People who inject drugs (PWID) are at high risk for hepatitis C (HCV), hepatitis B (HBV) and HIV without accessible harm reduction programmes. Coverage of needle and syringe and opioid substitution therapy (OST) services in South Africa is below global recommendations and no hepatitis services exist for PWID. We assessed HCV, HBV and HIV prevalence and risk factors among PWID accessing harm reduction services in Cape Town, Durban and Pretoria to inform policy and programming. We conducted a cross-sectional survey among PWID in these cities between August 2016 and October 2017. Participants were opportunistically sampled while accessing services. Study team members administered a questionnaire that assessed sociodemographic characteristics, drug use and sexual risk practices. We tested for HCV (antibody, viral load and genotype), HBV surface antigen (HBsAg) and HIV. Bivariate and multivariate analyses assessed associations with HCV serostatus. Nine hundred and forty-three PWID were included in the per protocol analysis. The majority (87%, 819/943) were male, the overall median age was 29 and most lived on the street (66%, 626/943). At last injection, 77% (722/943) reported using a new needle and syringe and 17% (163/943) shared equipment. HIV prevalence was 21% (196/926), HBsAg positivity 5% (47/936), HCV seroprevalence 55% (513/937), HCV viraemic prevalence (proportion tested with detectable HCV) 43% (404/937) and HCV viraemic rate (proportion HCV antibody positive with detectable HCV) 79% (404/513). HCV genotype 1a (73%, 270/368) was the most prevalent. In multivariate analysis, HCV infection was positively associated with residing in Pretoria (adjusted odds ratio (aOR) 1.27, 95% CI 1.21–1.34), living on the street (aOR 1.90, 95% CI 1.38–2.60), frequent injecting (aOR 1.58, 95% CI 1.15–2.16) and HIV infection (aOR 1.69, 95% CI 1.15–2.47), and negatively associated with black race (aOR 0.52, 95% CI 0.36–0.74) and sexual activity in the previous month (aOR 0.61, 95% CI 0.42–0.88). HCV and HIV are major health threats affecting PWID in these cities. Access to OST and needle and syringe services needs to be increased and integrated with HCV services. Social and structural factors affecting PWID who live on the street need to be addressed.

As South Africa transitions from endemic to intermediate endemicity, hepatitis A surveillance needs strengthening to monitor trends in disease incidence and to identify outbreaks. We used passive laboratory-based surveillance data from the National Health Laboratory Services to calculate national hepatitis A incidence and to establish thresholds for outbreaks. Incidence was calculated by age and geographic location. The static threshold used two or three standard deviations (SDs) above the mean hepatitis A incidence in 2017–2019, and a cumulative summation (CuSum2) threshold used three SDs above the mean of the preceding seven months. These thresholds were applied to hepatitis A data for 2020. From 2017 to 2020, the mean incidence of hepatitis A IgM was 4.06/100,000 and ranged from 4.23 to 4.85/100,000 per year. Hepatitis A incidence was highest in the Western Cape province (WCP) (7.00–10.92/100,000 per year). The highest incidence was in the 1–9-year-olds. The incidence of hepatitis A in 2020 exceeded the static threshold in two districts of the WCP: Cape Winelands in January and Overberg district in August. The provincial incidence did not exceed the static and CuSum2 thresholds. District-level analysis using either threshold was sensitive enough to monitor trends and to alert district health authorities, allowing early outbreak responses.

Data on viral hepatitis in South Africa is scarce. Although viral hepatitis A, B and C are notifiable conditions in South Africa, discrepancies have been noted in the number of viral hepatitis cases notified by the National Department of Health (NDOH) compared with laboratory confirmed cases from the National Institute for Communicable Diseases (NICD). The aim of the study was to assess the knowledge, attitudes and practices of health care professionals on the notification of viral hepatitis A, B and C. A descriptive, cross-sectional study on 385 health care professionals was conducted at Charlotte Maxeke Johannesburg Academic and Tshwane District hospitals in Gauteng province, South Africa, between March and May 2015. A pre-tested, structured questionnaire with 21 (6 demographic and 15 knowledge, attitudes, and practice (KAP)) questions was used to collect information from invited participants. A score was assigned to each KAP question and a mean (SD) score was calculated for each section. Data were analyzed using descriptive statistics in STATA version 13. Of the total 385 respondents, 65% (n = 250) were nurses and 35% (n = 135) were doctors. The overall mean knowledge score for health care professionals was 2.0 ± 1.6 (mean ± SD) out of a score of 6 regarding viral hepatitis notification. Overall mean scores of practice and attitude towards notification were higher at 2.9 ± 0.4 and 3.3 ± 0.7, out of a score of 4 and 5, respectively. Lack of training, poor knowledge, a complex process and excessive workload were some of the reasons for poor notification of viral hepatitis. Overall, knowledge on notification of viral hepatitis was poor among health care professionals. Adequate training on viral hepatitis, notification process, roles and responsibilities of health care professionals to notify and the implication of viral hepatitis notifications is recommended to improve reporting rate of notifiable diseases and referrals to increase linkage to care.

Hepatitis A (HAV) presents a significant global health concern with diverse clinical manifestations primarily transmitted through fecal–oral routes, emphasizing the critical role of sanitation and water cleanliness in transmission dynamics. Age-related variations, notably asymptomatic presentation in children, add complexity. The World Health Organization’s (WHO) endemicity classification aids in understanding prevalence and control strategies. This study examines 2023 South African epidemiological data on HAV cases, evaluating age distribution, incidence rates, and provincial disparities. Data from the national surveillance system and weather services were analyzed. Findings reveal distinct age-related trends, with the highest seroprevalence observed in the 5–9 age group with the most burdened areas located in the Western Cape, KwaZulu-Natal, and Gauteng provinces. Furthermore, seasonal rainfall variations correlate with increased incidence in Western Cape and KZN. The amalgamation of results suggest a potential epidemiological shift, emphasizing the need for updated immunization strategies. Noteworthy patterns, like the rise in 5–9-year-olds, may be influenced by factors such as school clustering and migration. Provincial disparities and the impact of climatic events underscore the necessity for dynamic vaccination strategies and surveillance network enhancements. This study highlights the urgency for improved understanding and response to HAV in South Africa.