Prevalence of chronic HCV infection in EU/EEA countries in 2019 using multiparameter evidence synthesis

Background

Epidemiological data are crucial to monitoring progress towards the 2030 Hepatitis C Virus (HCV) elimination targets. Our aim was to estimate the prevalence of chronic HCV infection (cHCV) in the European Union (EU)/European Economic Area (EEA) countries in 2019.

Methods

Multi-parameter evidence synthesis (MPES) was used to produce national estimates of cHCV defined as: π = πrecρrec + πexρex + πnonρnon; πrec, πex, and πnon represent cHCV prevalence among recent people who inject drugs (PWID), ex-PWID, and non-PWID, respectively, while ρrec, ρex, and ρnon represent the proportions of these groups in the population. Information sources included the European Centre for Disease Prevention and Control (ECDC) national operational contact points (NCPs) and prevalence database, the European Monitoring Centre for Drugs and Drug Addiction databases, and the published literature.

Findings

The cHCV prevalence in 29 of 30 EU/EEA countries in 2019 was 0.50% [95% Credible Interval (CrI): 0.46%, 0.55%]. The highest cHCV prevalence was observed in the eastern EU/EEA (0.88%; 95% CrI: 0.81%, 0.94%). At least 35.76% (95% CrI: 33.07%, 38.60%) of the overall cHCV prevalence in EU/EEA countries was associated with injecting drugs.

Interpretation

Using MPES and collaborating with ECDC NCPs, we estimated the prevalence of cHCV in the EU/EEA to be low. Some areas experience higher cHCV prevalence while a third of prevalent cHCV infections was attributed to PWID. Further efforts are needed to scale up prevention measures and the diagnosis and treatment of infected individuals, especially in the east of the EU/EEA and among PWID.

Funding

ECDC.

Modern Approach to Melanoma Adjuvant Treatment with Anti-PD1 Immune Check Point Inhibitors or BRAF/MEK Targeted Therapy: Multicenter Real-World Report

BACKGROUND

The landscape of melanoma management changed as randomized trials have launched adjuvant treatment.

MATERIALS AND METHODS

An analysis of data on 248 consecutive melanoma stage III and IV patients given adjuvant therapy in eight centers (February 2019 to January 2021) was conducted.

RESULTS

The analyzed cohort comprised 147 melanoma patients given anti-PD1 (33% nivolumab, 26% pembrolizumab), and 101 (41%) were given dabrafenib plus trametinib (DT). The 2-year overall survival (OS), relapse-free survival (RFS), and distant-metastases-free survival (DMFS) rates were 86.7%, 61.4%, and 70.2%, respectively. The disease stage affected only the RFS rate; for stage IV, it was 52.2% (95% CI: 33.4-81.5%) vs. 62.5% (95% CI: 52.3-74.8%) for IIIA-D, p = 0.0033. The type of lymph node surgery before adjuvant therapy did not influence the outcomes. Completion of lymph node dissection cessation after positive SLNB did not affect the results in terms of RFS or OS. Treatment-related adverse events (TRAE) were associated with longer 24-month RFS, with a rate of 68.7% (55.5-84.9%) for TRAE vs. 56.6% (45.8-70%) without TRAE, p = 0.0031. For TRAE of grade ≥ 3, a significant decline in OS to 60.6% (26.9-100%; p = 0.004) was observed.

CONCLUSIONS

Melanoma adjuvant therapy with anti-PD1 or DT outside clinical trials appears to be effective and comparable with the results of registration studies. Our data support a de-escalating surgery approach in melanoma treatment.

Reversed urban-rural gradient in COVID-19 seroprevalence and related factors in a nationally representative survey, Poland, 29 March to 14 May 2021

BackgroundWe anticipated that people in rural areas and small towns with lower population density, lower connectivity and jobs less dependent on social interaction will be less exposed to COVID-19. Still, other variables correlated with socioeconomic inequalities may have a greater impact on transmission.AimWe investigated how COVID-19 affected rural and urban communities in Poland, focussing on the most exposed groups and disparities in SARS-CoV-2 transmission.MethodsA random digit dial sample of Polish adults stratified by region and age was drawn from 29 March to 14 May 2021. Serum samples were tested for anti-S1 and anti-N IgG antibodies, and positive results in both assays were considered indicative of past infection. Seroprevalence estimates were weighted to account for non-response. Adjusted odds ratios (AORs) were calculated using multivariable logistic regression.ResultsThere was serological evidence of infection in 32.2% (95% CI: 30.2-34.4) of adults in rural areas/small towns (< 50,000 population) and 26.6% (95% CI: 24.9-28.3) in larger cities. Regional SARS-CoV-2 seroprevalence ranged from 23.4% (95% CI: 18.3-29.5) to 41.0% (95% CI: 33.5-49.0) and was moderately positively correlated (R = 0.588; p = 0.017; n = 16) with the proportion of respondents living in rural areas or small cities. Upon multivariable adjustment, both men (AOR = 1.60; 95% CI: 1.09-2.35) and women (AOR = 2.26; 95% CI: 1.58-3.21) from these areas were more likely to be seropositive than residents of larger cities.ConclusionsWe found an inverse urban-rural gradient of SARS-CoV-2 infections during early stages of the COVID-19 pandemic in Poland and suggest that vulnerabilities of populations living in rural areas need to be addressed.

Hepatitis C in Poland in 2021

Background

In 2021, the COVID-19 pandemic continued, however, due to the implementation of vaccination, fewer disruptions were observed in healthcare. In the detection of HCV - inextricably linked to access to testing - there was an incomplete return to the pre-pandemic level of diagnostics (in the EU/EEA in 2021, 4.1 infections/100,000, in 2019 - 8.8). The aim of the article was to present the HCV situation in 2021 according to the data of the epidemiological surveillance in Poland compared to 2015-2020.

Material and methods

We used the data: 1) from individual epidemiological surveillance; 2) from bulletins for the years 2015-2021 (diagnosis rates) and 3) regarding deaths from the Statistics Poland, Demographic Surveys and Labour Market Department.

Results

In 2021, a 30% increase in the detection of new HCV infections was observed (3.26/100,000, 1,244 cases) - about 70%, more than 2,500 cases, are missing to return to the pre-pandemic level. The demographic distribution was different than in Europe: 1) the ratio of women to men 1:1.07; 2) people <25 years: 2.4% of all diagnoses - this may imply worse access to testing among men than women (tested during pregnancy), especially in younger age groups. In Poland, a large percentage of diagnoses involves people outside the high- risk population - mainly exposures related to medical procedures (>75%). The role of primary health care in diagnosing HCV has strengthened (38.6%) - despite the fact that the tests were not yet available within health insurance benefits. The burden on healthcare and sanitary inspection continued to reduce the quality of data. There were more deaths due to acute hepatitis C in 2020-2021 (4 and 6 cases) compared to 2018 2019 (0 and 1 death).

Conclusions

The highlighted gaps in diagnosing HCV infections in Poland should be taken into consideration while developing the policy for HCV infections elimination. Poland still lacks in long term solutions, acceptable by and reaching the target population.

Healthcare-associated hepatitis B and C transmission to patients in the EU/EEA and UK: a systematic review of reported outbreaks between 2006 and 2021

Healthcare-associated transmission was the second most common hepatitis B (HBV) and hepatitis C (HCV) transmission route according to 2006-2012 European surveillance data, but data quality and completeness issues hinder comprehensive characterisation of this important issue. We carried out a systematic review of published literature on healthcare-associated transmission of HBV or HCV in European Union (EU) and European Economic Area (EEA) countries and the United Kingdom to complement surveillance data and identify higher-risk settings. We searched the PubMed and Embase databases and grey literature over the period January 2006 to September 2021, for publications reporting transmission events after 2000 in the EU/EEA and UK related to a healthcare setting or procedure. We collected data on the country, number of patients, setting type and route of transmission. In 65 publications from 16 countries, 43 HBV and 48 HCV events were identified resulting in 442 newly infected patients. Most events were reported from Italy (7 HBV and 12 HCV), Germany (8 HBV and 5 HCV) and the United Kingdom (8 HBV and 5 HCV). The number of patients infected from a single source within an event ranged from 1 to 53. Five large outbreaks of over 20 cases were identified, including two in Poland and one each in Belgium, Hungary and Slovakia. The majority of transmission events occurred through blood transfusions or in dialysis units. However, there were a number of outbreaks in seemingly low risk settings such as CT/MRI scanning units. A failure to adequately follow infection prevention control (IPC) precautions was reported in 30% of included studies. Healthcare-associated transmission of hepatitis B and C continues to occur in a range of community and hospital settings across EU/EEA countries and often results in large outbreaks, although the true extent of the situation cannot be fully determined due to under-reporting. Strict IPC precautions should be implemented across all healthcare settings and regularly audited, and surveillance systems strengthened and standardised to allow for comprehensive and consistent reporting of nosocomial transmission of hepatitis across the EU.

Healthcare workers highly affected during the COVID-19 epidemic wave in Poland prior to vaccination availability: seroprevalence study

BACKGROUND

The aim of the study was to assess seroprevalence of anti-SARS-CoV-2 antibodies among healthcare workers (HCW) before introduction of vaccination, in selected areas in Poland as well as to identify potential risk factors and estimate the cumulative incidence of COVID-19 infections in this population.

MATERIAL AND METHODS

The authors conducted a sero-epidemiological, cross-sectional study among HCW of 5 non-COVID-19 hospitals in Poland. The recruitment took place in December 1-23, 2020, all HCW at selected hospitals could volunteer into the study. All persons were screened with rapid SARS-CoV-2 IgM/IgG tests in capillary blood. In case of positive result, 5 ml of venous blood was drawn for confirmatory testing with ELISA assay. The authors estimated prevalence of laboratory confirmed anti-SARS-CoV-2 antibody presence and examined factors associated with positive result. Cumulative incidence was estimated applying 2-source capture-recapture method to serology results and self-report of past infection.

