A Cross-sectional Study to Identify Risk Factors for Hepatitis C in Punjab, India

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.

The objective of this study was to identify behavioral and demographic predictors of screening positive for HCV in Punjab.

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.

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.

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.