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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 2  |  Issue : 1  |  Page : 9-12

Viral hepatitis C infection among injecting drug users and their partners in Manipur


1 Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
2 BABINA Diagnostics, Manipur, India
3 Department of Community Medicine Department, Regional Institute of Medical Sciences, Imphal, Manipur, India
4 Community Network for Empowerment Imphal, Manipur, India

Date of Submission10-Nov-2020
Date of Decision24-Feb-2021
Date of Acceptance25-Mar-2021
Date of Web Publication25-Apr-2021

Correspondence Address:
Prof. Romeo Singh Karam
Department of Medicine, Regional Institute of Medical Sciences, Lamphelpat, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_184_20

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  Abstract 

Background: People who inject drugs (PWID) are the key population at risk of hepatitis C virus (HCV) infection. In this study, HCV infection among PWID was carried out with the objective of determining the proportion of hepatitis C antibody-positive individuals in the state of Manipur, in Manipur, a small northeastern state of India. Aims: The present study aims to establish prevalence data of hepatitis C antibody among population in the state of Manipur, India. The study was conducted from July to December 2018 in the nine districts of state of Manipur. Blood samples were collected for HCV testing; along with this, we conducted awareness sessions during camps. Pre- and post-tests were done using a questionnaire. A total of 2219 participants are PWID and their spouses were enrolled. Results: Male: female ratio was 1885/334. Majorities of the participants were from 25 to 44 years of age. Forty-three per cent were positive in the screening. Ukhrul district has the highest HCV positive closely followed by Churachandpur district. About 13.5% of participants with known human immunodeficiency virus (HIV) status were positive of HCV. Conclusions: HCV infection in PWID in Manipur, Northeast of India, is 43%, most of them are young and co-infection with HIV is seen in 13.5%.

Keywords: Cirrhosis, co-infection, DAAs, hepatitis C virus, hepatocellular carcinoma, human immunodeficiency virus, morbidity, mortality, prevalence, people who inject drugs


How to cite this article:
Karam RS, Singh TD, Akoijam BS, Rajkumar N. Viral hepatitis C infection among injecting drug users and their partners in Manipur. J Med Evid 2021;2:9-12

How to cite this URL:
Karam RS, Singh TD, Akoijam BS, Rajkumar N. Viral hepatitis C infection among injecting drug users and their partners in Manipur. J Med Evid [serial online] 2021 [cited 2022 Aug 12];2:9-12. Available from: http://www.journaljme.org/text.asp?2021/2/1/9/314621


  Introduction Top
Hepatitis C virus (HCV) infects nearly 170 million people worldwide and is a leading cause of progressive liver damage, cirrhosis and hepatocellular carcinoma.[1] Fortunately, HCV infection is curable. HCV infection is very common among people who inject drugs (PWID) and the burden of HCV-related liver disease among PWID is increasing, but treatment uptake remains extremely low. Manipur which has a population of about 28.56 lakhs (as per Census 2011, Manipur) harbours a sizeable proportion of drug and substance users. Manipur has an estimated 34,344 population of PWID[2] (Magnitude of Substance Use in India, 2019 MSJE). Among the various diseases closely associated with PWID community, hepatitis C has also been one which affects the community to a large extent and is a serious concern for them as sharing contaminated injecting paraphernalia highly increases the risk of hepatitis C infection. Unfortunately, there are no authenticated and official HCV prevalence and incidence data to understand the disease burden among this population. The need to focus in this section of the population has thus arisen. HCV is readily transmissible via non-sterile injections.[3],[4] Its transmissibility combined with a high population prevalence among PWID is estimated at 43%–67%,[5],[6],[7] and a high prevalence of drug injecting behaviours that facilitate transmission (e.g., 30% rates of receptive syringe sharing)[8] leads to situations of high annual incidence of HCV infection.[9],[10] Treatment is likely to have a synergistic impact on HCV prevention efforts. Modelling studies suggest that antiviral treatment could play an important, and cost-effective, role in preventing HCV in PWID by reducing the number at risk of transmitting HCV.[11]
  Materials and Methods Top
Ethical approval from the Research Ethics Board, Regional Institute of Medical Sciences, Lamphelpat, Manipur, was obtained before conducting the study. A cross-sectional study was conducted to determine the HCV infection among injection drug users (IDUs) in Manipur, a northeastern state of India, through service outlets. Partners of IDUs also were included in the study whenever possible. The primary objective of this study was to determine the proportion of hepatitis C antibody positivity among IDUs in Manipur, and the secondary objective was to estimate the awareness of HCV infection among the study population. The study aimed to include as much as possible participants from the targeted intervention sites located in the nine districts of the state (Imphal East, Imphal West, Thoubal, Ukhrul, Senapati, Churachandpur, Bishnupur, Tamenglong and Chandel). Those participants who were at the age group of 18 years and above, self-report of illicit drug injection in the prior 2 years and who were informed consent were eligible to participate in the study. PWIDs were recruited from drug treatment centres (DTC), opiate substitution treatment centres, needle and syringe exchange programmes (NSEPs) and hospitals. Purposive sampling was used for recruitment of participants in the study. This approach was taken into account considering the hidden and hard-to-reach nature of the population. The sites for the study were identified where there was a high concentration of PWID which include DTCs, opioid substitution treatment (OST) centres and NSEPs. After taking consent, the participants underwent a rapid test for HCV with pre- and post-test counselling. To avoid duplication, signatures were taken. Pre- and post-tests to assess the knowledge of HCV infection were done using a questionnaire. The study was conducted from 10 July 2018 to 29 December, 2018. Statistical analysis IBM SPSS version 21(IBM, USA) was used for summarizing and analysis of data.
  Results Top
The screening was carried out in nine districts of Manipur, i.e., Imphal East, Imphal West, Thoubal, Ukhrul, Senapati, Churachandpur, Bishnupur, Tamenglong and Chandel. There were 2219 participants, including 1885 males and 334 females as mentioned in [Table 1]. Imphal East and Imphal West have the highest participation (33.3%) and Tamenglong has the lowest (6.9%) as mentioned in [Table 2].
Table 1: Distribution of the participants by marital and partner statuses

