Table 3 Health outcomes and associated individual and structural level risk factors

Afghanistan

Abadi, 2012 [29]

Human rights violation defined as maltreatment, abuse, gender inequality: Maltreatment (threatened/denial of food or shelter; forced social isolation, drug use or working in poppy cultivation) = 36%

Abuse (physical or sexual assault) = 35%

Gender inequality (denied education, driving a car or being alone in public) = 4%

Suicidal ideation = 41%; attempted suicide within 30 days of entering drug treatment centre = 27%

Social function (physical/emotional health limits social activities) = 91%

MV

Associated with any human rights violations (maltreatment, abuse or gender inequality): being married AOR 5.08; Pashtun ethnicity AOR 5.80; literate AOR 14.7; unemployed AOR 4.76; entering drug treatment because of their own desire AOR 2.30; lower levels of social functioning AOR 1.72; previous suicide attempt AOR 3.99. All significant at p < 0.05 level

Factors associated with social functioning: Maltreatment (AOR = 2.36), physical/sexual abuse (AOR = 12.24), any human rights violation(AOR = 1.72). p values not reported

Factors association with suicide attempt: Any human right violation (AOR = 2.80), maltreatment (AOR = 5.74), sexual/physical abuse (AOR = 26.05) and one human right violation (AOR = 3.99). P values not reported

Factors associated with suicide ideation: None significant

Bautista, 2010[31]

HCV: 37%

MV

Associated with HCV among younger injectors: ever-sharing needles AOR 7.8 (95%CI 3.6–16.8); unemployment AOR 2.8 (95% CI 1.1–7.3)

Associated with HCV among older injectors: heroin use AOR 3.0 (95%CI 1.0–8.7); ever-sharing needles AOR 3.4 (95% CI 1.7–7.0); each additional year of injecting AOR 4.45, 95% CI: 2.92–7.66)

Nasir, 2011[41]

HIV: 1.8% (95% CI: 0.88–3.2)

HCV: 36.0% (95% CI 33–41)

HBV: 5.8% (95% CI 3.9–7.6)

MV

Associated with HBV: higher monthly income AOR 1.74 (95%CI 1.55–1.96); paying a sex worker for sex in the last 6 months AOR 2.24 (95%CI 1.64–3.06); ever having sex with another male AOR 0.61 (95%CI 0.36–1.02)

Associated with HCV: sharing injecting equipment last 6 months AOR 1.83 (95%CI 1.25–2.69); ever incarcerated AOR 1.79 (95% CI 1.16–2.77); ever had sex with man/boy AOR 0.69 (95% CI 0.58–0.82); median income > 3800 Afs AOR 0.76 (95%CI 0.60–0.97)

HIV: No statistically significant correlates

Rasekh, 2019[44]

HIV 0.2%

HBV 3.7

HCV 11%

HIV/HCV 0.2%

HCV/HBV 0.5%

MV

Associated with HCV: shared needles and use of drugs by injection AOR 5.40 (95% CI 2.60–11.23)

Associated with any viral infection: use of drugs by injection AOR 3.57 (95% CI 1.76–7.24)

Ruisenor-Escudero, 2014[46]

HIV: 7.1%

HCV: 40.3%

MV

Associated with HIV: living in Herat AOR 15.2 (95%CI 1.5–145.2); prior incarceration AOR 9.4 (95%CI 1.1–78.0); injecting drugs for > 3 years AOR 7.2 (95%CI 1.3–39.6); being positive for HCV AOR 15.7 (95%CI 3.4–72.5)

Associated with HCV: living in Kabul AOR 1.8 (95% CI1.0–3.2); living in Herat AOR 1.9 (95%CI 1.0–3.8); injecting for 1–3 yrs AOR 2.3 (95%CI 1.5–3.7); injecting for > 3 years AOR 5.4 (95%CI 3.0–9.5); being positive for HIV AOR 14.9 (95%CI 3.2–70.2)

Todd, 2007[54]

HIV: 3.5% HCV: 36.6% HBsAg 6.5%

MV

Associated with HIV: None

Associated with HBsAg: injecting drugs in prison (OR 3.23 95% CI 1.16–9.00)

Associated with HCV: ever N/S sharing (OR 2.60 95% CI 1.71–3.96); being married (OR = 0.60 95% CI 0.40–0.92); higher educational level (OR 0.51 95% CI 0.29–0.88); duration injection (> 3 years) (Or = 3.28 95% CI 2.17–4.96); injections by a nonmedical provider (OR = 2.71 95% CI 1.26–5.82)

Todd, 2010 [56]

Syphilis 3.72% (95% CI 2.66%-5.06%)

MV

Associated with syphilis: any other STI diagnosis (adjusted odds ratio AOR 3.84 (95%CI 1.12–13.19); paying a sex worker for sex AOR 3.82 in the last 6 months (95%CI 1.23–11.85); < 6 years formal education AOR 2.20 (95%CI 1.04–4.68)

Todd, 2011[57]

HIV: 2.1% (95%CI: 1.0–3.8)

HCV Ab: 36.1% (95%CI: 31.8–40.4)

HBV: 4.6% (95%CI 2.9–6.9)

syphilis: 1.2% (95%CI 0.5–2.7)

MV

Associated with HIV: ever share needles or syringes AOR 5.96 (95%CI 1.58–22.38)

Associated with HBV: Current needle and syringe program use AOR 0.36 (95%CI 0.14–0.94)

