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Nourani N, Taghvimi A, Bavili-Tabrizi A, Javadzadeh Y, Dastmalchi S. Microextraction Techniques for Sample Preparation of Amphetamines in Urine: A Comprehensive Review. Crit Rev Anal Chem 2022:1-16. [PMID: 36093632 DOI: 10.1080/10408347.2022.2113028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Psychological disorders and dramatic social problems are serious concerns regarding the abuse of amphetamine and its stimulant derivatives worldwide. Consumers of such drugs experience great euphoria along with serious health problems. Determination and quantification of amphetamine-type stimulants are indispensable skills for clinical and forensic laboratories. Analysis of low drug doses in bio-matrices necessitates applications of simple and also effective preparation steps. The preparation procedures not only eliminate adverse matrix effects, but also provide reasonable clean-up and pre-concentration benefits. The current review presents different methods used for sample preparation of amphetamines from urine as the most frequently used biological matrix. The advantages and limitations of various sample preparation methods were discussed focusing on the miniaturized methods.
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Affiliation(s)
- Nasim Nourani
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arezou Taghvimi
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahad Bavili-Tabrizi
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Pharmaceutical Analysis Research Center and Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yousef Javadzadeh
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Siavoush Dastmalchi
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medicinal Chemistry, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
- Faculty of Pharmacy, Near East University, North Cyprus, Turkey
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Croxford S, Emanuel E, Shah A, Chau C, Hope V, Desai M, Ijaz S, Shute J, Edmundson C, Harris RJ, Delpech V, Phipps E. Epidemiology of HIV infection and associated behaviours among people who inject drugs in England, Wales, and Northern Ireland: Nearly 40 years on. HIV Med 2022; 23:978-989. [PMID: 35352446 PMCID: PMC9545638 DOI: 10.1111/hiv.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/21/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Abstract
Introduction People who inject drugs are at high risk of blood‐borne infections. We describe the epidemiology of HIV among people who inject drugs in England, Wales, and Northern Ireland (EW&NI) since 1981. Methods National HIV surveillance data were used to describe trends in diagnoses (1981–2019), prevalence (1990–2019), and behaviours (1990–2019) among people who inject drugs aged ≥15 years in EW&NI. HIV care and treatment uptake were assessed among those attending in 2019. Results Over the past four decades, the prevalence of HIV among people who inject drugs in EW&NI remained low (range: 0.64%–1.81%). Overall, 4978 people who inject drugs were diagnosed with HIV (3.2% of cases). Diagnoses peaked at 234 in 1987, decreasing to 78 in 2019; the majority were among white men born in the UK/Europe (90%), though the epidemic diversified over time. Late diagnosis (CD4 <350 cells/µl) was common (2010–2019: 52% [429/832]). Of those who last attended for HIV care in 2019, 97% (1503/1550) were receiving HIV treatment and 90% (1375/1520) had a suppressed viral load (<200 copies/ml). HIV testing uptake has steadily increased among people who inject drugs (32% since 1990). However, in 2019, 18% (246/1404) of those currently injecting reported never testing. The proportion of people currently injecting reporting sharing needles/syringes decreased from 1999 to 2012, before increasing to 20% (288/1426) in 2019, with sharing of any injecting equipment at 37% (523/1429). Conclusion The HIV epidemic among people who inject drugs in EW&NI has remained relatively contained compared with in other countries, most likely because of the prompt implementation of an effective national harm reduction programme. However, risk behaviours and varied access to preventive interventions among people who inject drugs indicate the potential for HIV outbreaks.
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Affiliation(s)
| | | | - Ammi Shah
- UK Health Security Agency, London, UK
| | | | - Vivian Hope
- UK Health Security Agency, London, UK.,Liverpool John Moores University, Liverpool, UK
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Hadjikou A, Pavlopoulou ID, Pantavou K, Georgiou A, Williams LD, Christaki E, Voskarides K, Lavranos G, Lamnisos D, Pouget ER, Friedman SR, Nikolopoulos GK. Drug Injection-Related Norms and High-Risk Behaviors of People Who Inject Drugs in Athens, Greece. AIDS Res Hum Retroviruses 2021; 37:130-138. [PMID: 33126818 DOI: 10.1089/aid.2020.0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Drug use involves social interactions. Therefore, norms in the proximal environment of people who inject drugs (PWID) can favor behaviors that may result in HIV transmission. This work aimed at studying drug injection-related norms and their potential association with risky behaviors among PWID in Athens, Greece, in the context of economic recession and political activism that followed the fiscal crisis and soon after a recent HIV outbreak had leveled off. The Transmission Reduction Intervention Project (TRIP) was a social network-based approach (June 2013 to July 2015) that involved two groups of PWID seeds-with recent HIV infection and with long-term HIV infection and one control group of HIV-negative PWID. Network contacts of seeds were also enrolled. TRIP participants answered a questionnaire that included items on injection-related norms and behaviors. TRIP recruited 320 PWID (HIV positive, 44.4%). TRIP participants, especially those without HIV, often recalled or perceived as normative among their partners and in their networks some behaviors that can lead to HIV transmission. TRIP participants who recalled that they were encouraged by their regular drug partners to use an unclean syringe were almost twice as likely to report that they share syringes [odds ratio (OR) = 2.03; 95% confidence interval (CI) = 1.86-2.21], or give syringes to someone else (OR = 1.70; 95% CI = 1.42-2.04) as those who did not recall such an encouragement. Associations were modified by HIV status. HIV negatives, who were reportedly encouraged to share nonsyringe injecting equipment, were almost 4.5 times as likely to share that material as HIV-negative participants who were not encouraged (OR = 4.59, 95% CI = 4.12-5.11). Further research is needed on the multiple determinants (social, economic, and political) of norms in the social environments of PWID. Since peer norms are associated with risky behaviors, interventions should be developed to encourage norms and peer pressure against the sharing of injection equipment.
