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

Judd, A; Rhodes, T; Johnston, LG; Platt, L; Andjelkovic, V; Simić, D; Mugosa, B; Simić, M; Zerjav, S; Parry, RP; et al. Judd, A; Rhodes, T; Johnston, LG; Platt, L; Andjelkovic, V; Simić, D; Mugosa, B; Simić, M; Zerjav, S; Parry, RP; Parry, JV (2009) Improving survey methods in sero-epidemiological studies of injecting drug users: a case example of two cross sectional surveys in Serbia and Montenegro. BMC INFECTIOUS DISEASES, 9 (14). ISSN 1471-2334 https://doi.org/10.1186/1471-2334-9-14
SGUL Authors: Simic-Lawson, Milena

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Abstract

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

Item Type: Article
Additional Information: PubMed ID: 19203380 © 2009 Judd et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: AIDS Serodiagnosis, Adult, Anonymous Testing, Cross-Sectional Studies, Drug Users, Female, HIV Infections, HIV Seroprevalence, Health Surveys, Hepatitis C, Hepatitis C Antibodies, Humans, Male, Montenegro, Prevalence, Risk Factors, Serbia, Substance Abuse, Intravenous, Science & Technology, Life Sciences & Biomedicine, Infectious Diseases, HEPATITIS-C VIRUS, HIV-INFECTION, HIDDEN POPULATIONS, RISK, FIELD, SURVEILLANCE, PREVALENCE, DIAGNOSIS, SETTINGS, ANTIBODY
Journal or Publication Title: BMC INFECTIOUS DISEASES
ISSN: 1471-2334
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Dates:
DateEvent
9 February 2009Published
Web of Science ID: WOS:000264192800001
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URI: http://openaccess.sgul.ac.uk/id/eprint/1937
Publisher's version: https://doi.org/10.1186/1471-2334-9-14

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