The European Journal of Public Health Advance Access originally published online on April 5, 2009
The European Journal of Public Health 2009 19(4):428-433; doi:10.1093/eurpub/ckp041
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Infectious Diseases |
Measuring risk of HIV and HCV among injecting drug users in the Russian Federation
Lucy Platt1, A. J. Sutton2, P. Vickerman1,3, E. Koshkina4, S. Maximova5, N. Latishevskaya6, M. Hickman3, C. Bonell1, J. Parry7 and T. Rhodes1
1 Centre for Research on Drugs and Health Behaviour, Public and Environmental Health Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
2 Ecology and Epidemiology Group, Department of Biological Sciences, University of Warwick, Coventry CV4 7AL, UK
3 Department of Social Medicine, University of Bristol, Carnynge Hall, Whiteladies Road, Bristol BS8 2PR, UK
4 National Scientific Centre of Addictions, Moscow, Russia
5 Faculty of Social Sciences, Altai State University, Barnaul, Russia
6 Volgograd Medical Academy, Volgograd, Russia
7 Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK
Correspondence: Lucy Platt, Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK, tel: +44 207 9588156, fax: +44 207 580 4524, e-mail: lucy.platt{at}lshtm.ac.uk
Received September 23, 2008 , accepted March 3, 2009
Background: The aim of the study was to measure risk of HIV and HCV infection among injecting drug users (IDUs) through force of infection (FOI) models in three cities of the Russian Federation and assess the value of behavioural data and FOI in predicting risk of infection as a method of second-generation surveillance. Methods: FOI models were fitted to prevalence data collected through an anonymous, cross-sectional community-recruited survey of IDUs with oral fluid sample collection for antibodies to HIV and HCV. Risk of infection was estimated from FOI estimates obtained by fitting a model to prevalence data by length of injecting career for each city and then overall. Risk behaviours were examined by injecting career length. Results: A total of 1473 IDUs were recruited. Prevalence of HIV was 8.1% (95% CI 6.7–9.6%) and HCV 63.4% (95% CI 60.9–65.9%). A higher FOI in new initiates to injecting (injecting career length <1 year) was found for both HIV and HCV compared with experienced IDUs (injecting career length <5 years). Increased risk of infection was not corroborated by injecting risk behaviours among new initiates into injecting (n = 38). Only 5.7% (n = 2) reported receptive sharing in the last 4 weeks, 57.9% (n = 22) sharing any injecting paraphernalia, 2.6% (n = 1) frontloading and 8.5% (n = 3) ever injecting with used needles/syringes. However, 29% of new initiates reported exchanging sex in the last 4 weeks (29%) compared with 11% long term IDUs. Conclusions: FOI models can play an important role in surveillance of HIV but caution is needed in the interpretation of behavioural data for predicting current or future risk of HIV.
Keywords: force of infection, HIV, risk of infection, Russia, surveillance