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Affiliation(s)
- Andria Hadjikou
- Department of Health Sciences European University of Cyprus, Nicosia, Cyprus
- Medical School, University of Cyprus, Nicosia, Cyprus
| | - Ioanna D. Pavlopoulou
- Pediatric Research Laboratory, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Leslie D. Williams
- National Development and Research Institutes, New York, New York, USA
- Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA
| | | | | | - Giagkos Lavranos
- Department of Health Sciences European University of Cyprus, Nicosia, Cyprus
| | - Demetris Lamnisos
- Department of Health Sciences European University of Cyprus, Nicosia, Cyprus
| | | | - Samuel R. Friedman
- National Development and Research Institutes, New York, New York, USA
- Department of Population Health, NYU Medical School, New York, New York, USA
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Kostaki EG, Nikolopoulos GK, Pavlitina E, Williams L, Magiorkinis G, Schneider J, Skaathun B, Morgan E, Psichogiou M, Daikos GL, Sypsa V, Smyrnov P, Korobchuk A, Malliori M, Hatzakis A, Friedman SR, Paraskevis D. Molecular Analysis of Human Immunodeficiency Virus Type 1 (HIV-1)-Infected Individuals in a Network-Based Intervention (Transmission Reduction Intervention Project): Phylogenetics Identify HIV-1-Infected Individuals With Social Links. J Infect Dis 2018; 218:707-715. [PMID: 29697829 PMCID: PMC6057507 DOI: 10.1093/infdis/jiy239] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/23/2018] [Indexed: 01/04/2023] Open
Abstract
Background The Transmission Reduction Intervention Project (TRIP) is a network-based intervention that aims at decreasing human immunodeficiency virus type 1 (HIV-1) spread. We herein explore associations between transmission links as estimated by phylogenetic analyses, and social network-based ties among persons who inject drugs (PWID) recruited in TRIP. Methods Phylogenetic trees were inferred from HIV-1 sequences of TRIP participants. Highly supported phylogenetic clusters (transmission clusters) were those fulfilling 3 different phylogenetic confidence criteria. Social network-based ties (injecting or sexual partners, same venue engagement) were determined based on personal interviews, recruitment links, and field observation. Results TRIP recruited 356 individuals (90.2% PWID) including HIV-negative controls; recently HIV-infected seeds; long-term HIV-infected seeds; and their social network members. Of the 150 HIV-infected participants, 118 (78.7%) were phylogenetically analyzed. Phylogenetic analyses suggested the existence of 13 transmission clusters with 32 sequences. Seven of these clusters included 14 individuals (14/32 [43.8%]) who also had social ties with at least 1 member of their cluster. This proportion was significantly higher than what was expected by chance. Conclusions Molecular methods can identify HIV-infected people socially linked with another person in about half of the phylogenetic clusters. This could help public health efforts to locate individuals in networks with high transmission rates.
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Affiliation(s)
- Evangelia-Georgia Kostaki
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | | | | | - Leslie Williams
- National Development and Research Institutes, New York, New York
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | - John Schneider
- Departments of Medicine and Public Health Sciences, University of Chicago Medical Center, Center for AIDS Elimination, Illinois
| | - Britt Skaathun
- Departments of Medicine and Public Health Sciences, University of Chicago Medical Center, Center for AIDS Elimination, Illinois
| | - Ethan Morgan
- Departments of Medicine and Public Health Sciences, University of Chicago Medical Center, Center for AIDS Elimination, Illinois
| | - Mina Psichogiou
- Laikon General Hospital, First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Greece
| | - Georgios L Daikos
- Laikon General Hospital, First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | | | | | - Meni Malliori
- Medical School, National and Kapodistrian University of Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
| | | | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece
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5
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Marzel A, Kusejko K, Weber R, Bruggmann P, Rauch A, Roth JA, Bernasconi E, Calmy A, Cavassini M, Hoffmann M, Böni J, Yerly S, Klimkait T, Perreau M, Günthard HF, Kouyos RD. The Cumulative Impact of Harm Reduction on the Swiss HIV Epidemic: Cohort Study, Mathematical Model, and Phylogenetic Analysis. Open Forum Infect Dis 2018; 5:ofy078. [PMID: 29868622 PMCID: PMC5965087 DOI: 10.1093/ofid/ofy078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) transmission among injecting drug users (IDUs) is increasing in the United States due to the recent opioid epidemic and is the leading mode of transmission in Eastern Europe. Methods To evaluate the overall impact of HIV harm reduction, we combined (1) data from the Swiss HIV Cohort Study and public sources with (2) a mathematical model expressed as a system of ordinary differential equations. The model reconstructs the national epidemic from the first case in 1980 until 2015. Phylogenetic cluster analysis of HIV-1 pol sequences was used to quantify the epidemic spillover from IDUs to the general population. Results Overall, harm reduction prevented 15903 (range, 15359–16448) HIV infections among IDUs until the end of 2015, 5446 acquired immune deficiency syndrome (AIDS) deaths (range, 5142–5752), and a peak HIV prevalence of 50.7%. Introduction of harm reduction 2 years earlier could have halved the epidemic, preventing 3161 (range, 822–5499) HIV infections and 1468 (range, 609–2326) AIDS deaths. Suddenly discontinuing all harm reduction in 2005 would have resulted in outbreak re-emergence with 1351 (range, 779–1925) additional HIV cases. Without harm reduction, the estimated additional number of heterosexuals infected by HIV-positive IDUs is estimated to have been 2540 (range, 2453–2627), which is equivalent to the total national reported incidence among heterosexuals in the period of 2007 to 2015. Conclusions Our results suggest that a paramount, population-level impact occurred because of the harm reduction package, beyond factors that can be explained by a reduction in risk behavior and a decrease in the number of drug users over time.