RESULTS

Out of 1040 HCW included in the analysis, one-fourth (25.2%) received a positive result for anti-SARS-CoV-2 antibodies by ELISA test, the prevalence among women was 25.3% (95% CI: 22.5-28.4) and 24.6% (95% CI: 19-31.2) among men. The prevalence of anti-SARS-CoV-2 antibodies was the highest among respondents who declared home contact with a confirmed COVID-19 case, 43.9% (95% CI: 32.4-56.1). It was also elevated among those who indicated contact with patients with COVID-19, 32.5% (95% CI: 26.7-38.8) and business contacts, including at the workplace, 28.9% (95% CI: 22.5-36.3). The estimated cumulative incidence of COVID-19 infections in the population, using the capture-recapture method was 41.2% (95% CI: 38.1-44.2).

CONCLUSIONS

Healthcare workers remained at increased risk of infection largely due to work-related contacts with infected patients, although home exposure was also common. Estimated cumulative incidence is higher than the antibody prevalence, which indicates the need to monitor HCW for possible immunity waning, also post-immunization immunity. Med Pr. 2022;73(2).

Risk assessment of COVID-19 epidemic resurgence in relation to SARS-CoV-2 variants and vaccination passes

The introduction of COVID-19 vaccination passes (VPs) by many countries coincided with the Delta variant fast becoming dominant across Europe. A thorough assessment of their impact on epidemic dynamics is still lacking. Here, we propose the VAP-SIRS model that considers possibly lower restrictions for the VP holders than for the rest of the population, imperfect vaccination effectiveness against infection, rates of (re-)vaccination and waning immunity, fraction of never-vaccinated, and the increased transmissibility of the Delta variant. Some predicted epidemic scenarios for realistic parameter values yield new COVID-19 infection waves within two years, and high daily case numbers in the endemic state, even without introducing VPs and granting more freedom to their holders. Still, suitable adaptive policies can avoid unfavorable outcomes. While VP holders could initially be allowed more freedom, the lack of full vaccine effectiveness and increased transmissibility will require accelerated (re-)vaccination, wide-spread immunity surveillance, and/or minimal long-term common restrictions.

Assessing the impact of vaccines, other public health measures, and declining immunity on SARS-CoV-2 control is challenging. This is particularly true in the context of vaccination passes, whereby vaccinated individuals have more freedom of making contacts than unvaccinated ones. Here, we use a mathematical model to simulate various scenarios and investigate the likelihood of containing COVID-19 outbreaks in example European countries. We demonstrate that both Alpha and Delta SARS-CoV-2 variants inevitably lead to recurring outbreaks when measures are lifted for vaccination pass holders. High re-vaccination rates and a lowered fraction of the unvaccinated population increase the benefit of vaccination passes. These observations are important for policy making, highlighting the need for continued vigilance, even where the epidemic is under control, especially when new variants of concern emerge.

Krueger, Gogolewski, and Bodych et al. assess the risk of COVID-19 epidemic resurgence in relation to SARS-CoV-2 variants and vaccination passes. Their model predicts that new COVID-19 infection waves within two years from the onset of the vaccination program are possible but that suitable adaptive policies can help to avoid unfavorable outcomes.

How sex and gender matter in infectious diseases - outcomes of the first Polish conference "A woman in an infectious diseases circle"

Occurrence of infectious disease in a woman is an interdisciplinary area of medicine. The common problem of lower recruitment of women to clinical trials leads to the necessity to rely in clinical practice on the exchange of practical experiences, specialist consultations and individualization of treatment. As the COVID-19 pandemic shows, there is a close relationship between infectious diseases and civilization diseases. People suffering from chronic diseases are both more susceptible to infection and the more severe course of an infectious disease. On the other hand, infection may accelerate or initiate the onset of a noncommunicable disease. Women, especially those living with HIV, are a group with an underestimated risk of high blood pressure or some cancers. Therefore, one of the main goals of the conference is to break the stereotypes of thinking about health, in which gender is the main determinant of some screening tests. Late presentation of women to medical care is a significant problem that is of great importance in the diagnosis and treatment of both communicable and non-communicable diseases. Women put family and professional responsibilities in the first place, and they are known to downplay their own health problems. It leads to the diagnosis of cardiovascular diseases or cancer at the stage of advanced changes, limiting the possibilities of effective therapy. Understanding gender attributed differences in the etiology and epidemiology of diseases allows for the improvement of patient care, as well as determines the right direction of reforms in the area of healthcare. It is essential to build models of care based on an interdisciplinary and patient-centered approach, with broad support from both stakeholders and NGOs. Each contact of the patient with the health care system should be seen as an opportunity for screening both in the area of civilization diseases, women's health, and infectious diseases corresponding to her lifestyle.

Infectious diseases in Poland in 2020

OBJECTIVE OF THE WORK

The article reviews the main problems of the epidemiology of infectious diseases in Poland in 2020. It summarizes relevant findings from the national infectious disease surveillance system.

MATERIAL AND METHODS

The data contained in this article come from the reports collected by the State Sanitary Inspection on cases of notifiable infectious diseases notified by clinicians and/or laboratories. These are supplemented by mortality data published by the Statistics Poland.

RESULTS AND THEIR DISCUSSION

The epidemiology of infectious diseases was highly impacted by the COVID-19 pandemic. There were 1,306,983 cases notified in 2020 and 41,451 deaths attributed to COVID-19 (according to Statistics Poland). The reported incidence of other infections decreased by 10-98%. We noted especially high decreases in the incidence of viral gastrointestinal infections (by over 70%). The incidence of influenza and influenza-like infections decreased by 34% and tuberculosis by 36% as compared to 2019. However, important decreases were also noted for other diseases under surveillance, which could point to disruption of diagnosis services and reporting due to lockdowns and high workload on the public health services.

Hepatitis C in Poland in 2020

BACKGROUND

The year 2020 in the extent of HCV infection was set for the first milestones on the road to the eradication of HCV infection in 2030. In addition, in 2020 there was a global public health crisis - the COVID-19 pandemic. The aim of this paper was to assess the epidemiological situation of HCV infection based on epidemiological surveillance data in Poland in 2020.

MATERIAL AND METHODS

Analysis of: 1) individual data from surveillance in 2020 conducted by EpiBaza system; 2) diagnosis rate from bulletins "Infectious diseases and poisonings in Poland" for the years 2014-2020; and 3) data about deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of Statistics Poland.

RESULTS

In 2020, there was a significant decrease in the number of reported cases and thus in the diagnosis rate of HCV infection in Poland - 955 HCV infections were reported (2.49/100,000 - in comparison with 2019, 3.5 times less). The decrease occurred in all voivodeships (ranging from 0.50 to 6.37/100,000), we observe more districts in which HCV infections were not detected (in 2020 - 35.3%; in 2019 - 16.8%). The diagnosis rate of HCV infection in women and men was at a similar level. However, large disproportions are visible if age groups are considered in addition to gender. For years, we have observed a variation of the diagnosis rate of HCV infection depending on the environment of residence - also in 2020, higher values were reported overall in residents of urban than in rural areas (2.90 vs. 1.88/100,000). In 2.9% of newly diagnosed HCV infections, at the same time cirrhosis was already present, 0.4% had liver failure, and 0.1% had hepatocellular carcinoma. Among exposures of HCV infection, those related to nosocomial transmission still dominate (59%), also in acute hepatitis C (60%). One-third of reported infections were diagnosed in primary health care, and one in four were diagnosed during hospitalization.

CONCLUSIONS

The data presented in this paper show that the COVID-19 pandemic deepened the inequalities observed for years in HCV areas. Establishing a diverse system of testing and linking to care in Poland, reaching those in the greatest risk of ongoing transmission of HCV infection, and providing methodologically correct studies to assess progress in the eradication of HCV infection is becoming increasingly urgent to achieve the planned 2030 WHO targets.

Changes in HIV testing trends in Poland during COVID-19 pandemic

INTRODUCTION

At the beginning of COVID-19 pandemic, due to lockdown, limited mobility, as well as changes in the activity profile of some laboratories, the restriction also applied to access to various screening tests, including HIV screening tests.

AIM

The aim of the study was to assess HIV testing trend during COVID-19 pandemic in laboratories in Poland and its comparison to the preceding years, with special focus on testing in the network of Voluntary Testing and Counselling (VCT) sites serving population with higher behavior risk, which increase the possibility of HIV infection.

MATERIAL AND METHODS

Analysis of the changes in HIV tests number was based on the results of the annual survey of HIV tests conducted among the laboratories throughout the country. The questionnaire included data on screening and positive tests by testing site type, age group and gender. In addition, we extracted data collected in comprehensive National AIDS Centre database, based on epidemiological and behavior data collected by VCT on people who come for testing.

RESULTS

There are approximately 400,000 HIV tests annually run in general population in last years. COVID-19 pandemic, which occurred in beginning of 2020 did not have a huge impact on HIV test number among these population, because there was observed 1% decreased. Pandemic COVID-19, due to few lockdown reduced the HIV tests number among VCT clients - population with higher HIV risk infection. Tests number decreased by 44% compare to previous year, due to temporal closed of these centres. Data analysis shows that due to the pandemic, the structure of the surveyed people changed, especially in terms of age and gender, and the place where the study was performed.

CONCLUSION

We confirmed low HIV testing rates in general population and low positivity rate over the studied period. The positivity rate was higher in the testing site network targeting individuals engaging in high risk behaviors. Changes observed in HIV testing trends in recent years have been affected by the COVID-19 pandemic.

Factors determining adherence to guidelines and restrictions during the initial period of the COVID-19 pandemic in Poland before the vaccination rollout

INTRODUCTION

In Poland, like in many other countries, guidelines and certain restrictions were introduced in order to reduce the impact of the pandemic and curb the spread of the virus. These related to such behaviours as washing and disinfecting hands, wearing face masks in designated places, keeping social distance and frequently ventilating rooms. However, not all people follow the guidelines, which can lead to both health and social ramifications. The key objective of this study was an in-depth analysis of how safety rules (SR) were complied with in Poland during the initial pandemic period before the vaccines were rolled out, as well as determining factors that could affect the compliance with SR.

