Community led testing among people who inject drugs: A community centered model to find new cases of HIV and Hepatitis C in Nepal

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Prevalence and Mother-to-newborn Transmission of Hepatitis B Virus in Tertiary Care Hospital in Nepal

BACKGROUND

The prevalence of hepatitis B infection is heterogeneous and ubiquitous. This study aimed to identify the prevalence of the infection among the pregnant women who attended in a tertiary care hospital, transmission of the infection in their newborn and associated risk factors.

METHODS

A one year prospective study was conducted. Mother's venous blood was collected for the hepatitis B serological test during the antenatal care or before delivery; the newborn's cord blood was also collected for the HBsAg.

RESULTS

A total 16400 pregnant women were tested; of them 53 were HBsAg positive. The total prevalence of the infection was 0.32% among the pregnant: 0.5% among the indigenous and 0.2% in other than indigenous. The infection was significantly high in the indigenous group compare to other than indigenous [2.596 (1.475-4.569), p=.001]. Thirty-two out of 53 hepatitis B positive pregnant were delivered in the hospital, of them 75% (n=24) were indigenous and 25% (n=8) were other than indigenous. Eight out of 32 were highly infectious (HBeAg+), of them majority (75%) were indigenous ethnicities. Twenty-one out of 32 were anti-HBe reactive, among which majority were indigenous ethnicities (76.2%). Six out of eight babies, born with HBeAg reactive mothers, were infected (75%), of which majority were indigenous ethnicities (67%). In total, one-fifth of the newborn delivered were HBsAg positive (18.8%).

CONCLUSIONS

The prevalence of hepatitis B infection among the total pregnant was low. The proportion of the infection in the indigenous ethnicity was significantly high compared to other ethnic group, which shows that the infection was clustered among the indigenous people.

Hepatitis B infection among indigenous people in Nepal: looking through an equity lens

Background: Disparity in health care service and disease prevalence are global issues. Hepatitis B infection is a global public health problem; its prevalence is ubiquitous and heterogeneous.This article reviews the situation and an impact of hepatitis B infection in the indigenous people in Nepal through the lens of equity perspective.Methods: Literature search and collection of information from different sources.Results: Hepatitis B prevalence is low (0.9%) at the country level in Nepal but higher, up to 38%, among the indigenous population compared to the national prevalence. Those who live in the high endemic areas are at risk of getting the infection from both vertical and horizontal mode of transmission. The unvaccinated cohort of infant (0-11 months) between 2003 and 2016 has swollen, 2764362 in number or 29 % of the total cohort. The National Immunization Program (NIP) administered hepatitis B vaccination at 6 weeks of birth, considering the low prevalence at the national level. The NIP does not prevent perinatal transmission of the infection. The mother to child transmission of the infection often leads to chronic liver diseases and about 20–30% of adults who are chronically infected will develop cirrhosis and/or liver cancer. The indigenous populations are thus disproportionately affected by the infection.Conclusions: The policy update is required to implement the hepatitis B vaccination at birth or within 24 hours in high endemic setting along with a comprehensive package to reduce the disparity, prevent the transmission, risk of chronic infection and its sequelae to achieve the national goal and international commitment on the sustainable development goal by 2030.

Prevalence and risk factors of hepatitis B infection among mothers and children with hepatitis B infected mother in upper Dolpa, Nepal

Background

Hepatitis B Virus (HBV) infection is a worldwide public health problem. In Nepal, the prevalence of HBV is found to be low (0.9%), although high prevalence (≥8%) of HBV infection is depicted among subgroup/population in the mountain region by various studies. This study assessed the prevalence and the risk of HBV infection among mothers, as well as among the youngest child under 5 years old living with hepatitis B positive mothers in Dolpa, the most remote mountain district of Nepal.

Methods

The cross sectional study survey was conducted between June and July 2014. All mothers with their youngest child under 5 years old were invited to participate in the survey and tested for hepatitis B surface antigen (HBsAg). The HBsAg positive mothers were further tested by 5-panel HBV test card. Children living with HBsAg positive mothers were also tested for HBsAg.

Results

One hundred fifty-one mothers, comprising 37% of the total study population in the selected Village Development Committees (VDCs), were surveyed in the mobile health camps. The seroprevalence of HBsAg among mothers and their youngest child under 5 years old living with HBsAg positive mothers were 17% (95% CI, 11.01–22.99%) and 48% (95%CI, 28.42–67.58%) respectively.

The majority of HBV infected mothers were indigenous (84%) followed by Dalit (4%) and other castes (12%). Among HBV infected mothers, 40% were hepatitis B envelope antigen (HBeAg) positive. The prevalence of HBsAg was higher among children living with HBeAg positive mothers as compared to HBeAg negative (60% vs 40%) and male children compared to female (60% vs 33%). Thirty-six percent of children were vaccinated with a full course of the hepatitis B vaccine. Of these vaccinated children, 56% were HBsAg sero-positive.

Conclusions

The HBV infection rate is high among mothers and children living with HBsAg positive mothers in the indigenous population of the most remote mountain community of Nepal.

Fitting Community Based Newborn Care Package into the health systems of Nepal

Community-based strategies for delivering effective newborn interventions are an essential step to avert newborn death, in settings where the health facilities are unable to effectively deliver the interventions and reach their population. Effective implementation of community-based interventions as a large scale program and within the existing health system depends on the appropriate design and planning, monitoring and support systems. This article provides an overview of implementation design of Community-Based Newborn Care Package (CB-NCP) program, its setup within the health system, and early results of the implementation from one of the pilot districts. The evaluation of CB-NCP in one of the pilot districts shows significant improvement in antenatal, intrapartum and post natal care. The implementation design of the CB-NCP has six different health system management functions: i) district planning and orientation, ii) training/human resource development, iii) monitoring and evaluation, iv) logistics and supply chain management, v) communication strategy, and vi) pay for performance. The CB-NCP program embraced the existing system of monitoring with some additional components for the pilot phase to test implementation feasibility, and aligns with existing safe motherhood and child health programs. Though CB-NCP interventions are proven independently in different local and global contexts, they are piloted in 10 districts as a "package" within the national health system settings of Nepal.