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Affiliation(s)
- Alex Marzel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Andri Rauch
- Clinic for Infectious Diseases, Bern University Hospital, Switzerland
| | - Jan A Roth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, Switzerland
| | - Alexandra Calmy
- Laboratory of Virology and Division of Infectious Diseases, Geneva University Hospital, Switzerland
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, Switzerland
| | - Matthias Hoffmann
- Division of Infectious Diseases, Cantonal Hospital St. Gallen, Switzerland
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich, Switzerland
| | - Sabine Yerly
- Laboratory of Virology and Division of Infectious Diseases, Geneva University Hospital, Switzerland
| | - Thomas Klimkait
- Molecular Virology, Department Biomedicine-Petersplatz, University of Basel, Switzerland
| | | | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Switzerland
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Popescu B, Banica L, Nicolae I, Radu E, Niculescu I, Abagiu A, Otelea D, Paraschiv S. NGS combined with phylogenetic analysis to detect HIV-1 dual infection in Romanian people who inject drugs. Microbes Infect 2018; 20:308-11. [PMID: 29626632 DOI: 10.1016/j.micinf.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/24/2018] [Accepted: 03/21/2018] [Indexed: 11/23/2022]
Abstract
Dual HIV infections are possible and likely in people who inject drugs (PWID). Thirty-eight newly diagnosed patients, 19 PWID and 19 heterosexually HIV infected were analyzed. V2V3 loop of HIV-1 env gene was sequenced on the NGS platform 454 GSJunior (Roche). HIV-1 dual/multiple infections were identified in five PWID. For three of these patients, the reconstructed variants belonged to pure F1 subtype and CRF14_BG strains according to phylogenetic analysis. New recombinant forms between these parental strains were identified in two PWID samples. NGS data can provide, with the help of phylogenetic analysis, important insights about the intra-host sub-population structure.
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Fotiou A, Kanavou E, Antaraki A, Richardson C, Terzidou M, Kokkevi A. HCV/HIV coinfection among people who inject drugs and enter opioid substitution treatment in Greece: prevalence and correlates. Hepatol Med Policy 2016; 1:9. [PMID: 30288313 PMCID: PMC5918725 DOI: 10.1186/s41124-016-0017-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/15/2016] [Indexed: 12/12/2022]
Abstract
Background HCV/HIV coinfection in people who inject drugs is a public health issue, which presents a variety of challenges to healthcare providers. The determinants of HCV/HIV coinfection in this population are nonetheless not well known. The aim of the present study is to identify the factors associated with HCV/HIV coinfection in people who inject drugs and enter drug-related treatment. Methods Linked serological and behavioral data were collected from people who entered 38 opioid substitution treatment clinics in central and southern Greece between January and December 2013. Three mutually exclusive groups were defined based on the presence of HCV and HIV antibodies. Group 1 clients had neither infection, Group 2 had HCV but not HIV, and Group 3 had HCV/HIV coinfection. Multinomial logistic regression analyses identified differences between groups according to socio-demographic, drug use and higher-risk behavioral characteristics. Results Our study population consisted of 580 people who injected drugs in the past 12 months (79.8 % males, with median age 36 years).79.4 % were HCV and 15.7 % HIV infected. Of those with complete serological data in both HCV and HIV indicators, 20.4 % were uninfected, 64.0 % HCV monoinfected, and 14.9 % HCV/HIV coinfected. HCV infection with or without HIV coinfection was positively associated with living alone or with a spouse/partner without children, prior incarceration, drug injecting histories of ≥10 years, and syringe sharing in the past 12 months, and negatively associated with never having previously been tested for HCV. HCV/HIV coinfection, but not HCV infection alone, was positively associated with residence in urban areas (relative risk ratio [RRR] = 4.8, 95 % confidence interval [CI]: 1.7–13.7, p = 0.004) and averaging >3 injections a day in the past 30 days (RRR = 4.5, 95 % CI: 1.6–12.8, p = 0.005), and negatively associated with using a condom in the last sexual intercourse. Conclusions People who inject drugs and live in urban areas and inject frequently have higher risk of coinfection. Findings highlight the need for scaling-up needle and syringe programs in inner city areas and promoting access of this population to screening and treatment, especially in prisons. The protective role of living with parents and children could inform the implementation of indicated interventions.
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Affiliation(s)
- Anastasios Fotiou
- 1Epidemiology Unit, Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, 2 Soranou tou Efesiou St., Athens, 11527 Greece
| | - Eleftheria Kanavou
- 1Epidemiology Unit, Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, 2 Soranou tou Efesiou St., Athens, 11527 Greece
| | - Argyro Antaraki
- 1Epidemiology Unit, Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, 2 Soranou tou Efesiou St., Athens, 11527 Greece
| | - Clive Richardson
- 2Panteion University of Social and Political Sciences, 136, Leoforos A. Siggrou, Kallithea, Athens 17671 Greece
| | - Manina Terzidou
- 1Epidemiology Unit, Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, 2 Soranou tou Efesiou St., Athens, 11527 Greece
| | - Anna Kokkevi
- 3University Mental Health Research Institute, 2 Soranou tou Efesiou St., Athens, 11527 Greece
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Hernando V, Alvárez-del Arco D, Alejos B, Monge S, Amato-Gauci AJ, Noori T, Pharris A, del Amo J. HIV Infection in Migrant Populations in the European Union and European Economic Area in 2007-2012: An Epidemic on the Move. J Acquir Immune Defic Syndr 2015; 70:204-11. [PMID: 26068723 DOI: 10.1097/QAI.0000000000000717] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Migrants are considered a key group at risk for HIV infection. This study describes the epidemiology of HIV and the distribution of late HIV presentation among migrants within the European Union/European Economic Area during 2007-2012. METHODS HIV cases reported to European Surveillance System (TESSy) were analyzed. Migrants were defined as people whose geographical origin was different than the reporting country. Multiple logistic regression was used to model late HIV presentation. RESULTS Overall, 156,817 HIV cases were reported, of which 60,446 (38%) were migrants. Of these, 53% were from Sub-Saharan Africa, 12% from Latin America, 9% from Western Europe, 7% from Central Europe, 5% from South and Southeast Asia, 4% from East Europe, 4% from Caribbean, and 3% from North Africa and Middle East. Male and female migrants from Sub-Saharan Africa and Latin America had higher odds of late HIV presentation than native men and women. Migrants accounted for 40% of all HIV notifications in 2007 versus 35% in 2012. HIV cases in women from Sub-Saharan Africa decreased from 3725 in 2007 to 2354 in 2012. The number of HIV cases from Latin America peaked in 2010 to decrease thereafter. HIV diagnoses in migrant men who have sex with men increased from 1927 in 2007 to 2459 in 2012. CONCLUSIONS Migrants represent two-fifths of the HIV cases reported and had higher late HIV presentation. HIV epidemic in migrant populations in European Union/European Economic Area member states is changing, probably reflecting the global changes in the HIV pandemic, the impact of large-scale ART implementation, and migration fluctuations secondary to the economic crisis in Europe.