METHODS

The study was conducted in the form of a series of cross-sectional surveys using the CATI method on a representative Polish sample in 8 rounds of interviews. Random sampling was applied. The first round was carried out from 2 to 6 July 2020, the last from 17 to 21 August 2020. The authors' original survey questionnaire was used. Factors affecting the compliance with SR were analysed using the multivariate logistic regression method on a combined group of participants from all the study rounds.

RESULTS

In total, 4,800 subjects participated in the study, of which 2,512 were women (52.3%) and 2,288 were men (47.7%). Compliance with guidelines was defined based on four survey questions relating to: disinfecting hands when not at home, not touching items with bare hands when not at home, wearing face masks or covering mouth and nose, as well as washing hands after coming back home. Two affirmative answers to these questions or wearing a face mask alone (covering mouth and nose) were interpreted as compliance with SR. SR were more frequently followed by women OR=1.234 95% CI (0.988-1.543), persons over the age of 65 OR=2.098 95% CI (1.409-3.122), people with university education OR=1.315 95% CI (0.950-1.820) and residents of large cities OR=2.179 95% CI (1.382-3.437). Factors that supported compliance with SR were older age, fear of contracting COVID-19 and knowledge of SR.

DISCUSSION AND CONCLUSIONS

During the first wave of the pandemic, the SR compliance level was high. Nevertheless, the study identified social groups with a higher risk of non-compliance. This indicates a need for properly addressing communication to these groups, especially that, as was demonstrated, the knowledge alone of pandemic-related messages significantly increased the likelihood of following SR and restrictions. The study of infection-preventing behaviours and their context may provide essential information to guide public policies and communication strategies that would support these behaviours in order to control the spread of the virus more effectively.

Recent perspectives on the link between migration, human rights and HIV among women

There is a well-documented link between infectious diseases, especially HIV, armed conflict, lack of respect for human rights and migration. War leads to disruption of services, increased vulnerability to violence and social hardships that put individuals and especially women at risk of infections such as HIV. HIV in Europe is highly associated with migration, with over 40% of new infections being diagnosed among migrants. Our aim was to provide an overview of the factors that put migrant populations, and especially migrant women, at risk for HIV infection and to illustrate this from three different perspectives: 1) recent migration from the Ukraine, and Polish experiences in provision of HIV care to Ukrainian migrants; 2) successful HIV programs targeting African migrant women in the United Kingdom (UK); 3) the impact of the prolonged crisis and women's rights violations during the internal Afghanistan conflict. We conclude that although they may be dramatically different, situations having detrimental health effects in women often share common underlying causes, and therefore may potentially be addressed by applying universal principles that emphasise the importance of self-management of health needs, empowerment of vulnerable communities and building community strengths. As crisis situations are often unpredictable, and shortage of resources common, empowerment of communities and creation of systematic policies that proactively address women's specific needs is crucial to ensuring that vulnerable populations are able to thrive in their new environment, thereby becoming contributors to, rather than being seen as burdens to society. This can only be achieved by continuous dialogue between women's communities, health care providers, policy makers and other stakeholders involved in the care of women.

Data-driven case fatality rate estimation for the primary lineage of SARS-CoV-2 in Poland

After more than one and a half year since the COVID-19 pandemics outbreak the scientific world is constantly trying to understand its dynamics. In this paper of the case fatality rates (CFR) for COVID-19 we study the historic data regarding mortality in Poland during the first six months of pandemic, when no SARS-CoV-2 variants of concern were present among infected. To this end, we apply competing risk models to perform both uni- and multivariate analyses on specific subpopulations selected by different factors including the key indicators: age, sex, hospitalization. The study explores the case fatality rate to find out its decreasing trend in time. Furthermore, we describe the differences in mortality among hospitalized and other cases indicating a sudden increase of mortality among hospitalized cases at the end of the 2020 spring season. Exploratory and multivariate analysis revealed the real impact of each variable and besides the expected factors indicating increased mortality (age, comorbidities) we track more non-obvious indicators. Recent medical care as well as the identification of the source contact, independently of the comorbidities, significantly impact an individual mortality risk. As a result, the study provides a twofold insight into the COVID-19 mortality in Poland. On one hand we explore mortality in different groups with respect to different variables, on the other we indicate novel factors that may be crucial in reducing mortality. The later can be coped, e.g. by more efficient contact tracing and proper organization and management of the health care system to accompany those who need medical care independently of comorbidities or COVID-19 infection.

Univariable associations between a history of incarceration and HIV and HCV prevalence among people who inject drugs across 17 countries in Europe 2006 to 2020 – is the precautionary principle applicable?

Background

People who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes.

Aim

We aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe.

Methods

Aggregate data from PWID recruited in drug services (excluding prison services) or elsewhere in the community were reported by 17 of 30 countries (16 per virus) collaborating in a European drug monitoring system (2006–2020; n = 52,368 HIV+/−; n = 47,268 HCV+/−). Country-specific odds ratios (OR) and prevalence ratios (PR) were calculated from country totals of HIV and HCV antibody status and self-reported life-time incarceration history, and pooled using meta-analyses. Country-specific and overall population attributable risk (PAR) were estimated using pooled PR.

Results

Univariable HIV OR ranged between 0.73 and 6.37 (median: 2.1; pooled OR: 1.92; 95% CI: 1.52–2.42). Pooled PR was 1.66 (95% CI 1.38–1.98), giving a PAR of 25.8% (95% CI 16.7–34.0). Univariable anti-HCV OR ranged between 1.06 and 5.04 (median: 2.70; pooled OR: 2.51; 95% CI: 2.17–2.91). Pooled PR was 1.42 (95% CI: 1.28–1.58) and PAR 16.7% (95% CI: 11.8–21.7). Subgroup analyses showed differences in the OR for HCV by geographical region, with lower estimates in southern Europe.

Conclusion

In univariable analysis, a history of incarceration was associated with positive HIV and HCV serostatus among PWID in Europe. Applying the precautionary principle would suggest finding alternatives to incarceration of PWID and strengthening health and social services in prison and after release (‘throughcare’).

Increasing integrated testing in community settings through interventions for change, including the Spring European Testing Week

BACKGROUND

Maximising access to testing by targeting more than one infection is effective in identifying new infections in settings or populations. Within the EU funded Joint Action INTEGRATE, this paper examined the feasibility and impact of expanding integrated testing for HIV, hepatitis C (HCV), chlamydia, gonorrhoea and/or syphilis in four community-based pilots through targeted interventions in Croatia, Italy and Poland and the Spring European Testing Week since community settings are key in detecting new infections and reaching key populations.

METHODS

Pilots led by local INTEGRATE partners prioritised testing for other infections or key populations. The Croatian pilot expanded testing for men who have sex with men to syphilis, chlamydia and gonorrhoea. Italian partners implemented a HIV and HCV testing/information event at a migrant centre. A second Italian pilot tested migrants for HIV and HCV through outreach and a low-threshold service for people who use drugs. Polish partners tested for HIV, HCV and syphilis among people who inject drugs in unstable housing via a mobile van. Pilots monitored the number of individuals tested for each infection and reactive results. The pilot Spring European Testing Week from 18 to 25 May 2018 was an INTEGRATE-driven initiative to create more testing awareness and opportunities throughout Europe.

RESULTS

The Croatian pilot found a high prevalence for each syphilis, chlamydia and gonorrhoea respectively, 2.1%, 12.4% and 6.7%. The Italian migrant centre pilot found low proportions who were previously tested for HIV (24%) or HCV (11%) and the second Italian pilot found an HCV prevalence of 6.2%, with low proportions previously tested for HIV (33%) or HCV (31%). The Polish pilot found rates of being previously tested for HIV, HCV and syphilis at 39%, 37%, and 38%, respectively. Results from the Spring European Testing Week pilot showed it was acceptable with increased integrated testing, from 50% in 2018 to 71% in 2019 in participants.

CONCLUSIONS

Results show that integrated testing is feasible and effective in community settings, in reaching key populations and minimising missed testing opportunities, and the pilots made feasible because of the European collaboration and funding. For sustainability and expansion of integrated community testing across Europe, local government investment in legislation, financial and structural support are crucial.

On limits of contact tracing in epidemic control

Contact tracing and quarantine are well established non-pharmaceutical epidemic control tools. The paper aims to clarify the impact of these measures in evolution of epidemic. The proposed deterministic model defines a simple rule on the reproduction number R in terms of ratio of diagnosed cases and, quarantine and transmission parameters. The model is applied to the early stage of Covid19 crisis in Poland. We investigate 3 scenarios corresponding to different ratios of diagnosed cases. Our results show that, depending on the scenario, contact tracing prevented from 50% to over 90% of cases. The effects of quarantine are limited by fraction of undiagnosed cases. The key conclusion is that under realistic assumptions the epidemic can not be controlled without any social distancing measures.

HIV and AIDS in Poland in 2018

AIM

The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases and death among AIDS cases in Poland in 2018 in comparison to the changes in preceding years.

MATERIALS AND METHODS

Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases and the results of the annual survey of HIV testing conducted among the laboratories throughout the country.

