High burden of hepatitis C & HIV co-infection among people who inject drugs in Manipur, Northeast India.

Background & objectives: It is well documented that the Northeast State of Manipur in India has been dealing with the dual problems of injecting drug use and HIV for the last two decades, but the hepatitis C problem has not been so well characterized. The aim of this study was to assess the prevalence of hepatitis C virus (HCV) infection and HCV/HIV co-infection among people who inject drugs (PWID) in Manipur, and identify factors associated with infection. Methods: Data were obtained from the Integrated Behavioural and Biological Assessment (2009-2010), a cross-sectional survey among 821 male PWID in two districts of Manipur (Churachandpur and Bishnupur). Information about drug use, sexual and injecting risk behaviours, and exposure to interventions was obtained, and biological specimens tested for HIV and HCV. Logistic regression analyses identified factors associated with HCV infection and HCV/HIV co-infection. Results: HCV prevalence was 74 per cent (91% Churachandpur, 56% Bishnupur), and HCV/HIV co-infection was 29 per cent (38% Churachandpur, 21% Bishnupur). Among the 31 per cent of HIV positive PWID, 95 per cent were co-infected. HCV infection was associated with district, longer duration of injecting, injecting at least once daily, generally injecting with a used needle and syringe, and having had an HIV test. HCV/HIV co-infection was associated with district, older age, being employed, being widowed/divorced, longer duration of injecting, and feeling at risk of HIV infection. Interpretation & conclusions: The HCV/HIV co-infection among PWID in Manipur was very high, highlighting the urgent need for effective prevention, diagnosis and treatment.

Injection practices in the formal & informal healthcare sectors in rural north India.

BACKGROUND & OBJECTIVES: Unsafe injections in health settings contribute to a large burden of preventable blood-borne diseases. Current strategies to enhance injection safety in India almost exclusively target the formal health sector. However, injections are provided not only by doctors and nurses in the formal sector, but also by practitioners from the informal sector, such as traditional healers, who are not necessarily trained or authorized to administer these. The present study was undertaken to determine the extent to which patients using formal healthcare services also consult and receive injections in the informal sector, quantify the injections received by these patients and their relatives, and assess knowledge and attitudes in relation to injections. METHODS: A cross-sectional survey of 280 in patients and 120 of their relatives was undertaken between November 2004 and February 2005 in two rural hospitals in Bihar and Jharkhand states. RESULTS: Sixty one per cent of patients had consulted a healthcare practitioner in the month prior to admission, and 39 per cent of these had consulted in the informal sector at least once. Forty three per cent had received at least one injection in the month prior to admission, and 43 per cent of these were given by informal practitioners. About 13 per cent of relatives had received at least one injection in the last three months, 69 per cent of which were given by informal practitioners. Thirty per cent did not know that unsafe injections can spread diseases. INTERPRETATION & CONCLUSION: The findings of this survey highlight the fact that informal practitioners in India are commonly administering injections with clear implications for patient safety. There is a need to promote strategies for injection safety among both formal and informal practitioners.

HIV-related knowledge, attitudes and risk perception amongst nurses, doctors and other healthcare workers in rural India.

BACKGROUND AND OBJECTIVE: People with HIV in India frequently encounter discrimination while seeking and receiving healthcare services. The knowledge and attitudes of healthcare workers (HCWs) influences the willingness and ability of people with HIV to access care, and the quality of the care they receive. Previous studies of HIV-related knowledge and attitudes amongst Indian HCWs have been conducted primarily in large urban hospitals. The objective of this study was to asses HIV-related knowledge, attitudes and risk perception among a group of rural north Indian HCWs, and to identify predictors of willingness to provide care for patients with HIV infection. METHODS: A cross-sectional survey of 266 HCWs (78% female) from seven rural north Indian health settings was undertaken in late 2002. A self-administered written questionnaire was made available in English and Hindi, and the response rate was 87 per cent. Information was gathered regarding demographic details (age, sex, duration of employment, job category); HIV-related knowledge and attitudes; risk perception; and previous experience caring for HIV-positive patients. Logistic regression modelling was undertaken to identify factors associated with willingness to care for patients with HIV. RESULTS: The HCWs in this study generally had a positive attitude to caring for people with HIV. However, this was tempered by substantial concerns about providing care, and the risk of occupational infection with HIV was perceived by most HCWs to be high. After controlling for confounding, HCWs willingness to provide care for patients with HIV was strongly associated with having previously cared for patients with HIV (P = 0.001). Knowledge of HIV transmission and perception of risk were not associated with willingness to provide care. INTERPRETATION AND CONCLUSION: The findings of this study showed a general willingness of HCWs to provide care for patients with HIV, tempered by concerns regarding provision of such care. Strategies to address HCWs concerns are likely to ameliorate the discrimination experienced by people with HIV when accessing healthcare services. These include the development of programmes to promote occupational safety of HCWs and involving people with HIV in awareness training of HCWs.