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Kentikelenis A, Karanikolos M, Williams G, Mladovsky P, King L, Pharris A, Suk JE, Hatzakis A, McKee M, Noori T, Stuckler D. How do economic crises affect migrants' risk of infectious disease? A systematic-narrative review. Eur J Public Health 2015; 25:937-44. [PMID: 26318852 PMCID: PMC4668330 DOI: 10.1093/eurpub/ckv151] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It is not well understood how economic crises affect infectious disease incidence and prevalence, particularly among vulnerable groups. Using a susceptible-infected-recovered framework, we systematically reviewed literature on the impact of the economic crises on infectious disease risks in migrants in Europe, focusing principally on HIV, TB, hepatitis and other STIs. METHODS We conducted two searches in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar, websites of key organizations and grey literature to identify how economic changes affect migrant populations and infectious disease. We perform a narrative synthesis in order to map critical pathways and identify hypotheses for subsequent research. RESULTS The systematic review on links between economic crises and migrant health identified 653 studies through database searching; only seven met the inclusion criteria. Fourteen items were identified through further searches. The systematic review on links between economic crises and infectious disease identified 480 studies through database searching; 19 met the inclusion criteria. Eight items were identified through further searches. The reviews show that migrant populations in Europe appear disproportionately at risk of specific infectious diseases, and that economic crises and subsequent responses have tended to exacerbate such risks. Recessions lead to unemployment, impoverishment and other risk factors that can be linked to the transmissibility of disease among migrants. Austerity measures that lead to cuts in prevention and treatment programmes further exacerbate infectious disease risks among migrants. Non-governmental health service providers occasionally stepped in to cater to specific populations that include migrants. CONCLUSIONS There is evidence that migrants are especially vulnerable to infectious disease during economic crises. Ring-fenced funding of prevention programs, including screening and treatment, is important for addressing this vulnerability.
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Affiliation(s)
| | - Marina Karanikolos
- 2 European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK
| | - Gemma Williams
- 3 LSE Health, London School of Economics and Political Science, London, UK
| | - Philipa Mladovsky
- 4 Department of International Development, London School of Economics and Political Science, London, UK
| | - Lawrence King
- 1 Department of Sociology, University of Cambridge, Cambridge, UK
| | - Anastasia Pharris
- 5 European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Jonathan E Suk
- 5 European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Martin McKee
- 2 European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK
| | - Teymur Noori
- 5 European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - David Stuckler
- 7 Department of Sociology, University of Oxford, Oxford, UK
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10
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Hatzakis A, Sypsa V, Paraskevis D, Nikolopoulos G, Tsiara C, Micha K, Panopoulos A, Malliori M, Psichogiou M, Pharris A, Wiessing L, van de Laar M, Donoghoe M, Heckathorn DD, Friedman SR, Des Jarlais DC. Design and baseline findings of a large-scale rapid response to an HIV outbreak in people who inject drugs in Athens, Greece: the ARISTOTLE programme. Addiction 2015; 110:1453-67. [PMID: 26032121 PMCID: PMC4854521 DOI: 10.1111/add.12999] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/30/2015] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
Abstract
AIMS To (i) describe an intervention implemented in response to the HIV-1 outbreak among people who inject drugs (PWIDs) in Greece (ARISTOTLE programme), (ii) assess its success in identifying and testing this population and (iii) describe socio-demographic characteristics, risk behaviours and access to treatment/prevention, estimate HIV prevalence and identify risk factors, as assessed at the first participation of PWIDs. DESIGN A 'seek, test, treat, retain' intervention employing five rounds of respondent-driven sampling. SETTING Athens, Greece (2012-13). PARTICIPANTS A total of 3320 individuals who had injected drugs in the past 12 months. INTERVENTION ARISTOTLE is an intervention that involves reaching out to high-risk, hard-to-reach PWIDs ('seek'), engaging them in HIV testing and providing information and materials to prevent HIV ('test') and initiating and maintaining anti-retroviral and opioid substitution treatment for those testing positive ('treat' and 'retain'). MEASUREMENTS Blood samples were collected for HIV testing and personal interviews were conducted. FINDINGS ARISTOTLE recruited 3320 PWIDs during the course of 13.5 months. More than half (54%) participated in multiple rounds, resulting in 7113 visits. HIV prevalence was 15.1%. At their first contact with the programme, 12.5% were on opioid substitution treatment programmes and the median number of free syringes they had received in the preceding month was 0. In the multivariable analysis, apart from injection-related variables, homelessness was a risk factor for HIV infection in male PWIDs [odds ratio (OR) yes versus no = 1.89, 95% confidence interval (CI) = 1.41, 2.52] while, in female PWIDS, the number of sexual partners (OR for > 5 versus one partner in the past year = 4.12, 95% CI = 1.93, 8.77) and history of imprisonment (OR yes versus no = 2.76, 95% CI = 1.43, 5.31) were associated with HIV. CONCLUSIONS In Athens, Greece, the ARISTOTLE intervention for identifying HIV-positive people among people who inject drugs (PWID) facilitated rapid identification of a hidden population experiencing an outbreak and provided HIV testing, counselling and linkage to care. According to ARISTOTLE data, the 2011 HIV outbreak in Athens resulted in 15% HIV infection among PWID. Risk factors for HIV among PWID included homelessness in men and history of imprisonment and number of sexual partners in women.
