Background HIV is a major public health issue around the world, especially in developing countries. Although the overall prevalence of HIV in Nepal is relatively low, there are specific sub-populations where the prevalence is far higher than the national average. One of these sub-groups is male people who inject drugs (male PWIDs). In order to understand the reasons for the differences in prevalence, a series of socio-demographic, behavioural and knowledge-based risk factors need to be assessed. Methods The study used a series of 7 cross-sectional survey datasets from Pokhara (Nepal), collected between 2003 and 2017 (N = 2235) to investigate trends in HIV prevalence among male PWIDs by socio-demographic and behavioural and knowledge-based risk factors. A series of logistic regression models were conducted to investigate the association between study factors and HIV. Results HIV prevalence decreased from the levels seen in 2003 (22.0%) and 2005 (21.7%), with the lowest prevalence recorded in 2015 (2.6%), however prevalence has increased in the most recent period (4.9%). A lower risk of HIV was associated with younger age (<=24 years compared to > 24 years, OR = 0.17, 95% CI = 0.10–0.31), being married (OR = 1.91, 95% CI = 1.25–3.02) and shorter duration of drug use (<=4 years compared to > 4 years, OR = 0.16, 95% CI = 0.09–0.29). A higher risk of HIV was associated with low (compared to secondary or higher) education level (OR = 2.76, 95% CI = 1.75–4.36), a lack of addiction treatment (OR = 2.59, 95% CI = 1.64–4.08), and recent use of unsterilized injection equipment (OR = 2.22, 95% CI = 1.20–4.11). Conclusion The prevalence of HIV in male PWIDs in Pokhara has been variable, but overall has reduced in recent years to 2.6% before increasing in 2017 to 4.9%. The main determinants which increase the risk of HIV among male PWIDs in Pokhara are low education level, a lack of treatment for drug addiction and the recent use of unsterilised equipment. Each of these indicate the need to improve addiction treatment and education programs for intra-venous drug use to aid this key population in avoiding risk-taking behaviours.
Background: Hepatitis B virus (HBV) is a major source of disease burden worldwide, especially in developing nations. Although vaccine programs exist to control infections, certain sub-populations around the world continue to have very high prevalence of HBV infection. Methods: A systematic search of studies of HBV published after 2010 was conducted for India, Pakistan, Bangladesh, Nepal, Sri Lanka and Bhutan. Each paper was independently screened for risk of bias and inclusion. Data were extracted from included studies before being analysed to estimate pooled prevalence, and to conduct sub-group analyses. Random-effects models were used for estimating summary prevalence due to a high level of heterogeneity between studies, and funnel plots were combined with Eggers test to assess publication bias. Meta-regression was conducted to investigate sources of between-study heterogeneity. Results: The pooled prevalence of HBV across all studies was 4% (95% CI 0.02, 0.06). For countries with multiple studies, the pooled prevalence of HBV was 3% (95% CI 0.02, 0.05) for India, 6% (95% CI 0.04, 0.10) for Pakistan, 5% (95% CI of 0.02, 0.12) for Bangladesh, and 1% (95% CI 0.00, 0.08) for Nepal. There was some evidence of publication bias, and a high level of heterogeneity across studies. Risk of bias analysis found most studies to be of fair or moderate quality. Conclusions: The prevalence of HBV among sub-continental countries was higher than the global average but was not as high as some other regions. Countries with greater numbers of displaced persons had higher prevalence of HBV, with a wide range of prevalence between subpopulations likely reflecting differential uptake, and implementation, of vaccination programs.
Keywords Hepatitis B virus; health literacy; behavioural risk factors; public health Background Hepatitis B virus (HBV) remains a public health issue in many developing nations, including Nepal. In Nepal the vaccination program was implemented in 2002-3 and aimed to reduce national prevalence of HBV. This study investigated socio-demographic, behavioural, and health service factors associated with HBV infection in low (Pokhara) and high (Dolpa) prevalence populations. Methods A serosurvey of 400 participants from within each population was conducted (final N = 799). The study combined a blood-draw to ascertain HBV status and a questionnaire that included demographic questions and items on knowledge of HBV, behavioural, and social factors associated with the risk of HBV infection. The blood draws were used to confirm HBV status as well as identify any previous infections from which participants may have recovered. Results There were 8/399 (2.01%, 95% CI 0.87%, 3.91%) current HBV infections among participants from Dolpa, compared with 2/400 (0.5%, 95% CI0.06%, 1.79%) among participants from Pokhara. The average age of each of the cohorts was relatively high, indicating an unclear association between vaccination programs and the low prevalence observed in this study. There was evidence from both sites there had been previous infections within the community as many of the participants indicated some level of protection from HBV either through vaccination or past infection (Dolpa 58/399, Pokhara 21/400) and recent cases who had recovered (Dolpa 4/399, Pokhara 3/400). Due to the relatively low prevalence of active cases of HBV, no meaningful associations between demographic, behavioural, and healthcare factors could be calculated. In both samples low level of knowledge of HBV and stigma towards people with HBV was evident. Conclusions This study found a low prevalence of HBV infection in both low and putatively high prevalence populations. However, knowledge of how HBV can be spread was quite low in each of the groups, indicating participants are managing to avoid infections while not necessarily being cautious around behaviours representing the greatest infection risk. There was also evidence of stigma being associated with having an active HBV infection, which may reduce the willingness of individuals to seek diagnosis or treatment.
Background Hepatitis B virus (HBV) infections are a major global health burden. Although a vaccine exists for HBV, some developing nations still struggle to reduce prevalence. While the countries within the Indian Subcontinent have vaccination programs, HBV prevalence varies. It is important to identify population groups at risk. Methods Several databases were systematically searched for papers appropriate studies. Studies were included if the sample population lived within one of the selected countries and had no other existing health issues. The studies were assessed for risk of bias, and pooled estimates were created. Subgroups which were assessed included countries, sex, rural and urban populations. Results The pooled prevalence of all studies (N = 56) was 4%. For the countries with multiple included studies, the prevalence for India, Pakistan, Bangladesh and Nepal were calculated as 3%, 6%, 5% and 1% respectively. Most of the studies were assessed as being of reasonable quality. There was a chance that publication bias was present. Conclusions While some of the populations had the expected prevalence for the country in which the study was set, other subpopulations had higher prevalence. The highest HBV prevalence was found in displaced persons and those engaging in risk taking behaviours, however some high prevalence groups did not have a clear reason. Key messages Although HBV prevalence in general is lower at present than in the past, there are still at-risk groups with higher prevalence than the general population.
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