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

Ali Judd,Tim Rhodes,Lisa G Johnston,Milena Simić,Ruth P Parry,Danijela Simić,John V Parry,Lucy Platt,Boban Mugosa,Violeta Andjelkovic,Sonja Žerjav

doi:10.1186/1471-2334-9-14

Abstract

BackgroundLittle 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.MethodsRespondent 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.ResultsOverall 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 ≥ 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%)).ConclusionThe 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.

Highlights

Little is known about the prevalence of HIV or hepatitis C virus (HCV) in injecting drug users (IDUs) in Serbia and Montenegro
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
While an evidence base characterising the epidemiology of HIV and hepatitis C virus (HCV) among injecting drug users (IDUs) has emerged in many Eastern Europe countries,[1,2] less is known of South Eastern European countries, including the Western Balkans

Summary

Introduction

Little is known about the prevalence of HIV or HCV in injecting drug users (IDUs) in Serbia and Montenegro. While an evidence base characterising the epidemiology of HIV and hepatitis C virus (HCV) among injecting drug users (IDUs) has emerged in many Eastern Europe countries,[1,2] less is known of South Eastern European countries, including the Western Balkans This is despite countries in the Western Balkans and Eastern Europe sharing many characteristics of the HIV risk environment, such as major social and economic transition linking with expanding illicit drug markets, increased poverty, and weakening public health infrastructure.[3] Studies suggest low prevalence of HIV in IDUs in the region but higher prevalence of HCV, with estimates ≥ 50% in Bulgaria, Romania, Slovenia and Croatia.[4] There are only two published surveys of HIV prevalence among IDUs in Serbia,[5,6] and none in Montenegro. No estimates of anti-HCV prevalence in IDUs in Serbia and Montenegro have been published

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