Concordance between self-reported and measured HIV and hepatitis C virus infection status among people who inject drugs in Germany

Background: People who inject drugs (PWID) are disproportionately affected by both HIV and hepatitis C infection (HCV). Awareness of infection status is essential to ensure linkage to appropriate healthcare for those infected, who need treatment and regular follow-up, as well as for uninfected individuals, who need access to targeted testing and counselling services. In this paper we compare self-reported HIV and HCV status with serological markers of infection among PWID recruited through respondent driven sampling. Methods: From 2011 through 2014, biological and behavioural data was collected from 2,077 PWID in Germany. Dried blood spots from capillary blood samples were collected and screened for HCV antibodies, HCV RNA and HIV-1/-2 antibodies. HIV reactive samples were confirmed by Western blot. Results: Laboratory testing revealed that 5 % were infected with HIV and 81 % were aware of being infected. Chronic HCV infection was detected in 41 % of the participants, 2 % had an acute HCV infection, 22 % had a cleared infection, and 34 % were unexposed to HCV. The concordance between self-reported and measured HCV status was lower than for HIV, with 73 % of those with chronic HCV infection being aware of their infection. Conclusions: We found a relatively high awareness of HIV and HCV infection status among PWID. Nevertheless, access to appropriate testing, counselling and care services targeted to the needs of PWID should be further improved, particularly concerning HCV. Trial registration: Ethical approval was received from the ethics committee at the medical university of Charité, Berlin, Germany in May 2011 and with an amendment approved retrospectively on 19/11/2012 (No EA4/036/11). The German Federal Commissioner for Data Protection and Freedom of Information approved the study protocol retrospectively on 29/11/2012 (III-401/008#0035)

results from a cross-sectional study using respondent-driven sampling in eight German cities (2011–14)

Background People who inject drugs (PWID) are at increased risk of acquiring and transmitting HIV and Hepatitis C (HCV) due to sharing injection paraphernalia and unprotected sex. To generate seroprevalence data on HIV and HCV among PWID and related data on risk behaviour, a multicentre sero- and behavioural survey using respondent driven sampling (RDS) was conducted in eight German cities between 2011 and 2014. We also evaluated the feasibility and effectiveness of RDS for recruiting PWID in the study cities. Methods Eligible for participation were people who had injected drugs within the last 12 months, were 16 years or older, and who consumed in one of the study cities. Participants were recruited, using low-threshold drop-in facilities as study sites. Initial seeds were selected to represent various sub-groups of people who inject drugs (PWID). Participants completed a face-to-face interview with a structured questionnaire about socio-demographics, sexual and injecting risk behaviours, as well as the utilisation of health services. Capillary blood samples were collected as dried blood spots and were anonymously tested for serological and molecular markers of HIV and HCV. The results are shown as range of proportions (min. and max. values (%)) in the respective study cities. For evaluation of the sampling method we applied criteria from the STROBE guidelines. Results Overall, 2,077 PWID were recruited. The range of age medians was 29–41 years, 18.5–35.3 % of participants were female, and 9.2–30.6 % were foreign born. Median time span since first injection were 10–18 years. Injecting during the last 30 days was reported by 76.0–88.4 % of participants. Sharing needle/syringes (last 30 days) ranged between 4.7 and 22.3 %, while sharing unsterile paraphernalia (spoon, filter, water, last 30 days) was reported by 33.0–43.8 %. A majority of participants (72.8–85.8 %) reported incarceration at least once, and 17.8–39.8 % had injected while incarcerated. Between 30.8 and 66.2 % were currently in opioid substitution therapy. Unweighted HIV seroprevalence ranged from 0–9.1 %, HCV from 42.3–75.0 %, and HCV-RNA from 23.1–54.0 %. The implementation of RDS as a recruiting method in cooperation with low-threshold drop in facilities was well accepted by both staff and PWID. We reached our targeted sample size in seven of eight cities. Conclusions In the recruited sample of mostly current injectors with a long duration of injecting drug use, seroprevalence for HIV and HCV varied greatly between the city samples. HCV was endemic among participants in all city samples. Our results demonstrate the necessity of intensified prevention strategies for blood-borne infections among PWID in Germany

Developing and Piloting a Standardized European Protocol for Hepatitis C Prevalence Surveys in the General Population (2016-2019)

