Dual sexual and drug-related predictors of hepatitis C incidence among sex workers in a Canadian setting: gaps and opportunities for scale-up of hepatitis C virus prevention, treatment, and care

Abstract

Background Hepatitis C virus (HCV) represents a significant cause of morbidity and mortality globally. While sex workers (SWs) may face elevated HCV risks through both drug/sexual pathways, incidence data among SWs are severely lacking. We characterized HCV incidence and predictors of HCV seroconversion among women SWs in Vancouver, BC. Methods Questionnaire and serological data were drawn from a community-based cohort of women SWs (2010–2014). Kaplan-Meier methods and Cox regression were used to model HCV incidence and predictors of time to HCV seroconversion. Results Among 759 SWs, HCV prevalence was 42.7%. Among 292 baseline-seronegative SWs, HCV incidence density was 3.84/100 person-years(PY), with higher rates among women using injection drugs (23.30/100 PY) and non-injection crack (6.27/100 PY), and those living with HIV (13.27/100 PY) or acute STIs (5.10/100 PY). In Cox analyses adjusted for injection drug use, age (HR: 0.94, 95%CI: 0.86–1.01), acute STI infection (HR: 2.49, 95%CI: 1.02–6.06), and non-injection crack use (HR: 2.71, 95%CI: 1.18–6.25) predicted time to HCV seroconversion. Discussion While HCV incidence was highest among women who inject drugs, STIs and non-injection stimulant use appear to be pathways to HCV infections, suggesting potential dual sexual/drug transmission. Integrated HCV services within sexual health and HIV/STI programs are recommended.

Changing trends of HIV, syphilis, HCV infections and behavioural factors among female sex workers in Chongqing, China: findings from six serial surveillance surveys

“…46 FSWs who inject drugs are exposed to sexual and blood transmission routes and at a higher risk of contracting HIV and syphilis than other FSWs and injecting drug users. 35 47 Similar to previous studies, the present study showed a strong association between injecting drug use and HCV infection, 48 and sharing of needles may be the main and underlying route of HCV transmission. Drugs and prostitution involve relevant laws and ethics.…”

Barriers and facilitators to hepatitis B vaccination among sex workers in Vancouver, Canada: Implications for integrated HIV, STI, and viral hepatitis services

“…However, few studies on STBBIs within the context of sex work have included assessments of the burden of HBV or the uptake of vaccination or other HBV-related services amongst sex workers (Mak et al, 2003;Baars et al, 2009;Carneiro et al, 2014;Magalhães et al, 2017). In Canada, many sex workers face the potential for elevated HBV exposure through both sexual and drug-related pathways (Goldenberg et al, 2017c). In in-call sex work environments in Vancouver, as well as in similar settings in Canada and the USA, there is a significant representation of im/ migrants from HBV-endemic countries, where rates of vertical transmission of HBV remain high (World Health Organisation, 2013).…”

“…Previous studies in Metro Vancouver, British Columbia (BC), have explored the sexual and drug-related transmission pathways of viral hepatitis among women sex workers; however this work has focused primarily on HCV epidemiology (Goldenberg et al, 2017c). There remains a dearth of data describing HBV risk and prevention, and as a result much is unknown about the burden of HBV-related disease among women sex workers.…”

High hepatitis C virus infection among female sex workers in Viet Nam: strong correlation with HIV and injection drug use

“…12, 13 In contrast, a more recent study in Canada found higher anti-HCV seropositivity (42.5%) among FSW. 14 The 2013 Vietnamese IBBS round represents the first routine integration of HCV core antigen into national viral hepatitis surveillance, of which we are aware. In contrast to most population or risk group-based estimates of HCV infection, the inclusion of HCV core antigen testing provided data on active HCV infection.…”