90% of patients infected with the hepatitis C virus (HCV) worldwide live in resource-limited settings. The authors were interested in the prevalence of HCV monoinfection and HIV/HCV coinfection, and HCV care received by people who inject drugs in India. 14,481 people who inject drugs were examined from 15 cities throughout India using respondent-driven sampling. The median age of the participants was 30 years and 92·4% were men. The weighted HCV monoinfection prevalence in this population was 37·2% while the HIV/HCV coinfection prevalence was 13·2%. Risk factors for HCV infection were: high lifetime injection frequency, HIV positivity and a high prevalence of people with HIV RNA (>1000 copies/mL) in the community. Of the HCV-positive patients, 5·5% were aware of their status, 3·0% had seen a doctor for their HCV, 1·4% had taken HCV treatment and 0·4% had undetectable HCV RNA levels. Of the 12,128 participants who had never been previously tested for HCV, 50·5% did not get tested because they had not heard of HCV. Of the HCV-positive patients, 34·4% reported harmful or hazardous alcohol use, of whom 50·4% were dependent, and 65·3% reported needle sharing. Therefore there is an urgent need to include resource-limited settings in the global HCV agenda.
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