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Table 2: Distribution of the participants by district

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Before the awareness session was conducted, their level of knowledge on hepatitis C was measured through a survey and was found that 36% of the total participants were aware of the basic knowledge on HCV. Later after the awareness session was provided, it was found that 61% of them had acquired basic knowledge on HCV which shows an increase of 25% knowledge level among the participants which is significant with P > 0.0001. Compared to 40% among their female counterparts, it was also found that 65% of the male participants were aware of the mode of transmission of HCV. Majority of the participants were currently married (59.9%) [Table 3]. Most of them were undergraduate (84.3%) [Table 4]. Nearly half of the participants had HCV (43%) infection [Table 5]. Among 937 (43.1%) who were positive for HCV, 57% negative, out of these 933 (49.5%) were male and 24 (7.2%) were female.
Table 3: Gender-wise distribution of hepatitis C virus screening participation by marital status*

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Table 4: Distribution of the participants by literacy status

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Table 5: District-wise distribution of hepatitis C virus antibody reactivity of the participants

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Married individuals were 1330, whereas 833 were unmarried; however, HCV positivity was more in them (48.8% vs. 39.5%). Ukhrul had the highest HCV positivity rate followed by Churchandpur. Majority of the participants with HCV infection were from 25 to 44 years of age. There was a considerable low level of awareness about the disease.
  Discussion Top
Prevalence of HCV antibody positivity among PWID in Manipur is 43%, whereas in a study conducted in New York comprising 1535 people living with IDUs (PWID), it was 68.2%.[12] In a meta-analysis in Europe, the prevalence greatly varies from 2.7% to 66%.[10] Yet another study from India, 14,481 PWID were sampled from 15 cities, HCV prevalence was 37·2%.[13] Most of our PWIDs were married (59.9%). The valid reason for higher percentage among this group cannot be accessed in this study. The level of knowledge on hepatitis C was measured through a survey and was found that 36% of the total participants were aware of the basic knowledge on HCV. The awareness level was low as 78.1% were undergraduate. The two districts, i.e., Ukhrul and Churachandpur, had the highest HCV positivity. This is due to its sharing a porous border with Myanmar (one of the components of Golden Triangle). Majority of the participants with HCV infection were from 25 to 44 years of age. This is due to the fact that majority of the PWIDs are found to be in the young age group. The mean age was 33.7 years (standard deviation 10.1) and the median was 32 years, whereas in a study in India, the median age was 30 years.[13] A little more than a quarter of the participants had not undergone human immunodeficiency virus (HIV) testing. Among those who were already tested for HIV, 13.5% were found to be positive for HIV antibody.
  Conclusion Top
This study shows that HCV infection in PWID in Northeast of India is 43%, most of them are young and co-infection with HIV is seen in 13.5%. The level of awareness of the disease is relatively poor. Compared to 40% among their female counterparts, it was also found that 65% of the male participants were aware of the mode of transmission of HCV. Hence, more awareness campaigns should be conducted across the state. Re-infection rate among this group of people is expected to be high by virtue of the injecting habits (high-risk behaviour). Therefore, there is a further need to understand the re-infection rate and the method of preventing re-infection among this group. Acknowledgement The accomplishment of this study has been a long cherished dream of everyone who has been engaged with viral hepatitis C in Manipur and beyond including the authors who have contributed their time and effort and made the whole process fruitful. I would like to extend my special appreciation to Community Network for Empowerment (CoNE) for initiating the process of conducting this study at the first place. My sincere gratitude also goes to Mr. Ningombam Pramod Singh and Mr.Rimunchung Duroi Chongdur of Community Network for Empowerment (CoNE) who have contributed and got involved in the entire process, right from the development till the finalization. I also would like to extend much gratitude to Mr. Choudhurymayum Robedi Sharma, Research Scientist, Multidisciplinary Research Unit, Regional Institute of Medical Sciences (RIMS) who contributed in processing the data. I hope that this study report would be used as state authentic data which could also contribute in developing state HCV prevalence baseline to help us measure elimination target of 90% reduction in new infection and 65% reduction in mortality by 2030, which otherwise would not be possible. Financial support and sponsorship This study was funded by Coalition Plus, France. Conflicts of interest There are no conflicts of interest.

