Prevalence of Problem Drug Use and Injecting Drug Use in Luxembourg: A Longitudinal and Methodological Perspective

Origer, Alain

doi:10.1159/000337211

Cited by 8 publications

(4 citation statements)

References 39 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Access to opioid substitution treatment (OST) is fairly high with around 1,200 registered OST patients nationally. More than 200 users daily attend the national supervised drug consumption facility (SDCF) [13]. Both OST and national NSP are well developped, decentralised, and available in prison.…”

Section: Introductionmentioning

confidence: 99%

Injection of cocaine is associated with a recent HIV outbreak in people who inject drugs in Luxembourg

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background An outbreak of HIV infections among people who inject drugs (PWID) started in 2014 in Luxembourg. Objectives We conducted phylogenetic and epidemiological analyses among the PWID infected with HIV in Luxembourg or attending the supervised drug consumption facility (SDCF) to understand the main causes of the outbreak. Methods Between January 2013 and December 2017, analysis of medical files were performed from all PWID infected with HIV at the National Service of Infectious Diseases (NSID) providing clinical care nationwide. PWID were interviewed at NSID and SDCF using a standardized questionnaire focused on drug consumption and risk behaviours. The national drug monitoring system RELIS was consulted to determine the frequency of cocaine/heroin use. Transmission clusters were analysed by phylogenetic analyses using approximate maximum-likelihood. Univariate and multivariate logistic regression analyses were performed on epidemiological data collected at NSID and SDCF to determine risk factors associated with cocaine use. Results From January 2013 to December 2017, 68 new diagnosis of HIV infection reported injecting drug use as the main risk of transmission at NSID. The proportion of female cases enrolled between 2013–2017 was higher than the proportion among cases enrolled prior to 2013. (33% vs 21%, p < 0.05). Fifty six viral sequences were obtained from the 68 PWID newly diagnosed for HIV. Two main transmission clusters were revealed: one HIV-1 subtype B cluster and one CRF14_BG cluster including 37 and 9 patients diagnosed since 2013, respectively. Interviews from 32/68 (47%) newly diagnosed PWID revealed that 12/32 (37.5%) were homeless and 27/32 (84.4%) injected cocaine. Increased cocaine injection was indeed reported by the RELIS participants from 53 to 63% in drug users with services contacts between 2012 and 2015, and from 5 to 22% in SDCF users between 2012 and 2016. Compared with PWID who injected only heroin (n = 63), PWID injecting cocaine and heroin (n = 107) were younger (mean of 38 vs 44 years, p≤0.001), reported more frequent piercing (≤0.001), shared and injected drugs more often (p≤0.01), and were more frequently HIV positive (p<0.05) at SDCF using univariate logistic regression analysis. Finally, in the multivariate analysis, use of heroin and cocaine was independently associated with younger age, piercing, sharing of drugs, and regular consumption (p<0.05). Conclusions Injecting cocaine is a new trend of drug use in Luxembourg associated with HIV infection in this recent outbreak among PWID.

show abstract

Section: Introductionmentioning

confidence: 99%

Injection of cocaine is associated with a recent HIV outbreak in people who inject drugs in Luxembourg

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Instead, indirect methods such as capture–recapture (CRC) estimation have been recommended 12, 13, 14, 15. CRC is used extensively to estimate the prevalence of problem drug use 11, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25.…”

