Improving survey methods in sero-epidemiological studies of injecting drug users: a case example of two cross sectional surveys in Serbia and Montenegro

Abstract

BackgroundLittle is known about the prevalence of HIV or HCV in injecting drug users (IDUs) in Serbia and Montenegro. We measured prevalence of antibodies to HIV (anti-HIV) and hepatitis C virus (anti-HCV), and risk factors for anti-HCV, in community-recruited IDUs in Belgrade and Podgorica, and determined the performance of a parallel rapid HIV testing algorithm.MethodsRespondent driven sampling and audio-computer assisted survey interviewing (ACASI) methods were employed. Dried blood spots were collected for unlinked anonymous antibody testing. Belgrade IDUs were offered voluntary confidential rapid HIV testing using a parallel testing algorithm, the performance of which was compared with standard laboratory tests. Predictors of anti-HCV positivity and the diagnostic accuracy of the rapid HIV test algorithm were calculated.ResultsOverall population prevalence of anti-HIV and anti-HCV in IDUs were 3% and 63% respectively in Belgrade (n = 433) and 0% and 22% in Podgorica (n = 328). Around a quarter of IDUs in each city had injected with used needles and syringes in the last four weeks. In both cities anti-HCV positivity was associated with increasing number of years injecting (eg Belgrade adjusted odds ratio (AOR) 5.6 (95% CI 3.2–9.7) and Podgorica AOR 2.5 (1.3–5.1) for ≥ 10 years v 0–4 years), daily injecting (Belgrade AOR 1.6 (1.0–2.7), Podgorica AOR 2.1 (1.3–5.1)), and having ever shared used needles/syringes (Belgrade AOR 2.3 (1.0–5.4), Podgorica AOR 1.9 (1.4–2.6)). Half (47%) of Belgrade participants accepted rapid HIV testing, and there was complete concordance between rapid test results and subsequent confirmatory laboratory tests (sensitivity 100% (95%CI 59%–100%), specificity 100% (95%CI 98%–100%)).ConclusionThe combination of community recruitment, ACASI, rapid testing and a linked diagnostic accuracy study provide enhanced methods for conducting blood borne virus sero-prevalence studies in IDUs. The relatively high uptake of rapid testing suggests that introducing this method in community settings could increase the number of people tested in high risk populations. The high prevalence of HCV and relatively high prevalence of injecting risk behaviour indicate that further HIV transmission is likely in IDUs in both cities. Urgent scale up of HIV prevention interventions is needed.

HIV among people who inject drugs in Central and Eastern Europe and Central Asia: a systematic review with implications for policy

“…A study among 600 PWID in Odessa, Ukraine found that police beatings were common, with nearly 50% reporting at least one such experience 20 119. Studies in other regions also suggest relatively high rates of police arrest (42–76% ever having been arrested) 18 27 107 120. In Estonia and Lithuania, an estimated 58–70% of PWID had been in prison at least once 74.…”

“…In Estonia and Lithuania, an estimated 58–70% of PWID had been in prison at least once 74. In Georgia and Russia, this figure was between 6% and 37%,18 52 64 65 79 121 122 In Central Europe, between 18% and 50% of respondents report previously having been in prison 93 107…”

Hepatitis C Virus Infection and Related Risk Factors among Injection Drug Users in Montenegro

“…Despite only one HIV case found in the study, the growing presence of HCV may also have long-term implications for the emergence of other blood-borne infections, including HIV. The comparison between the 2 study waves is limited, however, because the 2005 prevalence was a population-level estimate for the city of Podgorica [11] while this study included participants from across Montenegro. …”

“…We selected the covariates that were found to be associated with positive anti-HCV status in a comparable study of IDUs in Montenegro carried out in 2005 [11]. These variables were: frequency of injecting, ever having injected with used needles or syringes, being arrested in the past 12 months, age at first injection and ever having been tested for HCV.…”

“…The cumulative HIV incidence between 1989 and 2009, as reported in the national HIV/AIDS registry, is 103 infected persons, out of whom three injected drugs. In the first risk surveillance study among 328 IDUs carried out in the capital Podgorica in 2005, population-level prevalence of anti-HCV was estimated at 22% [11]. In the same survey, no HIV cases were detected.…”