Funding Information: This work was funded by the European Center for Disease Prevention and Control (ECDC) through a contract. Publisher Copyright: © Copyright © 2021 Sperle, Nielsen, Bremer, Gassowski, Brummer-Korvenkontio, Bruni, Ciccaglione, Kaneva, Liitsola, Naneva, Perchemlieva, Spada, Toikkanen, Amato-Gauci, Duffell and Zimmermann.Background: A robust estimate of the number of people with chronic hepatitis C virus (HCV) infection is essential for an appropriate public health response and for monitoring progress toward the WHO goal of eliminating viral hepatitis. Existing HCV prevalence studies in the European Union (EU)/European Economic Area (EEA) countries are heterogeneous and often of poor quality due to non-probability based sampling methods, small sample sizes and lack of standardization, leading to poor national representativeness. This project aimed to develop and pilot standardized protocols for undertaking nationally representative HCV prevalence surveys in the general adult population. Methods: From 2016 to 2019 a team from the Robert Koch-Institute contracted by the European Centre for Disease Prevention and Control synthesized evidence on existing HCV prevalence surveys and survey methodology and drafted a protocol. The methodological elements of the protocol were piloted and evaluated in Bulgaria, Finland and Italy, and lessons learnt from the pilots were integrated in the final protocol. An international multidisciplinary expert group was consulted regularly. Results: The protocol includes three alternative study approaches: a stand-alone survey; a "nested" survey within an existing health survey; and a retrospective testing survey approach. A decision algorithm advising which approach to use was developed. The protocol was piloted and finalized covering minimum and gold standards for all steps to be implemented from sampling, data protection and ethical issues, recruitment, specimen collection and laboratory testing options, staff training, data management and analysis and budget considerations. Through piloting, the survey approaches were effectively implemented to produce HCV prevalence estimates and the pilots highlighted the strengths and limitations of each approach and key lessons learnt were used to improve the protocol. Conclusions: An evidence-based protocol for undertaking HCV prevalence serosurveys in the general population reflecting the different needs, resources and epidemiological situations has been developed, effectively implemented and refined through piloting. This technical guidance supports EU/EEA countries in their efforts to estimate their national hepatitis C burden as part of monitoring progress toward the elimination targets.publishersversionPeer reviewe

第758回千葉医学会例会・第9回千葉大学第三内科懇話会 25.

HCV prevalence. (TIF 566 kb

Recency and frequency of HIV testing among men who have sex with men in Germany and socio-demographic factors associated with testing behaviour

Background: Testing for presence of HIV infection is a pre-requisite to qualify for antiretroviral treatment. A considerable proportion of German men who have sex with men (MSM) infected with HIV have a CD4 cell count below 350 cells/μl at time of diagnosis and are thus defined as “late presenters”. Late presentation increases the risk of adverse disease outcomes. In addition, knowledge and assessment of HIV status is often used for decisions about condom use and anal intercourse with steady and non-steady partners. Incorrect assumptions may result in high risk for HIV transmission. Methods: Between 11/2013 and 01/2014 MSM were recruited to an online survey predominantly by personalized invitation messages from MSM social networking and dating websites. Respondents were asked about demographic characteristics, HIV testing history, reasons for testing decisions, and sexual behaviours. We describe reasons for not testing and analyse factors associated with not or infrequent testing using univariable and multivariable multinomial regression. Results: Questions on HIV testing history were answered by 15,297 respondents. An HIV test within the last 12 months was reported by 38 %, a test more than 12 months ago by 27 % and 35 % had never been tested for HIV. Compared to recently tested, respondents who had never tested were more likely to be younger than 25 years (adjusted relative risk ratio (aRRR) 2.90, 95 % CI 2.11-3.99), living in a settlement with less than 100,000 inhabitants (aRRR 1.47, 95 % CI 1.18-1.83), being less open about their sexual orientation to their co-workers/classmates, and particularly to their primary care provider (aRRR 4.54, 95 % CI 4.02-5.11). Untested and less frequently tested respondents reported less sex partners and a lower proportion reported unprotected anal intercourse (UAI) with a non-steady partner (24 % compared to 38 % among those recently tested). Conclusions: MSM who were younger, who did not live in large cities, and who were not out about their sexual orientation tested less frequently for HIV. Apart from strengthening protection from sexual orientation-related discrimination and empowering MSM who conceal their orientation, more opportunities to test anonymously and without revealing one’s sexual orientation should be provided