Associated with HCV: ever have abscess at injecting site AOR 2.22 (95%CI 1.33–3.70); ever share needles or syringes AOR 2.33 (95%CI 1.38–3.95); initiated injecting outside Afghanistan AOR 1.95 (95%CI 1.26–3.04); frequency daily injections (# injections) AOR 1.47 (95%CI 1.11–1.94); duration of injecting (per year) AOR 1.05 (95% CI 1.00–1.10); age (per year) AOR 1.04 (95% CI 1.01–1.07)

Todd, 2015[59]

HCV incidence: 35.6/100 p-y (95%CI 28.3–44.6)

HIV incidence: 1.5/100 p-y (95%CI 0.6–3.3)

MV

Associated with HCV: changing from injecting to smoking adjusted hazard ratio (AHR) 0.53 (95%CI 0.31–0.92)

Associated with HIV: duration of injecting drug use AHR 1.09 (95%CI 1.01–1.18)/year; sharing needles/syringes AHR 10.08 (95% CI 1.01–100.3)

No statistically significant association between conflict and HIV/HCV

Todd, 2016[58]

STI symptoms

Sharing of needle/syringes

Paying women for sex

MV

Associated with STI symptoms: Impact of conflict AOR 1.98 (95% CI 1.10–3.56)

Associated with needle/syringe sharing: Impact of conflict AOR 6.23 (95% CI 1.41–27.6)

Conflict defined as enumeration of of anti-government attacks in KabulProvince between February and May 2009 that resulted in dsplacement throughout the city

Colombia

Berbesi-Fernandez, 2015 [36]

HCV: 31.0% antibodies; 22.3% active infection

HIV:2.6% (plus 1.1% were undetermined)

MV

Associated with HCV: People who did not got syringes at drugstores in the last six months AOR 2.7 (95% CI 1.32–5.48)

Berbesi-Fernandez, 2017[37]

HCV: 17.5%

HIV:4.2%

HIV/HCV coinfection 54%

MV

Associated with HCV: Having HIV AOR 6.87 (95%CI 2.86–16.06); injection with people with hepatitis AOR 2.45 (95%CI 1.33–4.53); shared syringes AOR 1.9 (95%CI 1.12–3.2)

Berbesi-Fernandez, 2020[35]

HIV- 3.6%

UV

Association with being HIV + . More than three people with whom a needle was shared (reference category of none): OR 5.07 (CI 1.19–21.55), P 0.03; always injected with used needles accompanied by a close friend in last six months (ref category of almost always): OR 10.69 (95% CI 2.26–50.61), p < 0.01). Nothing significant in multivariable analysis

Toro-Tobon. 2018[61]

HCV: 27.3%

MV

Associated with HCV: In Pereira and Armenia, high injection frequency AOR 2.0 (95% CI 1.1–3.6) and AOR 2.5 (95% CI 1.40–4.20), respectively; increased frequency of using gifted, sold, or rented needles or syringes AOR 4.5 (95% CI 1.00–7.10) in Pereira; HIV seropositivity AOR 16.9 (95% CI 3.51–81.52) in Cúcuta

Toro-Tobon 2020[60]

HIV 5.3%

HCV 28.9%

HIV/HCV co-infection 3.3%

UV

Associated with HIV/HCV co-infection: female sex OR 2.2 (95% CI 1.0–4.7)

Associated with HIV OR HCV mono-infection: higher education protective OR: 0.6 (95%CI 0.4–0.8)

Associated with co-infection: injecting ≥ 4 times/day OR 3.5 (95%CI 1.7–7.2); cleaning needles and syringes with water OR 3.2 95%CI 1.6–6.3); passing drug mix between syringes OR: 2.5 (95%CI 1.3–5.3); injecting in illicit indoor shooting galleries OR 2.4 (95%CI 1.0–5.3); being injected by someone who charges for injecting OR 2.3 (95%CI 1.0–5.2)

Myanmar

Swe, 2010[51]

N/A

UV

Associated with HIV: being illiterate OR 2.31 (95%CI 1.09–4.83); living in a rural location OR 2.42; 95% CI 1.36–4.29); using a used syringe (vs disposable) at first injection OR 5.13 (95%CI 2.79–9.44); sharing syringes at first injection OR 4.50 (95%CI 2.49–8.16); returning a used syringe OR 3.32 (95%CI 1.01–6.86); having had drug treatment OR 4.91 (95%CI 1.84–13.14)

Swe, 2012 [52]

HIV: 25.8%

UV

Associated with HIV: being female OR 5.96 (95%CI 1.31–30.45); using a ‘used’ syringe at first injection OR 1,81 (95%CI 1.23–2.68); sharing syringe at first injection OR 2.98 (95%CI 2.00–4.44)

Aye, 2018[30]

HIV: 15–17%

HBV: 4–7%

HCV: 68–76%

MV

Associated with HIV: Age (reference group aged 21–30 years): 30–40 yr AOR 1.7 (95%CI 1.1–2.7); > 40 yr AOR 2.1 (95% CI 1.2–3.6)

Associated with HCV: Being single AOR 1.2 (95%CI 1.1–1.3)

Myanmar and China

Zhou, 2011[63]

Prevalence (Burmese):

HCV: 48.1%. HBV: 43.1%. HIV: 27.0%

Prevalence (Chinese)

HCV: 69.0% HBV:51.6%; HIV 33.7%

UV

Associated with all infections: more prevalent among Chinese PWID compared to Burmese PWID: HCV (69.0% vs. 48.1%, p < 0.001); HBV (51.6% vs. 43.1%, P < 0.05); HIV (33.7% vs. 27.0%, p > 0.05)