Please cite this article in press as: Bowring, A. L., et al. An urgent need to scale-up injecting drug harm reduction services in Tanzania: Prevalence of blood-borne viruses among drug users in Temeke District, Dar-es-Salaam, 2011. International Journal of Drug Policy (2012), http://dx.doi.org/10.1016/j.drugpo.2012.08.005 ARTICLE IN PRESS G Model DRUPOL-1137; No. of Pages 4 International Journal of Drug Policy xxx (2012) xxx–xxx Contents lists available at SciVerse ScienceDirect International Journal of Drug Policy jo ur n al homep age: www.elsevier.com/locate/drugpo Short report An urgent need to scale-up injecting drug harm reduction services in Tanzania: Prevalence of blood-borne viruses among drug users in Temeke District, Dar-es-Salaam, 2011 Anna L. Bowring a,* , Niklas Luhmann b , Sandrine Pont c , Céline Debaulieu c , Stéphanie Derozier b , Fatima Asouab b , Abdalla Toufik b , Caroline van Gemert a , Paul Dietze a,d , Mark Stoove a,d a Burnet Institute, 85 Commercial Rd, Melbourne, Victoria 3004, Australia b Médecins du Monde France, 62 rue Marcadet, 75014 Paris, France c Médecins du Monde Tanzania, PO Box 105948, Dar-es-Salaam, Tanzania d Department of Epidemiology and Preventative Medicine, Monash University, Victoria, Australia a r t i c l e i n f o Article history: Received 23 April 2012 Received in revised form 16 August 2012 Accepted 27 August 2012 Keywords: Tanzania HIV HCV Blood-borne virus Injecting drug use Harm reduction a b s t r a c t Background: Injecting drug use (IDU) is a growing concern in Tanzania compounded by reports of high- risk injecting and sexual risk behaviours among people who inject drugs (PWID). These behaviours have implications for transmission of blood-borne viruses, including HIV and hepatitis C (HCV). Methods: We recruited 267 PWID (87% male) from Temeke District, Dar-es-Salaam through snowball and targeted sampling. A behavioural survey was administered alongside repeated rapid HIV and HCV antibody testing. HIV and HCV prevalence estimates with 95% confidence intervals (CIs) were calculated. Results: Among PWID, 34.8% (95%CI 29.1–40.9) tested HIV positive (29.9% of males and 66.7% of females); 27.7% (95%CI 22.0–34.0) tested HCV antibody positive. Almost all (97%) participants were aware of HIV and 34% of HCV. 45% of male and 64% of female PWID reported a previous HIV test; only five (2%) PWID reported a previous HCV test. Of HIV and HCV positive tests, 73% and 99%, respectively, represented newly diagnosed infections. Conclusion: High prevalence of HIV and HCV were detected in this population of PWID. Rapid scale-up of targeted primary prevention and testing and treatment services for PWID in Tanzania is needed to prevent further transmission and consequent morbidities. © 2012 Elsevier B.V. All rights reserved. Introduction Injecting drug use (IDU) is a growing concern in Tanzania and sub-Saharan Africa, adding a new dimension to HIV and other blood-borne virus (BBV) transmission in the region (McCurdy, Williams, Kilonzo, Ross, & Leshabari, 2005). A local market for heroin developed in the 1980s once East Africa was incorpo- rated into international trafficking routes (UNODC, 1999). Initially only smoked or inhaled, IDU emerged in Tanzania after 1998 with market shifts from ‘brown’ to ‘white’ heroin, which is more readily injected (McCurdy et al., 2005). Tanzania has an estimated 25,000–50,000 people who inject drugs (PWID) (Nieburg & Carty, 2011). Mainland Tanzania has a generalised HIV epidemic spread predominantly through heterosexual sex. HIV prevalence has * Corresponding author at: GPO Box 2284, Melbourne, Victoria 3001, Australia. Tel.: +61 3 8506 2302; fax: +61 3 9282 2138. E-mail address: annab@burnet.edu.au (A.L. Bowring). stabilised at approximately 5.7% (TACAIDS, 2009), but gender, regional and urban-rural disparities in HIV exist. In Dar-es-Salaam city, HIV prevalence among males and females in the general popu- lation are 7.2% and 10.2%, respectively (TACAIDS, 2009). In contrast, in Zanzibar general prevalence is low (0.6–0.9%) and HIV is predom- inantly spread through male-to-male sex, IDU, and transactional sex, with a prevalence of around 25% in PWID (Dahoma et al., 2006). A small number of studies of PWID in mainland Tanzania report high risk injecting and sexual risk behaviours (e.g., McCurdy, Ross, Williams, Kilonzo, & Leshabari, 2010; Williams et al., 2009) with implications for HIV and hepatitis C (HCV) transmission. Studies report HIV prevalence among PWID in Dar-es-Salaam as high as 64% in women and 28% in men, with higher prevalence in females associated with sexual risk factors (e.g. Williams et al., 2009). No HCV prevalence estimates exist for PWID in mainland Tanzania, but Dahoma et al. (2006) reported 22% HCV prevalence among PWID in Zanzibar. Despite increasing attention to IDU in Tanzania and calls for enhanced harm reduction responses (McCurdy, Kilonzo, Williams, & Kaaya, 2007), international and local HIV prevention policy 0955-3959/$ – see front matter © 2012 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.drugpo.2012.08.005