Estimating the burden of disease from unsafe injections in India: A cost-benefit assessment of the auto-disable syringe in a country with low blood-borne virus prevalence

Abstract

Background:Unsafe medical injections are a prevalent risk factor for viral hepatitis and HIV in India.Objectives:This review undertakes a cost–benefit assessment of the auto-disable syringe, now being introduced to prevent the spread of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV).Materials and Methods:The World Health Organization methods for modeling the global burden of disease from unsafe medical injections are reproduced, correcting for the concentrated structure of the HIV epidemic in India. A systematic review of risk factor analyses in India that investigate injection risks is used in the uncertainty analysis.Results:The median population attributable fraction for hepatitis B carriage associated with recent injections is 46%, the median fraction of hepatitis C infections attributed to unsafe medical injections is 38%, and the median fraction of incident HIV infections attributed to medical injections is 12% in India. The modeled incidence of blood-borne viruses suggests that introducing the auto-disable syringe will impose an incremental cost of $46–48 per disability adjusted life year (DALY) averted. The epidemiological evidence suggests that the incremental cost of introducing the auto-disable syringe for all medical injections is between $39 and $79 per DALY averted.Conclusions:The auto-disable syringe is a cost-effective alternative to the reuse of syringes in a country with low prevalence of blood-borne viruses.

Burden of HCV infection among pregnant women with assessment of risk factors and pregnancy outcome in HCV infected: A hospital based study from Uttarakhand

“…Intravenous drug use is the predominant mode of transmission of HCV in several developed countries, however in developing countries, the main modes of transmission are transfusion of infected blood and its components and surgical, dental procedures with improperly sterilized instruments and unsafe therapeutic injections with reused syringes. 38% of HCV infection in India may be attributable to unsafe therapeutic injections (19) In our study, past history of surgical procedures was found in majority of patients which is consistent with the findings of a study from Pakistan in which previous vaginal deliveries with episiotomy, previous surgeries, previous blood transfusion and Previous Dilatation and Curettage for abortion or Dysfunctional Uterine Bleeding were taken as independent variables, Only past history of surgical procedures was found to be the most important risk factor for transmission of H.C.V (20) In present study, previous blood transfusion as important risk factor for transmission of HCV infection was observed in 8% of patients. Blood transfusion is also reported to be a major source of HCV infection in a study from Hazra, Pakistan (21) Our study showed that about 42 % of anti-HCV positive women had no identifiable risk factors for HCV infection.…”

Tackling the Hepatitis B Disease Burden in India

“…[81][82][83] The estimated median population attributable fraction for chronic hepatitis B linked to injections in India was 46% while that for hepatitis C and HIV was 38% and 12% respectively. 84 …”

Consensus Statement of HCV Task Force of the Indian National Association for Study of the Liver (INASL). Part I: Status Report of HCV Infection in India

“…83 It has been estimated that 38% of HCV infections in India may be attributable to unsafe medical injections. 84 …”