RESULTS

In 2018 there were 1,209 HIV cases newly diagnosed in Poland (diagnosis rate: 3.15 per 100,000), including 100 among non-Polish citizens. The frequency of newly detected HIV infections decreased by nearly 14.8% compared to the previous year and was higher by almost 6.8% compared to the median in 2012-2016 years. The total number of AIDS cases was 110 (incidence 0.29 per 100,000), and 23 people died from AIDS disease (0.06 per 100,000). New HIV diagnoses were reported mainly among people in age 30 to 39 years (37.8%) and among men (86.8%). Among cases with known transmission route, 77.0% concerned among men who had sexual contact with men (MSM). However, compared to the previous year, there was a significant decrease in the percentage of infected people in all key populations, related to higher risk of HIV infection. In addition, we observe the drop in total number of infected people in 2018 compared to the previous year. Whether these observations represent just fluctuations or a stable tendency, related to decreasing incidence in different key populations can only be assessed in the following years. The percentage of AIDS cases diagnosed at the same time with HIV diagnosis decreased by 4% percent points in comparison to 2017 (from 75.7% to 71.84% of all incident AIDS cases).

CONCLUSIONS

Despite the decreasing total number of new HIV diagnoses overall and among different key populations compared to the previous year, it is too early to conclude that these are the results of positive preventive measures. Still, all actions should be taken to ensure timely linkage to care, considering the growing number of infected people among foreigners residing in Poland, and to improve the low frequency of testing towards HIV in the whole population.

Hepatitis C in Poland in 2018

OBJECTIVE

Analysis of data on hepatitis C, collected as part of epidemiological surveillance in 2018, compared to previous years.

MATERIAL AND METHODS

Analysis of: 1) individual data from surveillance in 2018 2) diagnosis rate from bulletins "Infectious diseases and poisonings in Poland" for the years 2012-2018 and 3) data about deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of the Central Statistical Office.

RESULTS

In 2018, there was a decrease in the number of reported hepatitis C cases (3,442 cases) and the diagnosis rate (8.96 per 100,000; taking into account the territorial distribution: from 3.29 per 100,000 in the Podkarpackie voivodeship to 13.69 per 100,00 in the Lubuskie voivodeship). The disproportion of the rates between the sexes returned (in men 9.34 per 100,000 vs. women: 8.61 per 100,000). The disproportion of the diagnosis rate depending on the place of residence was still evident (urban: 10.84 per 100,000 vs. rural: 6.12 per 100,000). There are differences in the values of the diagnosis rates, analyzed in terms of gender, age groups and the place of residence. Based on the EU definition, 14 acute hepatitis C were reported, while according to the PL definition, 88 cases (0.4% and 2.6% of all reported cases, respectively). HCV infections due to medical procedures are still the main route of transmission, also in cases of acute hepatitis C - which indicates the current route of transmission. According to the Demographic Surveys and Labour Market Department of the Central Statistical Office, 119 deaths related to hepatitis C were reported.

CONCLUSIONS

For years, the general picture of hepatitis C in Poland, observed through epidemiological surveillance, is determined by the availability of testing for HCV infections. The analysis identified subpopulations in which primary prevention activities (e.g. safer medical procedures, intensifying activities in the area of harm reduction for people who inject drugs) as well as secondary prevention (access to testing and quick inclusion in treatment) should be particularly strengthened. According to the micro-elimination strategy, the improvement of testing in particularly affected groups, including marginalized populations, is necessary to achieve the WHO goal of eliminating HCV by 2030.

[Epidemiology, diagnosis, and prevention of tick-borne encephalitis in Poland and selected European countries - a position statement of the Polish group of experts]

Tick-borne encephalitis (TBE) is one of the most common viral neuroinfections in Poland. Detection of specific IgM and IgG anti- TBE antibodies in the serum or cerebrospinal fluid with enzyme-linked immunosorbent assay (ELISA) is a method of choice in TBE diagnostics. No effective antiviral treatment is available for TBE. Increased intracranial pressure, epileptic seizures, and other neurological symptoms in the course of TBE are managed with standard procedures. A routine use of corticosteroids is not recommended. Adults with TBE-related neurological sequelae should undergo physical mobilization and periodic neurological assessments. All patients ought to control their psychological condition and visit a physician in case of worrisome symptoms. Additionally, children need to undergo regular psychological and otolaryngologic consultations. Notably, TBE cases are reported across Poland; therefore, the entire country must be considered as a TBE risk region. The degree of endemicity can be variable in particular parts of the country. Immunization against TBE containing a European subtype of the virus is the most effective prophylactic method. In areas where the disease is highly endemic (according to the WHO definition of ≥5 cases/100 000 population/year), immunization needs to be offered to all ages. Vaccination is recommended in the communities living in areas of moderate TBE endemicity (1-5 cases/100 000/ year), in particular for individuals at high risk of a TBE infection as well as children and the elderly. Vaccination should also be offered to subjects living in areas where TBE occurrence is rare (<1 case/100 000/year) but who are at high risk of infection. A TBE vaccine is recommended to the following populations at high risk of TBE: a) individuals undertaking outdoor leisure activities, b) all professionals working outdoors, particularly in green areas, and c) individuals traveling to endemic areas, if activities during their visit may pose a risk of a tick bite. Post-exposure immunization is not recommended. Med Pr. 2021;72(2):193-210.

HIV infections and AIDS in Poland in 2019

AIM OF THE STUDY

The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections, and AIDS cases, and death among AIDS cases in Poland in 2019 in comparison to the changes in preceding years.

MATERIAL AND METHODS

Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases received from doctors and laboratories and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. A dataset on clients from anonymous Voluntary Testing and Counselling (VCT) network was also used. The activities of the VCT are coordinated by the National AIDS Center, which collects epidemiological and behaviour data on people who come for testing.

RESULTS

In 2019 there were 1,551 HIV cases newly diagnosed in Poland (diagnosis rate was 4.04 per 100,000), including 144 among non-Polish citizens. The frequency of newly detected HIV infections increased by 28.2% compared to the previous year and was higher by 21.4% compared to the median in 2013-2017 years. The total number of AIDS cases was 95 (incidence was 0.25 per 100,000) and 15 people died from AIDS disease (0.04 per 100,000 ). The HIV infection was most often detected in the age group between 30 and 39 (36%) and among men (85,1%). Among cases with known transmission route, 73.6% concerned among men who had sexual contact with men (MSM). The percentage of AIDS cases diagnosed at the same time with HIV diagnosis increased by almost 8 percent points in comparison to 2018 (from 73% to 81.1% of all incident AIDS cases).

CONCLUSION

In 2019, the frequency of newly detected HIV infections increased compared to the previous year. All actions should be taken to provide medical care to people with newly detected HIV infection, including foreigners residing in Poland. Also HIV testing action should be promoted among total population. Initiatives should be taken to raise awareness of the risk of HIV infection and to disseminate methods of prevention of infection, especially among key populations. It is also advisable to integrate different data sources, the combination of which will allow to improve their quality, as well as reliable monitoring of key epidemiological indicators.

Hepatitis C in Poland in 2019

BACKGROUND

HCV infection continues to be a significant public health problem in Europe. The aim of the study was to assess the epidemiological situation of hepatitis C in Poland in 2019, based on data collected as part of epidemiological surveillance in 2019, comparing them to data from previous years.

MATERIAL AND METHODS

The following were analyzed: 1) data from epidemiological surveillance in 2019 2) diagnosis rates from "Infectious Diseases and Poisonings in Poland" bulletins for the years 2013-2019 3) data on deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of the Statistics Poland.

RESULTS

In 2019, the HCV diagnosis rate was 8.71 per 100 thousand - a total of 3 343 cases of HCV infection were reported. This was a slight decrease compared to 2018. Still we observe the rate differentiation, territorial (differences in the value of the diagnosis rate are noticeable already at the voivodeship and poviat level) and demographic (higher rates in men than in women, higher rates in urban than in rural areas), which is probably related to HCV testing accessibility. Among acute hepatitis C cases according to the EU definition, indicative of current HCV transmission, exposures related to health care (haemodialysis and nosocomial transmission) were identified, followed by non-medical injection (community needle stick injuries, tattoos, piercings) and sexual contact. A low number of diagnoses (5.9%; 196/3343) among people who inject drugs indicate diagnostic difficulties.

CONCLUSIONS

For years, the overview of hepatitis C in Poland, observed in epidemiological surveillance, has been determined by the availability of HCV testing. Developing the comfortable testing + treatment system in Poland that reaches people exposed to the current transmission of HCV infection (bearing in mind the possibility of re-infection) is the only possibility of eradication of HCV infections.

Syphilis in Poland in 2019

PURPOSE

The aim of the study was to assess the epidemiological situation of syphilis cases in Poland in 2019 in comparison to previous years.

MATERIAL AND METHODS

Analysis of the epidemiological situation was based on case-based data from reports of newly detected syphilis cases received from doctors and laboratories. Additionally aggregated data from MZ-56 reports on infectious diseases, infections and poisoning from 2013 to 2018 sent from Sanitary Inspections to NIPH NIH - NRI was used. Also, data about treatment patients in dermatology/venerology clinics in 2019 reported on MZ-14 forms and published in statistics bulletin on Ministry of Health on e-health system website (actually: https://e-zdrowie.gov.pl; https://cez.gov.pl) and NIPH NIH - NRI website were used.

RESULTS

In 2019 in Poland 1,511 syphilis cases were recognized (diagnosis rate was 3.96 per 100,000), including 79 cases among non-Polish citizens. The frequency of newly detected syphilis cases increased by 5% compared to the previous year and was higher by 13% compared to the median in 2013-2017 years. The syphilis cases were most often detected in the age group between 30 and 34 (20.7%) and among men (86.9%). Most cases were recognized among men who have sex with men (42%).

CONCLUSION

In 2019, the number of newly detected syphilis cases increased compared to the previous year. Preventive initiatives should be taken, especially among key population as young people, men who have sexual contact with men, and who have risky sexual behaviors. Low syphilis diagnosis rate compared to European countries and a huge difference in some regions in Poland for diagnosis rates indicate on problem with recognition and reporting. To improve the functioning of national surveillance is essential to adequate assessment of epidemiological situation.

