 月至 2020 年 2 月，在尼泊尔五个主要地区对 1029 名 PWID 进行了一项混合方法的横断面研究。经过培训的 PWID 同伴使用快速诊断检测（RDT）试剂盒进行 HIV 和 HCV 的筛查。评估了检测的可接受性和可行性。确定了参与者的社会人口学特征以及注射和非注射风险特征。使用多因素逻辑回归评估风险和预防特征与检测结果的关联。
PWIDs 表示检测提供者在咨询和检测方面既友好又有能力。在总共 1029 名 PWID 中，20.6% HCV 阳性，0.2% HIV 阳性。HCV 阳性与针具共享（优势比[OR]：1.83，95%置信区间[CI]：1.27，2.64；p=0.001）和注射器/针头重复使用（OR：2.26；95%CI：1.34，3.79；p=0.002）相关。此外，开始阿片类药物替代疗法（OST）（OR：1.88，95%CI：1.26，2.80，p=0.002）和参加康复中心（OR：1.66，95%CI：1.10，2.53，p=0.017）的 PWID 更有可能 HCV 阳性。
该 CLT 模式被发现是一种在尼泊尔对 PWID 进行 HIV 和 HCV 检测的新方法，得到了 PWID 的认可，并显示出 HCV 的高流行率及其与注射相关的风险行为以及 OST 和康复的使用者之间的关联。这些发现强调了在热点地区、OST 场所和康复中心进行社区主导的检测以筛查新的 HIV 和 HCV 感染的必要性。
