HCV Infection among Injecting Drug Users in Prishtina, Kosovo

Background: Globally, 10 million injecting drug users (IDUs) are estimated to be HCV-positive, resulting in a prevalence of 67%. We evaluated the previously unassessed HCV infection amongst IDUs in Kosovo. We determined the distribution of HCV genotypes among IDUs in Prishtina, ascertained their phylogenetic relatedness, and investigated the main risk factors associated with the HCV infection. Methods: Samples were obtained from 205 IDUs in Prishtina, Kosovo, during the Biological and Behavioral Surveillance Study (BioBSS). HCV-positive samples were further genotyped and sequenced. The results were linked with epidemiological data obtained in interviews determining the underlying causes of HCV transmission. Results: The majority of the 205 IDUs participating in the BioBSS were men (89.3%) with a mean age of 36 years and a history of imprisonment, unemployment, and over a decade of injection drug use. Forty-eight percent of the IDUs were positive for anti-HCV antibodies, and HCV RNA was detected in 70 IDUs (70.7% of the anti-HCV positive IDUs). The following HCV subtypes were detected: subtype 1a (64.3%), subtype 3a (34.3%), and subtype 2k (1.4%). Phylogenetic clustering was evident among 66.7% of the HCV subtype 1a samples and 71.4% of the subtype 3a samples. Significant independent predictors for anti-HCV positivity among IDUs were older age, longer duration of drug use, low education level, drug injection in “shooting galleries”, and imprisonment. Conclusions: In Prishtina, Kosovo, nearly half of the IDUs were determined to be anti-HCV positive and the majority had an active infection. HCV subtype 1a was found to be most prevalent, followed by subtype 3a. Our results emphasize the urgent need for the implementation of harm-reduction programsamongIDUs in Kosovo, specifically treatmentandprevention through needle/syringe exchange programs directed at gathering places, such as shooting galleries.