 
  References Top

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Szabó E, Lotz G, Páska C, Kiss A, Schaff Z. Viral hepatitis: New data on hepatitis C infection. Pathol Oncol Res 2003;9:215-21.  Back to cited text no. 1
    
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Government of India Ministry of Social Justice & Empowerment: Magnitude of Substance use in India; 2019 February 18.  Back to cited text no. 2
    
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Hagan H, Pouget ER, Des Jarlais DC. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. J Infect Dis 2011;204:74-83.  Back to cited text no. 4
    
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Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 2006;144:705-14.  Back to cited text no. 5
    
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Lansky A, Finlayson T, Johnson C, Holtzman D, Wejnert C, Mitsch A, et al. Estimating the number of persons who inject drugs in the united states by meta-analysis to calculate national rates of HIV and hepatitis C virus infections. PLoS One 2014;9:e97596.  Back to cited text no. 6
    
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World Health Organization. Guidelines for the Screening, Care and Treatment of Persons with Hepatitis C Infection. Geneva, Switzerland: World Health Organization; 2014.  Back to cited text no. 7
    
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Des Jarlais DC, Arasteh K, McKnight C, Hagan H, Perlman DC, Torian LV, et al. HIV infection during limited versus combined HIV prevention programs for IDUs in New York City: The importance of transmission behaviors. Drug Alcohol Depend 2010;109:154-60.  Back to cited text no. 8
    
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Backmund M, Reimer J, Meyer K, Gerlach JT, Zachoval R. Hepatitis C virus infection and injection drug users: Prevention, risk factors, and treatment. Clin Infect Dis 2005;40 Suppl 5:S330-5.  Back to cited text no. 9
    
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Wiessing L, Ferri M, Grady B, Kantzanou M, Sperle I, Cullen KJ, et al. Hepatitis C virus infection epidemiology among people who inject drugs in Europe: A systematic review of data for scaling up treatment and prevention. PLoS One 2014;9:e103345.  Back to cited text no. 10
    
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Martin NK, Vickerman P, Miners A, Foster GR, Hutchinson SJ, et al. Cost-effectiveness of hepatitis C virus antiviral treatment for injection drug user populations. Hepatology 2012;55:49-57.  Back to cited text no. 11
    
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Jordan AE, Jarlais DC, Arasteh K, McKnight C, Nash D, Perlman DC. Incidence and prevalence of hepatitis c virus infection among persons who inject drugs in New York city: 2006-2013. Drug Alcohol Depend 2015;152:194-200.  Back to cited text no. 12
    
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Solomon SS, Mehta SH, Srikrishnan AK, Solomon S, McFall AM, Laeyendecker O, et al. High burden of HCV disease and poor access to HCV services among people who inject drugs in India: A cross-sectional study among 14,481 drug users across India. Lancet Infect Dis 2015;15:36-45.  Back to cited text no. 13
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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