Healthcare professionals' assumptions as barriers to LGBTI healthcare

Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience significant healthcare inequalities and barriers to healthcare services. Contextualised within six Member States of the European Union (EU), this paper discusses efforts to identify and explore the nature of barriers to healthcare as part of Health4LGBTI, a 2-year pilot project funded by the EU. Data were generated through focus groups and interviews with LGBTI people and healthcare professionals and analysed using thematic analysis. Findings reveal that barriers to healthcare are underpinned by two related assumptions held by healthcare professionals: first, the assumption that patients are heterosexual, cisgender and non-intersex by default; second, the assumption that LGBTI people do not experience significant problems (and therefore that their experience is mostly irrelevant to healthcare). On the other hand, it is notable that responding healthcare professionals were broadly 'LGBTI-friendly'. Thus, we argue that efforts to improve LGBTI healthcare should not be limited to engaging with healthcare professionals with negative views of LGBTI people. Rather, such efforts should also tackle these assumptions amongst LGBTI-friendly healthcare professionals.

Hepatitis C in Poland in 2017

OBJECTIVE

The aim of this article was to analyze the epidemiological situation of HCV in Poland in 2017, based on data collected as part of epidemiological surveillance.

MATERIAL AND METHODS

The analysis was carried out based on: 1) individual data collected as part of epidemiological interviews with persons diagnosed with HCV infection in 2017, 2) diagnosis rate from bulletins “Infectious diseases and poisonings in Poland” for the years 2011-2017 and 3) data about deaths due to hepatitis C from the Demographic Surveys and Labour Market Department of the Central Statistical Office.

RESULTS

In 2017, the diagnosis rate of HCV infection stayed on high level: 10.44 per 100,000 (4010 cases were reported). Stabilization of hepatitis C epidemiological situation was observed in the following issues: 1) diagnosis rate reported in men and women remained at a similar level (10.55 vs. 10.33 per 100,000); 2) diagnosis rate still showed variation depending on the voivodship (from 4.09 to 18.48 per 100,000) and the location of residence (urban/rural, 12.7 vs. 7.0 per 100,000); 3) the percentage of hospitalization accompanying the new cases of HCV infection has shown downward trend (36% in 2017); 4) the decreasing hepatitis C mortality trend was continued (175 cases of death in 2017); 5) the most common possible transmission route were still medical procedures. In 2017, the outbreak of HCV infection in the Lubelskie was registered. (8 patients, 291 exposed persons, with whom computer tomography with a contrast from multi-dose packaging was conducted, using an automatic injection device).

CONCLUSIONS

Epidemiological situation of hepatitis C since 2015 is stable. The role of medical care in the transmission of HCV infections in Poland is worrying.

HIV and AIDS in Poland in 2017

AIM

The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases and death among AIDS cases in Poland in 2017 in comparison to the changes in preceding years.

MATERIALS AND METHODS

Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases and the results of the annual survey of HIV testing conducted among the laboratories throughout the country.

RESULTS

In 2017 there were 1,419 HIV cases newly diagnosed in Poland (diagnosis rate: 3.69 per 100,000), including 51 among non-Polish citizens. The frequency of newly detected HIV infections increased by nearly 8% compared to the previous year and by almost 28% compared to the median in 2011-2015 years. The total number of AIDS cases was 108 (incidence 0.28 per 100,000), and 20 people died from AIDS disease (0.05 per 100,000). New HIV diagnoses were reported mainly among people in age 20 to 39 years (69.5%) and among men (88.5%). Among cases with known transmission route, 69.5% concerned among men who had sexual contact with men (MSM). The percentage of MSM cases, similarly to heterosexual cases decrease in comparison to previous year, relatively by 5.7% and 6.4%. The percentage of AIDS cases diagnosed at the same time with HIV diagnosis increased by 6% percentage points in comparison with 2016 year (from 68% to 74% AIDS cases).

CONCLUSION

The most HIV cases are diagnosed among MSM, so prophylactic activities are still needed in this key population. It is also need to increase the number of new cases linkage-to-care and to improve the low frequency in HIV testing rate in all population.

COVID-19 module in SRWE system - application and use in epidemiological surveillance and reporting to international institutions

The new SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) coronavirus causing acute respiratory disease COVID-19 (2019 coronavirus disease) detected in China in 2019 very quickly revealed its epidemic potential and was recognized as a global health problem. The situation caused by the rapidly increasing number of new cases and deaths due to COVID-19 required the rapid development of international recommendations and procedures to limit the spread of infections and ongoing monitoring of the epidemiological situation. In the field of epidemiological surveillance of COVID-19 cases, international organizations - WHO and regionally ECDC, have developed basic requirements for reporting data on newly detected cases of infection. In order to ensure the possibility of reporting new cases and activities undertaken by sanitary-epidemiological services in the country and to fulfill the obligation to report data to the European surveillance network, it was necessary to adapt the electronic system supporting epidemiological surveillance operations, for registration of suspected and confirmed cases of SARS-CoV-2 infections. This work presents the characteristics of the new COVID-19 module created as part of the central Epidemiological Case Reporting System and a preliminary evaluation of its usefulness for the purposes of combating COVID-19. CONCLUSIONS. The Epidemiological Case Reporting System is an efficient and adequate tool that can be adapted to newly emerging threats. In order to use the module to monitor the current epidemiological situation, it is necessary to integrate it with other systems collecting data about COVID-19 patients - ie. EWP and the clinical patient register.

A review of lesbian, gay, bisexual, trans and intersex (LGBTI) health and healthcare inequalities

BACKGROUND

Lesbian, gay, bisexual, trans and intersex (LGBTI) people experience significant health inequalities. Located within a European Commission funded pilot project, this paper presents a review of the health inequalities faced by LGBTI people and the barriers health professionals encounter when providing care.

METHODS

A narrative synthesis of 57 papers including systematic reviews, narrative reviews, meta-analyses and primary research. Literature was searched in Cochrane, Campbell Collaboration, Web of Science, CINAHL, PsychINFO and Medline. The review was undertaken to promote understanding of the causes and range of inequalities, as well as how to reduce inequalities.

RESULTS

LGBTI people are more likely to experience health inequalities due to heteronormativity or heterosexism, minority stress, experiences of victimization and discrimination, compounded by stigma. Inequalities pertaining to LGBTI health(care) vary depending on gender, age, income and disability as well as between LGBTI groupings. Gaps in the literature remain around how these factors intersect to influence health, with further large-scale research needed particularly regarding trans and intersex people.

CONCLUSION

Health inequalities can be addressed via changes in policy, research and in practice through health services that accommodate the needs of LGBTI people. With improved training to address gaps in their knowledge of LGBTI health and healthcare, health professionals should work in collaboration with LGBTI people to address a range of barriers that prevent access to care. Through structural change combined with increased knowledge and understanding, services can potentially become more inclusive and equally accessible to all.

Behavioural and demographic correlates of undiagnosed HIV infection in a MSM sample recruited in 13 European cities

Background

Reducing the number of people with undiagnosed HIV infection is a major goal of HIV control and prevention efforts in Europe and elsewhere. We analysed data from a large multi-city European bio-behavioural survey conducted among Men who have Sex with Men (MSM) for previously undiagnosed HIV infections, and aimed to characterise undiagnosed MSM who test less frequently than recommended.

Methods

Data on sexual behaviours and social characteristics of MSM with undiagnosed HIV infection from Sialon II, a bio-behavioural cross-sectional survey conducted in 13 European cities in 2013/2014, were compared with HIV-negative MSM. Based on reported HIV-testing patterns, we distinguished two subgroups: MSM with a negative HIV test result within 12 months prior to the study, i.e. undiagnosed incident infection, and HIV positive MSM with unknown onset of infection. Bivariate and multivariate associations of explanatory variables were analysed. Distinct multivariate multi-level random-intercept models were estimated for the entire group and both subgroups.

Results

Among 497 participants with HIV-reactive specimens, 234 (47.1%) were classified as previously diagnosed, 106 (21.3%) as incident, and 58 (11.7%) as unknown onset based on self-reported status and testing history. MSM with incident HIV infection were twice as likely (odds ratio (OR) = 2.22, 95% confidence interval (95%CI): 1.17–4.21) to have used recreational substances during their last anal sex encounter and four times more likely (OR = 3.94, 95%CI: 2.14–7.27) not to discuss their HIV status with the last anal sex partner(s). MSM with unknown onset of HIV infection were 3.6 times more likely (OR = 3.61, 95%CI: 1.74–7.50) to report testing for a sexually transmitted infection (STI) during the last 12 months.

Conclusions

Approximately one third of the study participants who are living with HIV were unaware of their infection. Almost two-third (65%) of those with undiagnosed HIV appeared to have acquired the infection recently, emphasizing a need for more frequent testing. Men with the identified behavioural characteristics could be considered as primary target group for HIV Pre-Exposure Prophylaxis (PrEP) to avoid HIV infection. The increased odds of those with unknown onset of HIV infection to have had an STI test in the past year strongly suggests a lost opportunity to offer HIV testing.

Electronic supplementary material

The online version of this article (10.1186/s12879-018-3249-8) contains supplementary material, which is available to authorized users.

Prevalence of drug use during sex amongst MSM in Europe: Results from a multi-site bio-behavioural survey

BACKGROUND

Substance use has been consistently reported to be more prevalent amongst Men who have Sex with Men (MSM) compared to the general population. Substance use, in particular polydrug use, has been found to be influenced by social and contextual factors and to increase the risk of unprotected intercourse among MSM. The objective of this analysis was to investigate the prevalence and predictors of drug use during a sexual encounter and to identify specific prevention needs.

METHODS/DESIGN

A multi-site bio-behavioural cross-sectional survey was implemented in 13 European cities, targeting MSM and using Time-Location Sampling and Respondent-Driven Sampling methods Multivariable multi-level logistic random-intercept model (random effect of study site) was estimated to identify factors associated with the use of alcohol, cannabis, party drugs, sexual performance enhancement drugs and chemsex drugs.