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Affiliation(s)
- Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
| | - Georgios Nikolopoulos
- IAS/NIDA Fellow, Hellenic Center for Diseases Prevention and Control, Athens, Greece
| | - Chrissa Tsiara
- Hellenic Centre for Diseases Control and Prevention, Athens, Greece
| | | | | | - Meni Malliori
- Medical School, University of Athens, Athens, Greece
| | - Mina Psichogiou
- Department of Propedeutic Medicine, Medical School, University of Athens, Athens, Greece
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | | | - Martin Donoghoe
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Cruciani M, Wiessing L, Serpelloni G, Genetti B, Andreotti A, Iulia C, Zermiani M, Suligoi B. Increasing prevalence of HIV infection among first time clients in Italian drug treatment services - is it sexual transmission? BMC Infect Dis 2015; 15:201. [PMID: 25925747 PMCID: PMC4431036 DOI: 10.1186/s12879-015-0940-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 04/23/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Over the last two decades, the proportion of people who inject drugs among newly reported HIV cases in Italy has been continuously declining. This trend is reflected in the prevalence of HIV infection among problem drug users followed in drug treatment services. We report nationwide trends in the prevalence of HIV and HCV among tested clients in charge to drug addiction services from 2005 to 2011. METHODS Data on the prevalence of HIV and HCV among drug users from public drug treatment services across Italy were collected and analyzed for the period from 2005 to 2011. Prevalence of HIV and HCV were compared between clients returning to treatment and those entering treatment for the first time, and by gender. Due to the high percentage of missing data, the "inverse probability weight" method was used. Trends in testing uptake were also analysed. RESULTS A significant decrease of HIV and HCV prevalence is observed among all PDUs entering treatment (from 14.7% to 11.1% and from 61.6% to 50%, respectively, in 2005-2011). By contrast, among those entering the services for the first time, after an initial decline the prevalence of HIV infection steadily increased in both sexes, from 2.2% in 2009 to 5.3% in 2011. Self-reported injecting rates in this group decreased over time, and in 2011 the proportion reporting drug injecting was lower among new clients than in people returning to services (14.5 vs. 34.4%). We also observed a progressive and significant reduction in HIV and HCV testing in drug treatment services. CONCLUSIONS Changes in injection practice and type of drugs used, coupled with a concurrent reduction in HCV prevalence, do not support drug injection as the main explanation for an increased HIV transmission in people entering drug treatment services for the first time. While reductions in testing rates raise concerns over data quality, the possibility of increased sexual transmission needs to be considered.
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Affiliation(s)
- Mario Cruciani
- Center of Community Medicine and HIV Outpatient Clinic, Via Germania, 20, Verona, Italy.
| | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCCDA), Cais do Sodré, 1249-289, Lisboa, Portugal.
| | - Giovanni Serpelloni
- Dipartimento Politiche Antidroga, Presidenza del Consiglio dei Ministri, Via dei Laterani, 34, 00184, Roma, Italy.
| | - Bruno Genetti
- Dipartimento Politiche Antidroga, Presidenza del Consiglio dei Ministri, Via dei Laterani, 34, 00184, Roma, Italy.
| | - Alessandra Andreotti
- Dipartimento Politiche Antidroga, Presidenza del Consiglio dei Ministri, Via dei Laterani, 34, 00184, Roma, Italy.
| | - Carpignano Iulia
- Dipartimento Politiche Antidroga, Presidenza del Consiglio dei Ministri, Via dei Laterani, 34, 00184, Roma, Italy.
| | - Monica Zermiani
- Center of Community Medicine and HIV Outpatient Clinic, Via Germania, 20, Verona, Italy.
| | - Barbara Suligoi
- Istituto Superiore di Sanità (ISS), Viale Regina Elena, 299, 00161, Roma, Italy.
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Nikolopoulos GK, Fotiou A, Kanavou E, Richardson C, Detsis M, Pharris A, Suk JE, Semenza JC, Costa-Storti C, Paraskevis D, Sypsa V, Malliori MM, Friedman SR, Hatzakis A. National income inequality and declining GDP growth rates are associated with increases in HIV diagnoses among people who inject drugs in Europe: a panel data analysis. PLoS One 2015; 10:e0122367. [PMID: 25875598 PMCID: PMC4398461 DOI: 10.1371/journal.pone.0122367] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 02/16/2015] [Indexed: 11/18/2022] Open
Abstract
Background There is sparse evidence that demonstrates the association between macro-environmental processes and drug-related HIV epidemics. The present study explores the relationship between economic, socio-economic, policy and structural indicators, and increases in reported HIV infections among people who inject drugs (PWID) in the European Economic Area (EEA). Methods We used panel data (2003–2012) for 30 EEA countries. Statistical analyses included logistic regression models. The dependent variable was taking value 1 if there was an outbreak (significant increase in the national rate of HIV diagnoses in PWID) and 0 otherwise. Explanatory variables included the growth rate of Gross Domestic Product (GDP), the share of the population that is at risk for poverty, the unemployment rate, the Eurostat S80/S20 ratio, the Gini coefficient, the per capita government expenditure on health and social protection, and variables on drug control policy and drug-using population sizes. Lags of one to three years were investigated. Findings In multivariable analyses, using two-year lagged values, we found that a 1% increase of GDP was associated with approximately 30% reduction in the odds of an HIV outbreak. In GDP-adjusted analyses with three-year lagged values, the effect of the national income inequality on the likelihood of an HIV outbreak was significant [S80/S20 Odds Ratio (OR) = 3.89; 95% Confidence Interval (CI): 1.15 to 13.13]. Generally, the multivariable analyses produced similar results across three time lags tested. Interpretation Given the limitations of ecological research, we found that declining economic growth and increasing national income inequality were associated with an elevated probability of a large increase in the number of HIV diagnoses among PWID in EEA countries during the last decade. HIV prevention may be more effective if developed within national and European-level policy contexts that promote income equality, especially among vulnerable groups.