Investigating the Campylobacter enteritis winter peak in Germany, 2018/2019

Surveillance of notified Campylobacter enteritis in Germany revealed a recurrent annual increase of cases with disease onset several days after the Christmas and New Year holidays (“winter peak”). We suspected that handling and consumption of chicken meat during fondue and raclette grill meals on the holidays were associated with winter peak Campylobacter infections. The hypothesis was investigated in a case–control study with a case-case design where notified Campylobacter enteritis cases served as case-patients as well as control-patients, depending on their date of disease onset (case-patients: 25/12/2018 to 08/01/2019; control-patients: any other date between 30/11/2018 and 28/02/2019). The study was conducted as an online survey from 21/01/2019 to 18/03/2019. Adjusted odds ratios (aOR) were determined in single-variable logistic regression analyses adjusted for age group and sex. We analysed 182 data sets from case-patients and 260 from control-patients and found associations of Campylobacter infections after the holidays with meat fondue (aOR 2.2; 95% confidence interval (CI) 1.2–3.8) and raclette grill meals with meat (aOR 1.5; 95% CI 1.0–2.4) consumed on the holidays. The associations were stronger when chicken meat was served at these meals (fondue with chicken meat: aOR 2.7; 95% CI 1.4–5.5; raclette grill meal with chicken meat: aOR 2.3; 95% CI 1.3–4.1). The results confirmed our initial hypothesis. To prevent Campylobacter winter peak cases in the future, consumers should be made more aware of the risks of a Campylobacter infection when handling raw meat, in particular chicken, during fondue or raclette grill meals on the holidays.Peer Reviewe

HIV risk perception and testing behaviours among men having sex with men (MSM) reporting potential transmission risks in the previous 12 months from a large online sample of MSM living in Germany

Abstract Background HIV testing and serostatus awareness are essential to implement biomedical strategies (treatment as prevention; oral chemoprophylaxis), and for effective serostatus-based behaviours (HIV serosorting; strategic positioning). The analysis focuses on the associations between reported sexual risks, the perceived risk for HIV infection, and HIV testing behaviour in order to identify the most relevant barriers for HIV test uptake among MSM living in Germany. Methods MSM were recruited to a nationwide anonymous online-survey in 2013 on MSM social networking/dating sites. Questions covered testing behaviours, reasons for testing decisions, and HIV risk perception (5-point scale). Additional questions addressed arguments in favour of home/ home collection testing (HT). Using descriptive statistics and logistic regression we compared men reporting recent HIV testing (RT; previous 12 month) with men never tested (NT) in a subsample not previously diagnosed with HIV and reporting ≥2 episodes of condomless anal intercourse (CLAI) with a non-steady partner of unknown HIV serostatus in the previous 12 months. Results The subsample consisted of 775 RT (13 % of RT) and 396 NT (7 % of NT). The number of CLAI episodes in the last 12 months with non-steady partners of unknown HIV status did not differ significantly between the groups, but RT reported significantly higher numbers of partners (>5 AI partners: 65 vs. 44 %). While perceived risks regarding last AI were comparable between the groups, 49vs. 30 % NT were <30 years, lived more often in towns/villages <100,000 residents (60 vs. 39 %), were less out-particularly towards care providers-about being attracted to men (aOR 10.1; 6.9–14.8), more often identified as bisexual (aOR 3.5; 2.5–4.8), and reported lower testing intentions (aOR 0.08; 0.06–0.11). Perceived risks (67 %) and routine testing (49 %) were the most common testing reasons for RT, while the strong belief not to be infected (59 %) and various worries (41 %) and fears of testing positive (35 %) were predominant reasons of NT. Greater anonymity (aOR 3.2; 2.4–4.4), less embarrassment, (aOR 2.8; 1.9–4.1), and avoiding discussions on sexual behaviour (aOR 1.6; 1.1–2.2) were emphasized in favour of HT by NT. Conclusions Perceived partner knowledge and reasons reflecting perceived gay- and HIV-related stigma predicted testing decisions rather than risk perception. Access barriers for testing should be further lowered, e.g. by making affordable HT available, addressing structural barriers (stigma), and emphasizing beneficial aspects of serostatus awareness