RESULTS

Overall, 1261 (30.0%) participants reported drug use, and 436 of 3706 (11.8%) reported the use of two or more drugs during their last sexual encounter. By drug class, 966 (23.0%) reported using sexual performance enhancement drugs, 353 (8.4%) - party drugs, and 142 (3.4%) the use of chemsex drugs. Respondents who reported drug use were more frequently diagnosed with HIV (10.5% vs. 3.9%) before and with other STIs during the 12 months prior to the study (16.7% vs. 9.2%). The use of all the analysed substances was significantly associated with sexual encounter with more than one partner.

DISCUSSION

Substance and polydrug use during sexual encounters occurred amongst sampled MSM across Europe although varying greatly between study sites. Different local social norms within MSM communities may be important contextual drivers of drug use, highlighting the need for innovative and multi-faceted prevention measures to reduce HIV/STI risk in the context of drug use.

Significant proportion of acute hepatitis B in Poland in 2010-2014 attributed to hospital transmission: combining surveillance and public registries data

BACKGROUND

Efficient control of acute hepatitis B requires identification of current transmission routes. Countries in Central-Eastern Europe including Poland attribute an important fraction of cases to nosocomial transmission, as opposed to Western European countries. However, due to possible multiple exposures during the incubation time such assignment may be debatable. This study aimed at assessing of most affected groups and current transmission pattern of acute hepatitis B.

METHODS

We investigated exposures reported by acute hepatitis B cases notified to routine surveillance system in Poland in 2010-2014 in comparison to data on hospitalization rates in general population.

RESULTS

Hospitalization during incubation time significantly increased the risk of HBV infection (RR 3.13, 95%CI 2.58-3.80). Overall hospitalization population attributable risk (PAR%) was 25.7% (95% CI 20.3%-31.1%) as compared to 35% of acute cases assigned to hospital transmission in surveillance database. PAR% increased from 9.5% (1.12%-17.8%) in the age group 25-34 to 41.1% (28.2% - 53.9%) among those 65 +. In addition, cases < 40 more frequently than the older ones reported history of injecting drugs and risky sexual contacts (25% vs 5%). 27% of men < 40 did not report any exposure at all, drawing attention to possible underreporting of risk behaviors.

CONCLUSIONS

The distribution of probable transmission routes differed by age and gender. Further improvement of HBV control requires better coverage of vaccination in risk groups but also strengthening the blood-borne infections control in hospitals.

Hepatitis C in Poland in 2016

INTRODUCTION

In 2016, the World Health Organization implemented a Global Strategy to eliminate viral hepatitis. For Hepatitis C, the goals of this Strategy include increased harm reduction coverage, improved safety of medical procedures and an increase the percentage of people diagnosed and treated.

OBJECTIVE

This article aims are evaluating the epidemiological situation of HCV infections in Poland in 2016 in reference to the data from previous years.

MATERIAL AND METHODS

Analysis of epidemiological situation of hepatitis C in Poland in 2016 was carried out on case-based data collected through routine surveillance system. Data on hepatitis C mortality from the Demographic Surveys and Labour Market Department of the Central Statistical Office were also included.

RESULTS

In 2016, a total of 4,261 cases were reported. Diagnosis rate was 11.09 per 100,000, on the similar level as in 2015 (1% decrease), but in comparison to the median for the years 2010-2014 it increased by 88%. The most common possible route of HCV infection were medical procedures accounting for 69.8% of all cases and for 58.2% of acute hepatitis C virus infection cases. In 2016, 224 deaths due to hepatitis C were registered. In 2016, a hepatitis C outbreak was reported in małopolskie voivodeship (11 patients of the Hemato-oncolology Department, 129 people exposed).

CONCLUSIONS

The increase of HCV diagnosis rate, which has been reported for last three years, is probably a consequence of improved the surveillance, including mandatory reporting of positive laboratory results, but also increased availability of HCV laboratory screening. Medical exposures are still an important route of transmission of HCV in Poland.

HIV and AIDS in Poland in 2016

AIM

The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases in Poland in 2016 in comparison to the previous years.

MATERIALS AND METHODS

Descriptive analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. Data from the Department of Demographic and Labor Market Research of the Central Statistical Office on deaths due to HIV / AIDS were also used.

RESULTS

In 2016 there were 1,313 HIV cases newly diagnosed in Poland (diagnosis rate: 3.42 per 100,000), including 44 among non-Polish citizens. The number of newly detected HIV infections increased by nearly 10% compared to the previous year and by almost 19% compared to the median in 2010-2014. The total number of AIDS cases was 102 (incidence 0.27 per 100,000), and 102 people died of HIV disease (0.27 per 100,000). New HIV diagnoses were reported mainly in men (87.3%) and among people aged 20 to 39 years (71.2%). 81.2% of cases in men with known transmission category concerned men who had sexual contact with men (MSM).

CONCLUSIONS

The majority of new HIV cases are diagnosed in the MSM group. However, the assessment of the epidemiological situation is limited by the missing data on the likely route of transmission of newly detected HIV infections.

High Seroprevalence of CMV Among Women of Childbearing Age Implicates High Burden of Congenital Cytomegalovirus Infection in Poland

Cytomegaloviruses are common worldwide, with variable frequency of infections. The infection in pregnancy may lead to pregnancy loss or serious sequelae for the child. To understand the risk posed by CMV in Poland we conducted cross-sectional study on women aged 15-49 basing on existing serum bank. Age dependent incidence, the rates of congenital infection and sequelae were modelled from sero-prevalence, literature and demographic data. The overall anti-CMV IgG prevalence was 81.9% increasing from 74.3% in <30 years old to 94.3% in subjects 45+ years old. The lowest incidence was estimated at the age of 15 and the highest at the age 34 (3.8 and 8.95 respectively/100 women/year). The estimated rate of cCMV varies from 22.4 to 37.2 per 1000 live birth depending on the assumptions made. The proportion of cases due to secondary infection ranged from 34.8% to 49.9% accordingly.

HIV-1 Infection in Persons Homozygous for CCR5-Δ32 Allele: The Next Case and the Review

CC-chemokine receptor 5 serves as the coreceptor for the HIV-1 R5 strains, which are responsible for the majority of HIV transmissions. A deletion of 32 nucleotides in the gene encoding this receptor (termed CCR5-Δ32) leads to the suppression of CC-chemokine receptor 5 presentation at the cell surface, thus impeding process of HIV entry into the cell. Individuals homozygous for the CCR5-Δ32 allele are resistant to infection with HIV-1 R5 strains, and are extremely rare among HIV-1-infected individuals. We have described a case of person homozygous for CCR5-Δ32, who was infected with subtype B HIV-1. Based on examination of proviral V3 sequences obtained from the first clinical blood sample within less than five months after seroconversion, the CXC-chemokine receptor 4-using strains (X4 or R5/X4) were detected. Data on HIV-1-infected patients homozygous for the CCR5-Δ32 allele, course of HIV-1 infection in these cases, and the infecting viral strains from current and all former reports on HIV-1 infection in CCR5-Δ32 homozygotes were gathered and compared. Identification of HIV-1-infected persons homozygous for CCR5-Δ32 supports the evidence that the lack of functional CC-chemokine receptor 5 at the cell surface does not confer absolute protection against HIV-1 infection, which should be considered when designing future HIV pre-exposure prophylaxis schemes basing on CC-chemokine receptor 5 blocking drugs.

Factors associated with hepatitis C prevalence differ by the stage of liver fibrosis: A cross-sectional study in the general population in Poland, 2012-2016

Background & aims

There is a considerable burden of hepatitis C in Europe related to the lack of prompt diagnosis. We aimed to estimate the prevalence and related risk factors of HCV infections by the stages of liver fibrosis, using non-invasive methods, to understand testing needs in Poland.

Methods

A cross-sectional study was conducted in 2012–2016 adopting a stratified random sampling of primary health care units followed by systematic sampling of patients within each unit. Study participants filled a questionnaire and donated blood for laboratory HCV testing. Additionally, the results of liver function tests and platelet count were collected to calculate APRI and FIB-4 scores. Cases were classified according to the level of fibrosis: ‘significant fibrosis’ (APRI≥0.7 or FIB4≥1.45) and ‘no significant fibrosis’ (APRI<0.7 and FIB4<1.45).

Results

Of 21 875 study participants, 102 were HCV-RNA positive. Prevalence of HCV infections and significant fibrosis was estimated at 0.47% (95% CI 0.38% - 0.57%) and 0.12% (0.08% - 0.17%), respectively. Cases with significant fibrosis accounted for 51.6% (33.4%-69.9%) in men and 34.4% (17.3%-51.4%) in women. There was no correlation between the HCV prevalence and age. Blood transfusion prior to 1992 strongly predicted significant fibrosis as did the history of injecting drug use (IDU) and ever having an HCV-infected sexual partner in men and caesarean sections in women. Factors associated with HCV infection without significant fibrosis were tattooing in men and younger age in women. We acknowledge limited possibility to study the associations between IDU and ever having HCV-infected sexual partner, given small sample sizes for these exposures.

Conclusions

As no clear birth cohort affected by HCV could be identified, risk factor-based screening in the general population should be considered, taking into account the association between the increased risk of liver fibrosis and the history of transfusion prior to 1992 and caesarean sections.

Prevalence of Transmitted Drug-Resistance Mutations and Polymorphisms in HIV-1 Reverse Transcriptase, Protease, and gp41 Sequences Among Recent Seroconverters in Southern Poland

Background

Monitoring of drug resistance-related mutations among patients with recent HIV-1 infection offers an opportunity to describe current patterns of transmitted drug resistance (TDR) mutations.

Material/Methods

Of 298 individuals newly diagnosed from March 2008 to February 2014 in southern Poland, 47 were deemed to have recent HIV-1 infection by the limiting antigen avidity immunoassay. Proviral DNA was amplified and sequenced in the reverse transcriptase, protease, and gp41 coding regions. Mutations were interpreted according to the Stanford Database algorithm and/or the International Antiviral Society USA guidelines. TDR mutations were defined according to the WHO surveillance list.

