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Background:
South Africa has an estimated 82,000 people who inject drugs (PWID). PWID in Tshwane faces alarmingly high prevalences of HIV, 72%, and hepatitis c virus (HCV), 89%. Community-based services, including opioid agonist therapy (OAT), have been available in Tshwane since 2016, however coverage remain low.
Methods:
A retrospective review of Sediba Hope Medical Centre in Tshwane’s PWID clinical records from October 2015 to March 2025 identified unique participants using probabilistic record linkage, with a 0.75 match threshold. Patterns of HIV, hepatitis b (HBV) and HCV disease cascades were analyzed using descriptive statistics and binary regression in Stata 18.0.
Results:
From the 1,618 unique screening visits recorded, 737 unique participants were identified. Most were male, 90.9% (n=670), median age 32 [IQR 28-37] years, and current PWID, 92.7% (n=683). The period prevalence was 83.3% (n=614, 95%CI 80.4-85.9%) for anti-HCV, 53.4% (n=351, 95%CI 49.5-57.3%) for HIV, and 11.4% (n=73, 95%CI 9.1-14.1%) for HBsAg, with 48.8% (n=308, 95%CI 44.8-52.8%) HIV-HCV coinfections were observed. Of those assessed, 87.7% (n=429, 95%CI 84.5-90.5%) were HCV- and 96.0% (n=24, 95%CI 79.6-99.9%) HBV viremic. Of those with serial screens, 26.9% (n=118/631, 95%CI 22.8-31.4%) acquired infections within a median of 4.3 months [IQR3.1-6.4]. Those not seroconverting accessed OAT (25.3%, n=81), harm reduction packs (39.4%, n=126) or abstained (14.4%, n=46). The odds of seroconversion were significantly reduced in those accessing HCV- (OR=0.25, p<0.01) or HIV (OR=0.22, p<0.01) treatment.
Conclusion:
The persistent, escalating burden of HCV and HIV in PWID underscores the urgency for upscaled prevention interventions for PWID across South Africa. While the prevalence of HBV was comparatively lower, the rise in coinfection necessitates continued surveillance and targeted vaccination efforts.
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