Abstract:
Due to practical challenges associated with genetic sequencing in low-resource environments, the
burden of hepatitis C virus (HCV) in forcibly displaced people is understudied. We examined the use of field applicable
HCV sequencing methods and phylogenetic analysis to determine HCV transmission dynamics in internally displaced
people who inject drugs (IDPWID) in Ukraine.
Methods In this cross-sectional study, we used modified respondent-driven sampling to recruit IDPWID who were
displaced to Odesa, Ukraine, before 2020. We generated partial and near full length genome (NFLG) HCV sequences
using Oxford Nanopore Technology (ONT) MinION in a simulated field environment. Maximum likelihood and Bayesian methods were used to establish phylodynamic relationships.
Results Between June and September 2020, we collected epidemiological data and whole blood samples from 164
IDPWID (PNAS Nexus.2023;2(3):pgad008). Rapid testing (Wondfo® One Step HCV; Wondfo® One Step HIV1/2) identified an anti-HCV seroprevalence of 67.7%, and 31.1% of participants tested positive for both anti-HCV and HIV. We
generated 57 partial or NFLG HCV sequences and identified eight transmission clusters, of which at least two originated within a year and a half post-displacement.
Conclusions Locally generated genomic data and phylogenetic analysis in rapidly changing low-resource environments, such as those faced by forcibly displaced people, can help inform effective public health strategies. For
example, evidence of HCV transmission clusters originating soon after displacement highlights the importance of
implementing urgent preventive interventions in ongoing situations of forced displacement.