Results

Among 47 patients with recent HIV-1 infection only 1 (2%) had evidence of TDR mutation. No major resistance mutations were found, but the frequency of strains with ≥1 accessory resistance-associated mutations was high, at 98%. Accessory mutations were present in 11% of reverse transcriptase, 96% of protease, and 27% of gp41 sequences. Mean number of accessory resistance mutations in the reverse transcriptase and protease sequences was higher in viruses with no compensatory mutations in the gp41 HR2 domain than in strains with such mutations (p=0.031).

Conclusions

Despite the low prevalence of strains with TDR mutations, the frequency of accessory mutations was considerable, which may reflect the history of drug pressure among transmitters or natural viral genetic diversity, and may be relevant for future clinical outcomes. The accumulation of the accessory resistance mutations within the pol gene may restrict the occurrence of compensatory mutations related to enfuvirtide resistance or vice versa.

Prevention programmes in primary health care - 8 aspects of their effective implementation

INTRODUCTION

Primary health care (PHC) is an optimal setting for the purpose of primary and secondary prevention. Health education, vaccinations, screening may be successfully introduced to the PHC settings. Consequently, it would ensure better access to services and their accessibility for all social groups.

OBJECTIVE

The purpose of this paper was to determine factors which have an impact on the implementation of prevention programmes in the PHC settings as well as actions which improve the effectiveness of such programmes in Europe and worldwide with a special attention paid to the prevention programmes concerning chronic infectious diseases.

MATERIAL AND METHODS

A review of literature was conducted in PubMed using the following key words: primary care/general practice, prevention, screening, implementation. A total of 540 articles published in 1976-2016 were subject to analysis.

RESULTS

Having developed prevention programmes in the PHC settings, it should not be forgotten that it would be an additional task for medical personnel. It would be of importance to allocate adequate funds which would allow for an optimal execution of the programme – adequate time for visit, adequate number of visits, time for education of patients, follow-up visits, monitoring of the execution of the programme and care over diagnosed patients. Prevention programme must be accompanied by education (especially education of medical personnel). Effective execution of the prevention programmes is favoured by the following factors: simple inclusion criteria, less invasive diagnostic tests, support programmes and the presence of workers which are appointed for such a purpose.

FINDINGS

Execution of preventive programmes in the PHC settings is feasible. Furthermore, there is an evidence which suggests that they may be effectively executed there.

HIV and AIDS in Poland in 2015

AIM

AIM. The aim was to describe the epidemiological situation of newly diagnosed HIV infections and AIDS cases in Poland in 2015 in comparison to the previous years.

MATERIALS AND METHODS

Descriptive analysis of newly detected HIV cases and AIDS cases was performed based on routine notifications by clinicians and laboratories. Data on the number of HIV tests from annual survey among laboratories were also used.

RESULTS

In 2015 there were 1,281 HIV cases newly diagnosed in Poland (diagnosis rate 3.33 per 100,000 population), including 23 among non-Polish citizens. The rate of new cases rose by 15% compared to the previous year as well as to the median in 2009 - 2013. The total number of AIDS cases was 128 (incidence 0.38 per 100,000) and 41 AIDS patients died (0.11 per 100,000). HIV infection was mainly detected among people aged from 20 to 39 years (71.3%) and among males (84.8%). Among men, 67.6% of newly diagnosed infections with known transmission category were acquired by men who have sex with men (MSM). The percentage of infected men in this group, compared to 2014, increased from 64.5% to 67.6%. The percentage of newly diagnosed persons infected by heterosexual contact decreased from 24.1% to 21.1% (persons with known transmission category). The percentage of people with HIV diagnosed at the same time as AIDS diagnosed decreased in comparison with 2014 (from 9.2% to 6.9% of newly detected HIV infections).

CONCLUSIONS

HIV epidemic continues to develop among MSM in Poland. However, assessment of epidemiological situation is limited by the missing data on the probable transmission route in a large percentage of reported newly detected HIV infection.

The problem of elimination of HCV infections in Poland

The article concerns abbreviated presentation of the results obtained in the Project KIK / 35 “Prevention of HCV infection,” sponsored by the Government of the Swiss Federation and the Ministry of Health of the Republic of Poland. The Project concerned the analysis of the prevalence of HCV infection in the adult population in Poland, the risk factors and groups at risk of these infections. Two sub-projects were related to separate subpopulations: pregnant women and drug users. Research in one sub-project focused on the hazards of HCV infections in medical institutions and non-medical facilities, where the procedures are performed with the interruption of tissue. In all sub-projects were carried out surveys, which served to check the knowledge ofn HCV infections, but also practical measures aimed at preventing these infections. One of the sub projects KIK / 35 “Education of medical staff and nonmedical as a key element in the prevention of blood-borne infections” was devoted entirely to the education of professionals responsible for the proper, safety, performance of procedures running with interruption of tissues.“ The results of these studies revealed significant shortcomings in the detection of existing infections and large gaps in knowledge about prevention. Taking into account the range of expertise needed, it turned out that the lack of information applies to both the general public and to many professionals. The project KIK / 35 in its summary refers to the risks of HCV infection, both known from the literature and disclosed the specificity of our country. The ultimate result of the Project NCI / 35 is to develop a strategy for the elimination of HCV infections in Poland. This strategy, strongly linked to the WHO strategy includes integrated, permanent preventive measures related tot he introduction of screening programs for early detection of HCV infections and treat them as important element in prevention. Special emphasis was put on universal access to diagnosis and treatment for all social groups.

What affects response rates in primary healthcare-based programmes? An analysis of individual and unit-related factors associated with increased odds of non-response based on HCV screening in the general population in Poland

OBJECTIVES

Response rate in public health programmes may be a limiting factor. It is important to first consider their delivery and acceptability for the target. This study aimed at determining individual and unit-related factors associated with increased odds of non-response based on hepatitis C virus screening in primary healthcare.

DESIGN

Primary healthcare units (PHCUs) were extracted from the Register of Health Care Centres. Each of the PHCUs was to enrol adult patients selected on a random basis. Data on the recruitment of PHCUs and patients were analysed. Multilevel modelling was applied to investigate individual and unit-related factors associated with non-response. Multilevel logistic model was developed with fixed effects and only a random intercept for the unit. Preliminary analysis included a random effect for unit and each of the individual or PHCU covariates separately. For each of the PHCU covariates, we applied a two-level model with individual covariates, unit random effect and a single fixed effect of this unit covariate.

SETTING

This study was conducted in primary care units in selected provinces in Poland.

PARTICIPANTS

A total of 242 PHCUs and 24 480 adults were invited. Of them, 44 PHCUs and 20 939 patients agreed to participate. Both PHCUs and patients were randomly selected.

RESULTS

Data on 44 PHCUs and 24 480 patients were analysed. PHCU-level factors and recruitment strategies were important predictors of non-response. Unit random effect was significant in all models. Larger and private units reported higher non-response rates, while for those with a history of running public health programmes the odds of non-response was lower. Proactive recruitment, more working hours devoted to the project and patient resulted in higher acceptance of the project. Higher number of personnel had no such effect.

CONCLUSIONS

Prior to the implementation of public health programme, several factors that could hinder its execution should be addressed.

Bayesian inference for age-structured population model of infectious disease with application to varicella in Poland

The dynamics of the infectious disease transmission are often best understood by taking into account the structure of population with respect to specific features, for example age or immunity level. The practical utility of such models depends on the appropriate calibration with the observed data. Here, we discuss the Bayesian approach to data assimilation in the case of a two-state age-structured model. Such models are frequently used to explore the disease dynamics (i.e. force of infection) based on prevalence data collected at several time points. We demonstrate that, in the case when the explicit solution to the model equation is known, accounting for the data collection process in the Bayesian framework allows us to obtain an unbiased posterior distribution for the parameters determining the force of infection. We further show analytically and through numerical tests that the posterior distribution of these parameters is stable with respect to a cohort approximation (Escalator Boxcar Train) of the solution. Finally, we apply the technique to calibrate the model based on observed sero-prevalence of varicella in Poland.

Hepatitis C virus epidemiology and prevention in Polish and Swiss population - similar and contrasting experiences

OBJECTIVE

The aim of the study was to review available data on HCV in Poland and Switzerland, in order to compare the two European countries with respect to epidemiological situation and efficiency of the response systems.

MATERIALS AND METHOD

A search of registries, published and grey literature was performed to assemble data on prevalence, rate of detection of new cases, identified risk factors for transmission, mortality due to HCV, prevalence of HCC and the consequent liver transplantations, as well as data on treatment in Poland and Switzerland.

RESULTS

Overall, the prevalence of anti-HCV antibodies was similar, not exceeding 1%. However, the major transmission routes of HCV infections were different: medical procedures in Poland and drug injections in Switzerland. By combining the available information it was also possible to demonstrate important differences in efficiency of the response systems. There was approximately 1 new diagnosis per 100 estimated undiagnosed cases in the population in Poland per year, compared to 6 in Switzerland, and the treatment rate per 100 estimated active infections was 2 and 4, respectively.

CONCLUSIONS

Scaling up of the diagnosis and treatment is necessary in both countries; however, the means to achieve this might differ, taking into account the higher concentration of the infections in risk groups in Switzerland than in Poland.

Bio-behavioural HIV and STI surveillance among men who have sex with men in Europe: the Sialon II protocols

BACKGROUND

Globally, the HIV epidemic continues to represent a pressing public health issue in Europe and elsewhere. There is an emerging and progressively urgent need to harmonise HIV and STI behavioural surveillance among MSM across European countries through the adoption of common indicators, as well as the development of trend analysis in order to monitor the HIV-STI epidemic over time. The Sialon II project protocols have been elaborated for the purpose of implementing a large-scale bio-behavioural survey among MSM in Europe in line with a Second Generation Surveillance System (SGSS) approach.

