Injection Drug use Practices and HIV infection among People Who Inject Drugs in Kigali, Rwanda

Background In Rwanda, epidemiological data characterizing people who inject drugs (PWID) and their burden of HIV are limited. We examined injecting drug use (IDU) history, practices, and HIV infection in a sample of PWID in Kigali. Methods From October 2019–February 2020, 322 PWID aged >18 were enrolled in a cross–sectional study using convenience sampling in Kigali. Participants underwent a structured interview and HIV testing. We used Poisson regression with robust variance estimation to assess IDU practices associated with HIV infection. Results The median age was 28 years(IQR:24–31) and 81%(248) were male. The median age at first injection was 23 years (IQR:20–27). HIV prevalence was 9.5%(95%CI:8.7–9.3). In the six months preceding the study, heroin was the primary drug of choice for 99%(303); but cocaine and methamphetamine were also reported by 10%(31) and 4%(12) respectively. Furthermore, 31%(94) and 33%(103) of participants, shared or reused needles in the previous six months, respectively. Up to 43%(133) knew someone who died from a drug–related overdose. PWID reporting sharing needles at least half the time in the previous six months had increased likelihood of HIV infection, compared to those who did not (aPR: 2.67; 95%CI:1.23–5.78). Conclusion HIV infection was common in this sample of PWID in Kigali. The high prevalence of needle reuse and sharing practices highlight significant risk for onward transmission and acquisition of HIV and hepatitis B and C. PWID–focused harm reduction services, including needle and syringe programs, safer injection education, naloxone distribution, and substance use disorder treatment programs, are needed in Rwanda.