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Affiliation(s)
- Georgios K. Nikolopoulos
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
- Hellenic Centre for Disease Control and Prevention, Amarousio, Greece
- * E-mail:
| | - Anastasios Fotiou
- Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, Athens, Greece
- Department of Psychiatry, Athens University Medical School, Athens, Greece
| | - Eleftheria Kanavou
- Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, Athens, Greece
| | - Clive Richardson
- Greek Reitox Focal Point of the EMCDDA, University Mental Health Research Institute, Athens, Greece
- Panteion University of Social and Political Sciences, Athens, Greece
| | - Marios Detsis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Jonathan E. Suk
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Jan C. Semenza
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Claudia Costa-Storti
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
| | | | - Samuel R. Friedman
- National Development and Research Institutes, New York, New York, United States of America
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece
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Abstract
As a consequence of the massive restructuring of drug availability, heroin injection in Hungary was largely replaced by the injecting of new psychoactive substances (NPS) starting in 2010. In the following years in our sero-prevalence studies we documented higher levels of injecting paraphernalia sharing, daily injection-times, syringe reuse, and HCV prevalence among stimulant injectors, especially among NPS injectors. Despite the increasing demand, in 2012 the number of syringes distributed dropped by 35% due to austerity measures. Effects of drug market changes and the economic recession may have future epidemiological consequences. Study limitations are noted and future needed research is suggested.
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Affiliation(s)
- Anna Tarján
- 1Hungarian Reitox National Focal Point, National Centre for Epidemiology , Budapest , Hungary
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14
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Sypsa V, Paraskevis D, Malliori M, Nikolopoulos GK, Panopoulos A, Kantzanou M, Katsoulidou A, Psichogiou M, Fotiou A, Pharris A, Van De Laar M, Wiessing L, Jarlais DD, Friedman SR, Hatzakis A. Homelessness and Other Risk Factors for HIV Infection in the Current Outbreak Among Injection Drug Users in Athens, Greece. Am J Public Health 2015; 105:196-204. [PMID: 24524508 DOI: 10.2105/ajph.2013.301656] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objectives. We examined HIV prevalence and risk factors among injection drug users (IDUs) in Athens, Greece, during an HIV outbreak. Methods. We used respondent-driven sampling (RDS) to recruit 1404 IDUs to the Aristotle intervention in August to October 2012. We interviewed participants and tested for HIV. We performed bivariate and multivariate analyses. Results. Estimated HIV prevalence was 19.8% (RDS-weighted prevalence = 14.8%). Odds of infection were 2.3 times as high in homeless as in housed IDUs and 2.1 times as high among IDUs who injected at least once per day as among less frequent injectors (both, P < .001). Six percent of men and 23.5% of women reported transactional sex in the past 12 months, and condom use was low. Intercourse with non-IDUs was common (53.2% of men, 25.6% of women). Among IDUs who had been injecting for 2 years or less the estimated incidence rate was 23.4 new HIV cases per 100 person-years at risk. Conclusions. Efforts to reduce HIV transmission should address homelessness as well as scaling up prevention services, such as needle and syringe distribution and other risk reduction interventions.
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Affiliation(s)
- Vana Sypsa
- At the time of the study, Vana Sypsa, Dimitrios Paraskevis, Maria Kantzanou, Antigoni Katsoulidou, Mina Psichogiou, and Angelos Hatzakis were with the National Retrovirus Reference Center, Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, University of Athens, Greece. Meni Malliori and Anastasios Panopoulos were with the Organisation Against Drugs (OKANA), Athens. Georgios K. Nikolopoulos was with the Hellenic Center for Disease Control and Prevention, Athens. Anastasios Fotiou was with the Greek Reitox Focal Point of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), University Mental Health Research Institute, Athens. Anastasia Pharris and Marita Van De Laar were with the European Centre for Disease Prevention and Control, Stockholm, Sweden. Lucas Wiessing was with the EMCDDA, Lisbon, Portugal. Don Des Jarlais was with the Beth Israel Medical Center, New York, NY. Samuel R. Friedman was with the National Development and Research Institutes, New York, NY
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15
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Lazarus JV, Lundgren J, Casabona J, Wiessing L, Matheï C, Vickerman P, Prins M, Kretzschmar M, Kantzanou M, Giraudon I, Ferri M, Griffiths P, Harris M, Walker M, Chavdarova L, Schatz E, Schiffer K, Kools J, Farell J, Mendão L. Roundtable discussion: how lessons learned from HIV can inform the global response to viral hepatitis. BMC Infect Dis 2014; 14 Suppl 6:S18. [PMID: 25252919 PMCID: PMC4178551 DOI: 10.1186/1471-2334-14-s6-s18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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16
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Uusküla A, Raag M, Folch C, Prasad L, Karnite A, van Veen MG, Eritsyan K, Rosinska M, Des Jarlais DC, Wiessing L. Self-reported testing, HIV status and associated risk behaviours among people who inject drugs in Europe: important differences between East and West. AIDS 2014; 28:1657-64. [PMID: 25232900 DOI: 10.1097/QAD.0000000000000299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIMS To describe HIV-related risk behaviours, HIV testing and HIV status among people who inject drugs (PWIDs) in the 2000 in European countries with high-prevalence HIV epidemics among PWID. METHODS Data from 12 cross-sectional studies among PWID from seven countries were used. Meta-analysis was used to synthesize the data and meta-regression to explain heterogeneity [in addition to deriving adjusted odds ratios (AORmeta)]. RESULTS Data on 1791 PWID from western (the West) and 3537 from central and eastern (the East) European countries were available. The mean age of participating PWIDs was 30.6 years (SD 7.9), 75% were men, and 36% [95% confidence interval 34-37%) were HIV-infected (30% West, 38% East); 22% had not previously been tested for HIV. The prevalence of reported high-risk behaviour was significantly higher among PWID from the East. Comparison of HIV-infected and uninfected PWID within countries yielded similar results across all countries: HIV-infected PWID were less likely to be sexually active [AORmeta 0.69 (0.58-0.81)], reported less unprotected sex [AORmeta 0.59 (0.40-0.83)], but reported more syringe sharing [AORmeta 1.70 (1.30-2.00)] and more frequent injecting [AORmeta 1.40 (1.20-1.70)] than their HIV-uninfected counterparts. CONCLUSION Despite the absolute differences in reported risk behaviours among PWID in western and eastern Europe, the associations of risk behaviours with HIV status were similar across the sites and regions. There is a substantial potential for further HIV transmission and acquisition based on the continuous risk behaviours reported. HIV prevention and harm reduction interventions targeting PWID should be evaluated.
