Higher HCV antibody prevalence among Indigenous clients of needle and syringe programs

Objective: To compare prevalence of hepatitis C virus (HCV) antibody and associated risk behaviours among Indigenous and non-Indigenous participants in the Australian Needle and Syringe Program Survey. Methods: During 1 or 2 weeks each October from 1998 to 2008, clients of participating needle and syringe programs (NSPs) completed a self-administered questionnaire on demographics and risk behaviour and provided a capillary blood sample for HIV and HCV antibody testing. After de-duplication, 16,132 individuals participated during the 11 years, of whom 1,380 (8.6%) identified as Indigenous. Results: Higher proportions of Indigenous than non-Indigenous participants were HCV antibody positive (57% versus 51%, p<0.001). In an overall multivariable analysis, Indigenous status (OR 1.17; CI 1.03-1.32) and female gender (OR 1.25; CI 1.16-1.35) were independently associated with HCV antibody seropositivity. Indigenous participants also reported higher rates of risk behaviour, including receptive sharing of needle syringes (21% vs 16%; p<0.001), receptive sharing of ancillary injecting equipment (38% vs 33%; p<0.001), having been injected by others (18% vs 13%; p<0.001), and injecting in public (54% vs 49%; p<0.001). Conclusion and implications: These results highlight the need for targeted, culturally appropriate programs to minimise risks for bloodborne viral transmission among Indigenous people who inject drugs.