Cross-Sectional Comparison of Behavioral Risk Factors for HIV/HCV in People Who Inject Drugs (PWID) in Egypt

Background Egypt has the greatest HCV prevalence worldwide at 15% and a concentrated HIV epidemic in male people who inject drugs (PWID) at 6.8%, who are at a high risk for HCV infection as well. Injection drug use is criminalized in Egypt, and there is limited availability of harm reduction programs. Drug-use and sexual risk behaviors between PWID and the general population have not been studied there. Methods To address this gap, a cross-sectional HIV/HCV epidemiological study of 632 consenting injection drug users in Cairo and Alexandria was conducted. Bivariate logistic regression analysis was done to evaluate the associations between HIV/HCV and needle sharing or sexual practices using SAS 9.4. Results 10.6% (63/ 604) of the study population tested positive for HIV and 61.5% (384/624) tested positive for HCV. Sharing needles with more than 10 people was associated with HIV and HCV infection (OR=3.65, p-val=0.001; OR=2.05, p-val=0.02, respectably). Age was associated with both HIV and HCV (p-val=0.03 and Conclusions The results indicate that the growing epidemic among PWID in Egypt may place the general population at risk for HIV and HCV primarily through sexual contact. In Russia, repressive policies toward PWID allowed HIV to spread to the general population at the start of the epidemic in 2000. Now, 48% of HIV is heterosexually transmitted in Russia and the country contributes \u3e80% of the HIV cases in Eastern Europe and Central Asia. In response to the epidemic, even more punitive laws and regulations were introduced in Russia, and their HIV prevalence has seen a 49% increase between 2005 and 2015. A similar trajectory can be expected for Egypt if preventative measures are not taken. Common-sense harm reduction programs like clean needle exchanges and decriminalization of injection drug use should be part of a comprehensive plan to control the spread of HIV and HCV in Egypt

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Assessment of Knowledge, Attitude, and Practice of Risky Sexual Behavior Leading to HIV and Sexually Transmitted Infections among Egyptian Substance Abusers: A Cross-Sectional Study

Background. Rapidly growing youth population with changing sexual trend in Egypt raised HIV potential. The aim of this study is to assess knowledge, attitude, and practice regarding unsafe sexual behavior among Egyptian drug abusers. Methods. This crosssectional study was conducted in 2008 in the Freedom Drugs and HIV Program on 410 drug abusers in Egypt. Included respondents were subanalyzed by gender, age, education, and intravenous drug usage. Results. KAP average scores on safe sexual behavior were low compared to the maximum possible denoting low awareness and action of drug addicts towards avoidance of infection. Respondents with higher education had significantly better knowledge about safe sexual behavior. Significant positive correlation was shown between age and knowledge of safe sexual behavior. Older age groups were predicted to know more about safe sex, while gender; educational level and intravenous drug usage were not. Similarly, females and intravenous drug users were predicted to have higher attitude for safe sex while age and educational level did not. Conclusion. KAP of safe sexual behavior were low among drug addicts in Egypt increasing potential towards infection with STDs including HIV. The more the age and education level, the better the knowledge towards safe sexual behavior

Association of sociodemographic factors with needle sharing and number of sex partners among people who inject drugs in Egypt

People who inject drugs (PWID) are at a high risk for HIV. We conducted an evaluation of socio-demographic factors associated with injecting and sexual behaviour among PWID who had two or more visits at a drug outreach clinic in Cairo, Egypt from 2013 to 2017. Routinely collected information on socio-demographics and HIV risk behaviours were abstracted from client records. Bivariate analysis and logistic regression were conducted to evaluate associations between socio-demographics and HIV risk factors. All PWID who tested HIV-positive at the initial visit were excluded from analyses. PWID who were married were more likely to share needles or syringes in the last month of their baseline visit [adjusted odds ratio (aOR) = 4.3, 95% confidence interval (CI) = 1.4-13.1] as were unemployed PWID [aOR = 3.9, 95% CI = 1.5-10.3]. Married PWID were less likely to discontinue sharing needles/syringes [aOR = 0.4, 95% CI = 0.2-0.8] as were those living outside of the Shobra, downtown, and Imbabah districts within Greater Cairo [aOR = 0.2, 95% CI = 0.1-0.5]. No significant associations were found between socio-demographics and number of sex partners in the six months prior to the initial visit. At follow-up visit, 4.4% tested HIV-positive for an incidence rate of 3.9 per 100 person years. Sociodemographic factors should be considered when designing preventive services for PWID