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Abstract
HIV infection in Western Europe is mainly concentrated among men who have sex with men, heterosexuals who acquired HIV from sub-Saharan African countries, and in people who inject drugs. The rate of newly diagnosed cases of HIV has remained roughly stable since 2004 whereas the number of people living with HIV has slowly increased due to new infections and the success of antiretroviral therapy in prolonging life. An ageing population is gradually emerging that will require additional care. There are large differences across countries in HIV testing rates, proportions of people who present to care with low CD4+ cell counts, accessibility to treatment and care, and rates of retention once in care. Improved collection of HIV surveillance data will benefit countries and help to understand their epidemic better. However, social inequalities experienced by people with HIV still remain in some regions and urgently need to be addressed.
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Affiliation(s)
- Fumiyo Nakagawa
- Research Department of Infection and Population Health, UCL Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - Andrew N. Phillips
- Research Department of Infection and Population Health, UCL Royal Free Campus, Rowland Hill Street, London, NW3 2PF UK
| | - Jens D. Lundgren
- Copenhagen HIV Programme (CHIP), Department of Infectious Disease (8632), Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
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18
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Hedrich D, Kalamara E, Sfetcu O, Pharris A, Noor A, Wiessing L, Hope V, Van de Laar M. Human immunodeficiency virus among people who inject drugs: Is risk increasing in Europe? Euro Surveill 2013; 18:20648. [DOI: 10.2807/1560-7917.es2013.18.48.20648] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In most European Union (EU)/European Economic Area (EEA) countries, between 2010 and 2012, reports of new human immunodeficiency virus (HIV) diagnoses among people who inject drugs have been stable or declining. HIV outbreaks in Greece and Romania, first reported in 2011, continue and economic conditions hinder provision of effective response coverage. When measured against some established thresholds, prevention coverage remains inadequate in at least one-third of EU/EEA countries. Urgent consideration to scale up prevention efforts is merited.
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Affiliation(s)
- D Hedrich
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - E Kalamara
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - O Sfetcu
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - A Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - A Noor
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - L Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - V Hope
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
| | - M Van de Laar
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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19
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Oprea C, Ceausu E, Ruta S. Ongoing outbreak of multiple blood-borne infections in injecting drug users in Romania. Public Health 2013; 127:1048-50. [PMID: 24239282 DOI: 10.1016/j.puhe.2013.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 08/15/2013] [Accepted: 08/27/2013] [Indexed: 12/23/2022]
Affiliation(s)
- C Oprea
- Victor Babes Infectious and Tropical Diseases Hospital, 281 Mihai Bravu Bvd, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, 8 Eroilor Sanitari Bvd, Bucharest, Romania
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20
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Paraskevis D, Nikolopoulos G, Fotiou A, Tsiara C, Paraskeva D, Sypsa V, Lazanas M, Gargalianos P, Psichogiou M, Skoutelis A, Wiessing L, Friedman SR, Jarlais DCDES, Terzidou M, Kremastinou J, Malliori M, Hatzakis A. Economic recession and emergence of an HIV-1 outbreak among drug injectors in Athens metropolitan area: a longitudinal study. PLoS One 2013; 8:e78941. [PMID: 24265730 PMCID: PMC3827120 DOI: 10.1371/journal.pone.0078941] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/16/2013] [Indexed: 12/22/2022] Open
Abstract
Background During 2011, a dramatic increase (1600%) of reported HIV-1 infections among injecting drug users (IDUs) was noted in Athens, Greece. We herein assess the potential causal pathways associated with this outbreak. Methods Our study employed high resolution HIV-1 phylogenetic and phylogeographic analyses. We examined also longitudinal data of ecological variables such as the annual growth of gross domestic product (GDP) of Greece in association with HIV-1 and HCV sentinel prevalence in IDUs, unemployment and homelessness rates and HIV transmission networks in Athens IDUs before and during economic recession (2008–2012). Results IDU isolates sampled in 2011 and 2012 suggested transmission networks in 94.6% and 92.7% of the cases in striking contrast with the sporadic networking (5%) during 1998–2009. The geographic origin of most HIV-1 isolates was consistent with the recently documented migratory waves in Greece. The decline in GDP was inversely correlated with annual prevalence rates of HIV and HCV and with unemployment and homelessness rates in IDUs (all p<0.001). The slope of anti-HCV prevalence in the sentinel populations of IDUs and in “new” drug injectors was found 120 and 1.9-fold (p = 0.007, p = 0.08 respectively) higher in 2008–2012 (economic recession) compared with 2002–2006. The median (25th, 75th) size of transmission networks were 34 (12, 58) and 2 (2, 2) (p = 0.057) in 2008–2012 and 1998–2007, respectively. The coverage of harm reduction services was low throughout the study period. Conclusions Scaling-up harm reduction services and addressing social and structural factors related to the current economic crisis should be urgently considered in environments where HIV-1 outbreaks may occur.
