Indian Journal of Public Health (Sep 2024)
A Cross-sectional Study to Identify Risk Factors for Hepatitis C in Punjab, India
Abstract
Background: Hepatitis C virus (HCV) antibody prevalence in Punjab, India (0.56%) is higher than the national average (0.32%), but primary drivers of local transmission are unclear. Objectives: The objective of this study was to identify behavioral and demographic predictors of screening positive for HCV in Punjab. Materials and Methods: Interviews assessing exposure to potential HCV risk factors were administered cross-sectionally to persons screening for HCV across 10 treatment facilities. Risk ratios (RRs) were calculated using generalized estimating equation models accounting for clustering by health facility. Results: One thousand seven hundred and sixty-three patients tested anti-HCV positive; 595 were negative. 57.7% of respondents were male; the median age was 40 years. 13.8% reported injecting drugs. Males were more likely to test positive than females (RR: 1.14, 95% confidence interval [CI]: 1.07–1.21). Unmarried men were at higher risk of anti-HCV positivity compared with married men (RR: 1.16, 95% CI: 1.08–1.24), but unmarried women were at lower risk (RR: 0.65, 95% CI: 0.43–0.98). The strongest risk factors were history of injecting drugs (RR: 1.37, 95% CI: 1.24–1.51), incarceration (RR: 1.22, 95% CI: 1.12–1.33), acupuncture use (RR: 1.20, 95% CI: 1.09–1.33), having household member(s) with a history of incarceration (RR: 1.17, 95% CI: 1.08–1.26), and tattoos (RR: 1.16, 95% CI: 1.09–1.24). Additional risk factors among men included receiving injections in a public hospital or from unregistered medical practitioners and among women included a history of childbirth. Conclusion: Injecting drugs was most strongly associated with anti-HCV positivity in this population. Greater attention to HCV prevention is needed, with a focus on people-centered harm reduction programs, behavioral change interventions, and increasing safety in potential transmission settings.
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