Researchers in Greece have reported that a multifaceted response, including a “seek-test-treat” intervention, helped mitigate an outbreak of HIV among intravenous drug users.
“In 2011, an outbreak of HIV infection occurred among people who inject drugs in the Athens Metropolitan Area,” Vana Sypsa, PhD, of the department of hygiene, epidemiology and medical statistics at the Medical School of the University of Athens., and colleagues wrote. “Until then, Greece had had a low-level HIV epidemic mainly among MSM, with only a few new diagnoses reported annually among people who inject drugs. This outbreak occurred in the context of low levels of harm reduction service provision and a severe economic recession, which have been proposed as macro-level causes.”
Greek officials opened a large number of opioid substitution treatment centers, increasing the total number of centers from 25 to 58 between August 2011 and December 2012, as well as increasing the number of needle and syringe programs and beginning the ARISTOTLE seek-test-treat intervention.
Sypsa and colleagues collected data on behavior, provision of injection equipment, linkage to addiction treatment and HIV care from of five rounds of sampling between 2012 and 2013 (n = 3,320). The researchers used observed seroconversions to estimate HIV incidence.
The researchers reported an estimated coverage of 88%. HIV prevalence was 16.5%, Sypsa and colleagues wrote, falling from 7.8 cases per 100 person-years in 2012 (95% CI, 4.6-13.1) to 1.7 cases per 100 person-years in 2013 (95% CI, 0.55-5.31). A history of imprisonment, frequency of injection and homelessness were all risk factors for seroconversion. Reports of injecting more than once a day decreased from 45.2% to 18.8% (P < .001). The sharing of syringes also fell, from 36.8% to 26% (P = .007), as did the rate of undiagnosed HIV cases, which fell from 84.3% to 15% (P < .001). Opioid substitution treatment rose significantly, from 12.2% to 27.7% (P < .001). Nearly half (48.4%) of seropositive patients were linked to HIV care during the study period. Substitution treatment, syringe coverage and linkage to care were all more frequent in repeat participants, Sypsa and colleagues wrote.
“In conclusion, our findings suggest that prevention of HIV transmission among people who inject drugs in an HIV outbreak may be relatively successful, potentially with high impact on HIV incidence, when using high-coverage, fast-track combined approaches,” the researchers wrote. “The experience of the ARISTOTLE program may be useful for countries that need to provide rapid and massive interventions, in particular in the light of ongoing recent HIV outbreaks among people who inject drugs in several countries.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.