Section: Introductionmentioning

confidence: 99%

Problem drug use prevalence estimation revisited: heterogeneity in capture–recapture and the role of external evidence

et al. 2015

View full text Add to dashboard Cite

Background and AimsCapture–recapture (CRC) analysis is recommended for estimating the prevalence of problem drug use or people who inject drugs (PWID). We aim to demonstrate how naive application of CRC can lead to highly misleading results, and to suggest how the problems might be overcome.MethodsWe present a case study of estimating the prevalence of PWID in Bristol, UK, applying CRC to lists in contact with three services. We assess: (i) sensitivity of results to different versions of the dominant (treatment) list: specifically, to inclusion of non‐incident cases and of those who were referred directly from one of the other services; (ii) the impact of accounting for a novel covariate, housing instability; and (iii) consistency of CRC estimates with drug‐related mortality data. We then incorporate formally the drug‐related mortality data and lower bounds for prevalence alongside the CRC into a single coherent model.ResultsFive of 11 models fitted the full data equally well but generated widely varying prevalence estimates, from 2740 [95% confidence interval (CI) = 2670, 2840] to 6890 (95% CI = 3740, 17680). Results were highly sensitive to inclusion of non‐incident cases, demonstrating the presence of considerable heterogeneity, and were sensitive to a lesser extent to inclusion of direct referrals. A reduced data set including only incident cases and excluding referrals could be fitted by simpler models, and led to much greater consistency in estimates. Accounting for housing stability improved model fit considerably more than did the standard covariates of age and gender. External data provided validation of results and aided model selection, generating a final estimate of the number of PWID in Bristol in 2011 of 2770 [95% credible interval (Cr‐I) = 2570, 3110] or 0.9% (95% Cr‐I = 0.9, 1.0%) of the population aged 15–64 years.ConclusionsSteps can be taken to reduce bias in capture–recapture analysis, including: careful consideration of data sources, reduction of lists to less heterogeneous subsamples, use of covariates and formal incorporation of external data.

show abstract

“…substitution treatment register) and/or using other methods (e.g.capture-recapture, multivariate indicator method) (e.g. [28]). For now, it is (reasonably) assumed that the HIV prevalence among IDUs remained stable during the last ten years.…”

Section: Discussionmentioning

confidence: 99%

Improved benchmark-multiplier method to estimate the prevalence of ever-injecting drug use in Belgium, 2000–10

2013

View full text Add to dashboard Cite

BackgroundAccurate estimates of the size of the drug-using populations are essential for evidence-based policy making. However, drug users form a ‘hidden’ population, necessitating the use of indirect methods to estimate population sizes.MethodsThe benchmark-multiplier method was applied to estimate the population size of ever injecting drug users (ever-IDUs), aged 18–64 years, in Belgium using data from the national HIV/AIDS register and from a sero-behavioral study among injecting drug users. However, missing risk factor information and absence of follow-up of the HIV+/AIDS– cases, limits the usefulness of the Belgian HIV/AIDS register as benchmark. To overcome these limitations, statistical corrections were required. In particular, Imputation by Chained Equations was used to correct for the missing risk factor information whereas stochastic mortality modelling was applied to account for the mortality among the HIV+/AIDS– cases. Monte Carlo simulation was used to obtain confidence intervals, properly reflecting the uncertainty due to random error as well as the uncertainty associated with the two statistical corrections mentioned above.ResultsIn 2010, the prevalence (/1000) of ever-IDUs was estimated to be 3.5 with 95% confidence interval [2.5;4.8]. No significant time trends were observed for the period 2000–2010.ConclusionsTo be able to estimate the ever-IDU population size using the Belgian HIV/AIDS register as benchmark, statistical corrections were required without which seriously biased estimates would result. By developing the improved methodology, Belgium is again able to provide ever-IDU population estimates, which are essential to assess the coverage of treatment and to forecast health care needs and costs.

show abstract

Prevalence of Problem Drug Use and Injecting Drug Use in Luxembourg: A Longitudinal and Methodological Perspective

Cited by 8 publications

References 39 publications

Injection of cocaine is associated with a recent HIV outbreak in people who inject drugs in Luxembourg

Injection of cocaine is associated with a recent HIV outbreak in people who inject drugs in Luxembourg

Problem drug use prevalence estimation revisited: heterogeneity in capture–recapture and the role of external evidence

Improved benchmark-multiplier method to estimate the prevalence of ever-injecting drug use in Belgium, 2000–10

Contact Info

Product

Resources

About