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Affiliation(s)
- Dimitrios Paraskevis
- National Retrovirus Reference Center, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Athens, Greece
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21
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Friedman SR, Sandoval M, Mateu-Gelabert P, Rossi D, Gwadz M, Dombrowski K, Smyrnov P, Vasylyeva T, Pouget ER, Perlman D. Theory, measurement and hard times: some issues for HIV/AIDS research. AIDS Behav 2013; 17:1915-25. [PMID: 23564029 DOI: 10.1007/s10461-013-0475-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Economic and political instability and related "big events" are widespread throughout the globe. Although they sometimes lead to epidemic HIV outbreaks, sometimes they do not-and we do not understand why. Current behavioural theories do not adequately address these processes, and thus cannot provide optimal guidance for effective intervention. Based in part on a critique of our prior "pathways" model of big events, we suggest that cultural-historical activity theory (CHAT) may provide a useful framework for HIV research in this area. Using CHAT concepts, we also suggest a number of areas in which new measures should be developed to make such research possible.
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22
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De Vos AS, Kretzschmar MEE. The efficiency of targeted intervention in limiting the spread of HIV and Hepatitis C Virus among injecting drug users. J Theor Biol 2013; 333:126-34. [PMID: 23733004 DOI: 10.1016/j.jtbi.2013.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/10/2013] [Accepted: 05/21/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Interventions aimed at minimizing the spread of blood borne infections among Injecting Drug Users (IDU) are impeded by limitations in resources. To enhance their efficiency, it may be beneficial to target specific behavioural subpopulations, distinguished by syringe sharing tendencies. METHODS We used mathematical modelling to explore the effects of two types of intervention: removal of individuals from the injecting population and risk decrease at group-level (e.g. distribution of syringes). We computed the direct effects of intervention on the probability of obtaining and spreading infection as a function of baseline risk behaviour. Population level effects of (targeted) intervention were explored using a differential equations model, which incorporated two levels of risk. RESULTS Within most scenarios of risk distribution considered, HIV could be substantially reduced or eliminated by targeting high risk IDU only. Conversely, higher incidence reductions for HCV were reached in many scenarios when targeting low risk IDU. The potential for preventing infections by removal of uninfected IDU increases with baseline risk, but so does the probability that an IDU is already infected before being reached by intervention. Decreasing risk is likely to only delay rather than prevent infection for IDU borrowing many syringes, especially for a very infectious disease such as HCV. CONCLUSIONS The efficiency of intervention on injecting drug users may be much enhanced by targeting specific risk subgroups. However, the optimal targeting policy depends strongly on the infection under consideration.
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Affiliation(s)
- Anneke S De Vos
- Julius Center, University Medical Center Utrecht, Stratenum 6.131, Postbus 85500, 3508GA Utrecht, The Netherlands.
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Popescu GA, Otelea D, Gavriliu LC, Neaga E, Popescu C, Paraschiv S, Fratila M. Epidemiology of hepatitis D in patients infected with hepatitis B virus in bucharest: a cross-sectional study. J Med Virol 2013; 85:769-74. [PMID: 23408537 DOI: 10.1002/jmv.23524] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2012] [Indexed: 12/18/2022]
Abstract
Epidemiological analyses indicate a decreasing level of hepatitis D (HDV) infections in most developed countries during the last 15 years. Romania, however, is one of the European countries that still has high morbidity from HDV; this study was performed in order to estimate the HDV prevalence in the Bucharest area. Three thousand four hundred sixty-one hepatitis B (HBV) infected patients were invited to participate and 1,094 were recruited. Serum anti-HDV IgG was detected in 223 patients indicating a hepatitis D seroprevalence of 20.4% (95% CI = 18.1-22.9) in patients chronically infected with HBV, less than that seen in previous studies. Seroprevalence was not gender related, but patients over 40 years were more likely to have anti-HDV antibodies, RR = 1.9 (1.2; 3.0). Detectable hepatitis D viraemia was found in 67.7% of the patients who were positive for anti-HDV. The HDV genotype was characterized for 40 isolates; all were very similar and belonged to genotype 1. Serum HBV-DNA was detectable less frequently in patients positive for anti-HDV than in patients infected with HBV alone: 68.5% versus 89.3%, OR 3.9 (1.7; 10.0), but the extent of this HDV replicative dominance varies with the sensitivity of the HBV-DNA detection. 19.3% of the subjects who tested positive for anti-HDV IgG had a HBV-DNA level higher than four logs. This high prevalence prompts the need for better HBV vaccination coverage and measures to prevent super infection with HDV in patients infected with HBV.
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Affiliation(s)
- G A Popescu
- Infectious Diseases Department, Prof. Dr. Matei Bals National Institute for Infectious Diseases, Str. Calistrat Grozovici, Nr.1, Sector 2, 021105 Bucharest, Romania
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Jarlais DC, Cooper HL, Bramson H, Deren S, Hatzakis A, Hagan H. Racial and ethnic disparities and implications for the prevention of HIV among persons who inject drugs. Curr Opin HIV AIDS 2012; 7:354-61. [PMID: 22498481 DOI: 10.1097/COH.0b013e328353d990] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW There are now an estimated 16 million people who inject drugs (PWID) throughout the world, 3 million of whom are estimated to be infected with HIV. In many countries, substantial proportions of PWID belong to racial/ethnic/nationality minority groups, and are at increased likelihood of being infected with HIV. This article reviews current evidence on ethnic disparities in HIV infection among PWID and assesses the issues that would need to be addressed to reduce these disparities. RECENT FINDINGS An ongoing systematic review of ethnic disparities has found that, in a pooled weighted odds ratio, ethnic minority PWID are twice as likely to be HIV seropositive than ethnic majority, PWID from the same geographic area. If implemented with sufficient quality and coverage, current HIV prevention programs probably have the capability of ending HIV transmission among both ethnic majority and minority PWID. Large-scale, evidence-based prevention programs need to be implemented in the contexts of patterns of injecting drug use that continue to evolve-with injecting practices spreading to new areas, changes in drugs injected, and some transitions from injecting to noninjecting drug use. Lack of financial resources and policies against evidence-based programming are increasingly important problems that are likely to have particularly adverse effects on ethnic minority PWID. SUMMARY Racial/ethnic/nationality disparities in HIV infection are quite common among PWID. Addressing these disparities will be a fundamental challenge within a human rights approach to public health.
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