title: Prevalence and risk factors associated with HIV and tuberculosis in people who use drugs in Abidjan, Ivory Coast.
abstract: BACKGROUND
  The number of people who use drugs (PWUD) has dramatically increased in West Africa over the last 15 years, but targeted interventions are falling behind, notably because of the lack of awareness of the health needs of PWUD. We aimed to assess prevalence and factors associated with HIV and other infections in PWUD in Abidjan, Ivory Coast, one of the countries most affected by HIV in Western Africa.
  
  
  METHODS
  We used respondent-driven-sampling to obtain a representative sample of heroin or cocaine/crack users aged 18 years or more. Socio-behavioral data were obtained by face-to-face questionnaires. Blood samples were collected and tested for HIV. Two sputa were obtained in tuberculosis (TB) symptomatic participants for acid-fast-bacilli (AFB) smear testing. After a descriptive analysis, crude prevalence were calculated, then weighted to take account of the sampling method. Factors associated with HIV and TB were studied using adjusted log-binomial regression. Population size was estimated by capture-recapture.
  
  
  RESULTS
  450 PWUD were recruited in May 2014. The mean age was 33.5 years; 10.9% were women. Smoking was the main mode of consumption, ever injecting was reported by 12.7% of the participants (3.6% in the past month). Sex work was reported by 15.8% of the PWUD (13.7% of the men), and 10.2% of the men reported sexual relationships with other men (MSM). We found a weighted prevalence of 9.5% for HIV. Women were 3.4 times more likely to be infected than men. Among men, being a sex worker (SW) (adjusted OR 2.9 [95CI 1.06-7.98]) or MSM (adjusted OR 11.5 [95CI 4.22-31.42]) were the main factors associated with HIV infection in adjusted analysis. Injection was not associated with HIV. TB weighted prevalence was 1.8%, associated with poor living arrangements in adjusted analysis. We estimated that 3521; 95CI 3049-3993 PWUD live in Abidjan.
  
  
  CONCLUSIONS
  PWUD in Abidjan are at high risk of HIV due to sexual transmission, especially in women, SW and MSM who also use drugs. Interventions should be developed to improve HIV prevention and linkage to care in these specific populations. More generally, improving the health of PWUD involves a broader reflection on the living environment and access to health care of slum residents in large African cities.
authors.affiliation: Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France. Electronic address: julie.bouscaillou@medecinsdumonde.net.
authors.forename: Julie
authors.initials: J
authors.lastname: Bouscaillou
authors.affiliation: Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Evanno
authors.affiliation: Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France.
authors.forename: Myrtille
authors.initials: M
authors.lastname: Prouté
authors.affiliation: Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France.
authors.forename: André
authors.initials: A
authors.lastname: Inwoley
authors.affiliation: Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Kabran
authors.affiliation: Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: N'Guessan
authors.affiliation: Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France.
authors.forename: Samedi
authors.initials: S
authors.lastname: Djé-Bi
authors.affiliation: Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France.
authors.forename: Souleymane
authors.initials: S
authors.lastname: Sidibé
authors.affiliation: Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Thiam-Niangoin
authors.affiliation: Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France.
authors.forename: Badou Roger
authors.initials: BR
authors.lastname: N'guessan
authors.affiliation: Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Blanchetière
authors.affiliation: Analysis, Technical Support and Advocacy Unit, 62 rue Marcadet, 75018 Paris, France.
authors.forename: Niklas
authors.initials: N
authors.lastname: Luhmann
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D007560:Cote d'Ivoire / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission; D006556:Heroin Dependence / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D011477:Sex Work / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014376:Tuberculosis / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
keywords: Capture recapture; Drug users; HBV; HCV; HIV; Ivory Coast; Men having sex with men; Respondent Driven Sampling; Sex workers; Syphilis; Tuberculosis; West Africa