Identifying Potential Modes of Transmission of Hepatitis C in People Who Inject Drugs Versus the General Population in Punjab, India

Author: Gagandeep Grover Roli Tandon Caroline Boeke P Lakshmi Umesh Chawla Parag Govil

Theme: Epidemiology & Public Health Research Year: 2022

Hepatitis C antibody (Anti-HCV) prevalence in Punjab, India, is higher than the national average, along
with a high presence of people who inject drugs (PWID). In addition to understanding the primary
drivers of HCV transmission in the general population, understanding risk factors in PWID is important
to inform policy to expand access to prevention, diagnosis, and treatment of the disease.
A quantitative interview assessing exposure to HCV risk factors was administered to 2,358 people
(with sex and age enrolment targets) presenting for anti-HCV screening across 10 facilities in Punjab;
Risk ratios were calculated to assess risk factors for HCV positivity overall. Chi-square tests accounting
for data clustering by health facility were conducted to compare frequencies of risk factors between
PWID and the general population.
74.8% respondents tested anti-HCV positive; 13.7% reported injecting drugs, of which 60.6% reported
sharing needles. Injecting drugs was the strongest risk factor for testing positive (Risk Ratio: 1.37, 95%
Confidence Interval: 1.24 – 1.51). PWID, compared to the general population, were more likely to test
HCV positive (95.4% vs 71.5%), to be male (97.9% vs. 51.3%), younger (18-30 years) (70.8% vs. 21.4%),
unmarried (50.2% vs. 8.6%), and of higher (secondary) education (69.5% vs. 35.9%) with chi-square pvalues for all <0.001 Risk factors identified in overall respondents that were significantly more
common among PWID versus the general population were having tattoos (51.4% vs. 12.9%; p<0.001),
being a blood donor (36.0% vs. 15.7%; p=0.01), and a history of incarceration (20.3% vs. 4.3%;
Despite harm reduction programs, PWID continue to be at the highest risk of HCV infection. Greater
attention on HCV prevention is needed, with a focus on people centered harm reduction programs,
behavioral change interventions, and increasing safety in settings through which HCV may be
Disclosure of Interest Statement:

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