METHODS/DESIGN

Sialon II is a multi-centre biological and behavioural cross-sectional survey carried out across 13 European countries (Belgium, Bulgaria, Germany, Italy, Lithuania, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the UK) in community settings. A total of 4,966 MSM were enrolled in the study (3,661 participants in the TLS survey, 1,305 participants in the RDS survey). Three distinct components are foreseen in the study protocols: first, a preliminary formative research in each participating country. Second, collection of primary data using two sampling methods designed specifically for 'hard-to-reach' populations, namely Time Location Sampling (TLS) and Respondent Driven Sampling (RDS). Third, implementation of a targeted HIV/STI prevention campaign in the broader context of the data collection.

DISCUSSION

Through the implementation of combined and targeted prevention complemented by meaningful surveillance among MSM, Sialon II represents a unique opportunity to pilot a bio-behavioural survey in community settings in line with the SGSS approach in a large number of EU countries. Data generated through this survey will not only provide a valuable snapshot of the HIV epidemic in MSM but will also offer an important trend analysis of the epidemiology of HIV and other STIs over time across Europe. Therefore, the Sialon II protocol and findings are likely to contribute significantly to increasing the comparability of data in EU countries through the use of common indicators and in contributing to the development of effective public health strategies and policies in areas of high need.

HIV and AIDS in Poland in 2014

AIM

The aim was to analyze the epidemiological situation of newly diagnosed HIV infections and AIDS cases in Poland in 2014 and years earlier.

MATERIALS AND METHOD

Descriptive analysis of newly detected HIV cases and AIDS cases was performed based on routine notifications by clinicians and laboratories. Data on the number of HIV tests from annual survey among laboratories were also used.

RESULTS

In 2014 there were 1,157 HIV cases diagnosed in Poland (incidence rate 3.01 per 100,000 population), including 14 among non-Polish citizens. The rate of new cases rose by 4.4% compare to last year and increased by 20% compare to median in 2008 - 2012. The total number of AIDS cases was 148 (incidence 0.38 per 100,000) and 40 AIDS patients died (0.10 per 100,000). HIV infection was mainly detected among people aged 20 to 39 years (72.0%) and among males (82.2%). Among men 64.5% of newly diagnosed infections with known transmission category were acquired by men who have sexual contacts with men (MSM). The percentage of infected men in this group decreased by 4.1% compare to previous year, but there were the increase in the percentage of infected person who take heterosexual contacts, from 20.4% to 24.7% (person with known transmission category). The percentage of late presenters (defined by the time between HIV and AIDS diagnoses of less than 3 months) increased in comparison with year 2013 by almost one percentage (from 8.4% to 9.2% of newly diagnosed HIV infections).

CONCLUSIONS

HIV epidemic continues to develop among MSM in Poland. However, assessment of epidemiological situation is limited by the missing data on the probable transmission route in a large percentage of reported newly detected HIV infection.

Hepatitis C in Poland in 2014

INTRODUCTION

. Currently, hepatitis C (HCV infection) is one of the public health priorities worldwide. It is associated with a considerable improvement of methods undertaken to eliminate this disease. Due to the predominance of chronic infections of long asymptomatic course, the number of cases detected in successive years does not reflect the actual dynamics of the epidemiological situation of hepatitis C. To a large extent, it depends on current testing practices. The modifications in the provisions on the notification of diagnosed cases may also have an effect on the number of HCV infections registered in successive years.

OBJECTIVE

This article aims at evaluating the epidemiological situation of HCV infections in Poland in 2014 in reference to the data from previous years.

MATERIAL AND METHODS

Analysis of epidemiological situation of hepatitis C in Poland was carried out on a basis of aggregated data from routine surveillance system published in annual bulletin “Infectious diseases and poisonings in Poland”. Data on hepatitis C mortality from the Demographic Surveys and Labour Market Department of the Central Statistical Office were also employed.

RESULTS

In 2014, a total of 3 076 HCV infections (incidence – 7.99 per 100,000) meeting 2005 definition were registered. Compared to 2013 and median as of 2008-2012, there was an increase of the incidence by 14% (2 705; 6.03) and 34% (2 294; 5.85), respectively. In 2014, a total of 3 551 (9.23) HCV infections meeting 2009 definition were reported (the definition was modified in 2014). Compared to 2013 (2 268; 6.86), it was an increase by 35%. In 2014, 241 deaths due to hepatitis C were registered which is the highest mortality noted so far.

CONCLUSIONS

In recent years, a burden resulting from undiagnosed or untreated HCV infections is on the increase. It is demonstrated by increasing hepatitis C mortality and increasing trend of incidence according to 2005 definition (presence of symptoms). Increase of incidence according to 2009/2014 definition may be associated with the fact that laboratories were obliged to report positive test results for HCV since 2014.

Relating HIV testing patterns in Poland to risky and protective behaviour

The aim of the study was to understand HIV testing patterns needed to improve access to early HIV diagnosis, and to investigate the spread of the virus in different populations. We examined prior testing history of individuals presenting for an HIV test across all 30 voluntary testing and counselling sites in Poland, 2008-2010 to determine factors associated with the testing rate using zero-truncated Poisson regression. Of 2397 persons presenting for an HIV test, 25 (1%) were HIV positive and 470 (19.6%) were repeat testers. The proportion of repeat testers was higher among men who have sex with men (MSM) at 37% (90/246), and people who inject drugs (PWID) at 32% (21/65). Higher testing rate was independently associated with exposure category (testing rate ratio, RR for MSM = 2.0, 95% CI 1.6-2.6, and 1.6, 0.9-2.6 for PWID), >5 sex partners (1.9, 1.4-2.7), high-risk partner (1.3, 1.1-1.6), urban residence (2.1, 1.3-3.5) and higher education attainment (1.1, 1.0-1.5). Inconsistent condom use with casual partners and sex under the influence of alcohol were associated with lower testing rates. There is a need to increase HIV testing uptake in Poland, especially among the rural population. Despite testing rates being higher among populations with higher risk of exposure to HIV (MSM and PWID), they still remain low, indicating the existence of barriers to testing.

High regional variability of HIV, HCV and injecting risks among people who inject drugs in Poland: comparing a cross-sectional bio-behavioural study with case-based surveillance

Background

People who inject drugs (PWID) are an important group at risk of blood borne infections in Poland. However, robust evidence regarding the magnitude of the problem and geographical variation is lacking, while coverage of prevention remains low. We assessed the potential of combining bio-behavioural studies and case-based surveillance of PWID to gain insight into preventive needs in Poland.

Methods

Results of a bio-behavioural human immunodeficiency virus (HIV) and hepatitis C virus (HCV) prevalence study among ever injectors in six regions in Poland were compared with HIV case-based surveillance trends from 2000 to 2012. Logistic regression was used for multivariable analyses in the prevalence study. The case surveillance data were correlated with prevalence data, by region, to determine surveillance validity and identify any recent trends.

Results

HIV seroprevalence (18% overall) differed more than ten-fold across regions (2.4% to 32%), but HCV seroprevalence and the proportion of PWID sharing needles/syringes in the past 12 months were similar, 44% to 68% and 22% to 29%, respectively. In multivariable models accounting for socio-demographic factors, duration of injecting history and needle sharing practices, regional differences were significant for both HIV and HCV seroprevalence with adjusted odds ratios varying up to a factor of 12.6 for HIV and 3.8 for HCV. The number of new cases of HIV diagnosed in each region during the bio-behavioural study period was strongly correlated (r = 0.93) with HIV prevalence. There was an overall decreasing trend in the number of new diagnoses of HIV over time. However, a transient increase in three regions was preceded by a higher proportion of people with short injecting history (≤5 years) and a high prevalence of HCV coinciding with a low prevalence of HIV in the bio-behavioural study.

Conclusions

Bio-behavioural and case-based data were consistent with respect to the regional distribution of HIV and also provided complementary information, with the proportion of new injectors and high HCV prevalence predicting increases in HIV case rates. We identified three regions in Poland that appear to be at increased need for preventive measures. Data point to the need for a stronger investment in harm reduction programmes in Poland.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-015-0828-9) contains supplementary material, which is available to authorized users.

Hepatitis C in Poland in 2013

INTRODUCTION

Since 1997, hepatitis C (HCV infection) is registered separately in epidemiological surveillance in Poland. Having considered the predominance of chronic infections of long-term asymptomatic course, the number of infections detected in successive years and registered in surveillance system does not reflect the actual dynamics of hepatitis C epidemiological situation. To a large extent, it is dependent on current HCV testing practices. Furthermore, it may also result from modifications introduced to the regulations of HCV case notification.

OBJECTIVE

This article aims at evaluating the epidemiological situation of hepatitis C in Poland in 2013 with the reference to the data from previous years.

MATERIALAND METHODS

Epidemiological situation of hepatitis C in Poland was analyzed on a basis of aggregated data from routine surveillance system published in annual bulletin "Infectious diseases and poisonings in Poland in 2013"(Czarkowski MP et al. Warsaw: NIPH-NIH and CSI, 2013). Data on hepatitis C mortality was derived from the Demographic Surveys and Labour Market Department of the Central Statistical Office.

RESULTS

In 2013, a total of 2,705 (incidence 7.03 per 100,000) HCV infections meeting 2005 definition were reported in Poland, including 35 co-infections with HCV and HBV (1.3%). Having compared to 2012, there was an increase in incidence by 15% (2,359; 6.12). In 2013, 2,641 cases (6,86) meeting 2009 definition were registered. Compared to 2012, it was an increase by 16% (2,268; 5.89). In 2013, 175 HCV fatal cases were reported, of whom only 2 were due to the acute stage of disease.

CONCLUSIONS

In recent years, a societal burden resulting from undiagnosed or untreated chronic HCV infections is on the increase. It is demonstrated by high HCV mortality and increasing trend of incidence of symptomatic chronic hepatitis C (2005 definition) and hospitalizations.