STI tests and proportion of positive tests in female sex workers attending local public health departments in Germany in 2010/11

Background: In Germany, local public health departments (LPHD) are required to offer low-threshold access to confidential counselling and testing for sexually transmitted infections (STI) for sex workers. We collected data from LPHD in Germany to estimate the number of performed STI tests and the proportion of positive STI tests among attending female sex workers (FSW) in order to formulate recommendations for improving STI testing and care for FSW in Germany. Methods: We recruited LPHD across Germany to collect aggregated data on attending FSW between January 2010 and March 2011. Baseline characteristics, the number of attending FSW, STI tests (HIV, Chlamydia trachomatis, Neisseria gonorrhoea, syphilis and Trichomonas vaginalis) and the number of positive results were provided by participating LPHD. We described the number of STI tests per FSW visit and the proportion of positive test results, including interquartile range (IQR). We tested whether baseline characteristics of LPHD were associated with the proportion of positive test results. Results: Overall, 28 LPHD from 14 of the 16 federal states reported 9284 FSW visits over the study period, with a median of 188 FSW visits (IQR 45–440) per LPHD. Overall, a median of 77.1% (IQR 60.7–88.0) of visiting FSW received a test for Neisseria gonorrhoea, followed by HIV (66.0%, IQR 47.9–86.8), Chlamydia trachomatis (65.4%, IQR 50.7–83.6) and syphilis (61.6, IQR 48.6–78.6). In total, 22,914 STI tests were performed. The proportion of positive tests was 3.1% (IQR 1.3–4.8), with the highest proportion of positive tests for Chlamydia trachomatis (6.8%, IQR 2.5–10.4), followed by Neisseria gonorrhoea (3.2%, IQR 0.0–5.3), Trichomonas vaginalis (3.0%, IQR 0.0–15.4), syphilis (1.1%, IQR 0.0–1.3) and HIV (0.2%, IQR 0.0–0.4). The proportion of positive tests varied between 0 and 13.9% between LPHD, with a higher variation of proportion of positive tests in LPHD with a smaller number of reported STI tests. Conclusions: Participating LPHD varied in terms of performed STI tests and FSW visits. The proportion of positive STI tests was low, but varied between LPHD. This variation likely reflects different testing strategies. Existing testing guidelines should be used by all LPHD to ensure high quality care for FSW

The impact of meeting locations for men having sex with men on the risk for bacterial sexually transmitted infections: analyses from a cross-sectional online survey

Objectives: Opportunities for men having sex with men (MSM) to meet each other have very much improved by new communication technologies. Meeting venue-based characteristics can impact how many partners are met and how much sexual risk is taken. We analysed the association between physical and virtual venues and the risk for bacterial sexually transmitted infections (bSTIs) among participants in an MSM online survey. Methods: Data were collected during 2013/2014 with a survey targeting MSM living in Germany. The impact of the meeting place with the last non-steady anal sex partner on diagnosis with a bSTI in the previous year was analysed using bivariate and multivariate regression analysis, taking into account self-reported HIV status, serostatus communication, condom use, partner number, age and city size. Results: The study sample consisted of 8878 respondents (7799 not diagnosed with HIV; 1079 diagnosed with HIV). Meeting partners online was most common (62% HIV−/51% HIV+), followed by sex venues (11% HIV−/25% HIV+); other venues were each reported by 2–6% of the respondents. Venue-dependent proportions reporting bSTIs in the recent year were 2–4 folds higher among men diagnosed with HIV. In multivariate analysis, HIV status was the strongest predictor for bSTIs (OR=5.0; 95% CI 2.8 to 8.7). Compared with meeting partners online, sex (OR 1.6; 95% CI 1.0 to 2.5) and social venues (OR 1.9; 95% CI 1.4 to 2.6) were associated with increased bSTI risk for men not diagnosed with HIV, but the risk when meeting partners by smartphone apps was only of borderline significance (OR 1.5; 95% CI 0.9 to 2.3). For men diagnosed with HIV, bSTI risk increased for sex venues (OR 1.5; 95% CI 1.1 to 2.1), and was lower for non-gay/other venues (OR 0.2; 95% CI 0.1 to 0.5). Conclusions: Venues are connected to social-behavioural facets of corresponding sexual encounters, and may be important arenas for differential HIV and STI education, treatment and prevention