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THE ASSOCIATION OF HEALTH-CARE USE AND HEPATITIS C VIRUS INFECTION IN A RANDOM SAMPLE OF URBAN SLUM COMMUNITY RESIDENTS IN SOUTHERN INDIA

To determine whether health-care use was associated with prevalent hepatitis C virus (HCV) infection in Chennai, India, 1,947 adults from 30 slum communities were randomly selected to be interviewed about parenteral and sexual risks for HCV infection and to provide biological specimens for HCV and sexually transmitted infection (STI) testing. Prevalent HCV infection was detected in 2.4% of non-injection drug using (IDU) participants. Controlling for other associated factors, and excluding IDU, men who used informal health-care providers were five times as likely to be HCV infected as those who did not use informal providers (Adjusted Odds Ratio, AOR = 5.83; 95% confidence interval [CI]: 1.57, 21.6), a finding not detected in women. More research is needed to determine the extent to which HCV infection is associated with reuse of contaminated injection equipment in health-care settings in developing countries.

Received June 12, 2002. Accepted for publication November 4, 2002.

Acknowledgments: We thank the YRG-CARE staff, especially A.K. Ganesh, P. Balakrishnan, the interviewers who collected the data, and the participants in the study. We are also indebted to Dr. Vivian Go, Dr. Peggy Bentley, Clevetta Chandler, and Dr. Kenneth Mayer of the Johns Hopkins-based NIMH Chennai site for project support; Lisa Strader of Research Triangle Institute for logistical support; Paul Stamper of the Johns Hopkins School of Medicine, NIMH central laboratory for laboratory support; Dr. Steven Reynolds, Johns Hopkins School of Medicine, for STI data from Pune, India; Judith Bass, Dr. Patrick Tarwater, and Dr. Charles Rohde of the Johns Hopkins School of Public Health for statistical advice; and Dr. Susan Sherman for feedback on the manuscript.

Financial support: This study was funded with NIMH collaborative grant U10-MH61543 and a Fogarty New and Minority Investigator’s Award.

Authors’ addresses: Melissa A. Marx, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, 125 Worth St., Room 318, New York, NY 10013. K.G. Murugavel, P. Balakrishnan, S. Anand, Suniti Solomon, YR Gaitonde Centre for AIDS Research and Education, 1 Raman St., T. Nagar Chennai, Tamilnadu, India. Sudha Sivaram, Mark Steinhoff, and David Celentano, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Rm E6136, Baltimore, MD 21205. David L. Thomas, Johns Hopkins University School of Medicine, 424 N. Bond St., Baltimore, MD 21231.

Reprint requests: Melissa A. Marx, Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, 125 Worth St., Room 318, New York, NY 10013, Telephone: 212–788–4220, Fax: 212–788–5470, E-mail: mmarx{at}health.nyc.gov