Ongoing HIV transmission following a large outbreak among people who inject drugs in Athens, Greece (2014–20)
Background and Aims The human immunodeficiency virus (HIV) outbreak among people who inject drugs (PWID) in Athens, Greece in 2011–13 was the largest recent epidemic in Europe and North America. We aimed to assess trends in HIV prevalence, drug use and access to prevention among PWID in Athens to es...
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| Veröffentlicht in: | Addiction (Abingdon, England) England), 2022-06, Vol.117 (6), p.1670-1682 |
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| creator | Roussos, Sotirios Paraskevis, Dimitrios Psichogiou, Mina Kostaki, Evangelia Georgia Flountzi, Eleni Angelopoulos, Theodoros Chaikalis, Savvas Papadopoulou, Martha Pavlopoulou, Ioanna D. Malliori, Meni Hatzitheodorou, Eleni Pylli, Magdalini Tsiara, Chrissa Paraskeva, Dimitra Beloukas, Apostolos Kalamitsis, George Hatzakis, Angelos Sypsa, Vana |
| description | Background and Aims
The human immunodeficiency virus (HIV) outbreak among people who inject drugs (PWID) in Athens, Greece in 2011–13 was the largest recent epidemic in Europe and North America. We aimed to assess trends in HIV prevalence, drug use and access to prevention among PWID in Athens to estimate HIV incidence and identify risk factors and to explore HIV‐1 dispersal using molecular methods during 2014–20.
Methods
Two community‐based HIV/hepatitis C programmes on PWID were implemented in 2012–13 (n = 3320) and 2018–20 (n = 1635) through consecutive respondent‐driven sampling (RDS) rounds. PWID were uniquely identified among rounds/programmes. We obtained RDS‐weighted HIV prevalence estimates per round for 2018–20 and compared them to 2012–13. We assessed changes in HIV status, behaviours and access to prevention in PWID participating in both periods. We estimated HIV incidence in a cohort of seronegative PWID as the number of HIV seroconversions/100 person‐years during 2014–20 and used Cox regression to identify associated risk factors. Molecular sequencing and phylogenetic analysis were performed in HIV seroconverters.
Results
HIV prevalence per round ranged between 12.0 and 16.2% in 2012–13 and 10.7 and 11.3% in 2018–20 with overlapping 95% confidence intervals (95% CI). Among PWID participating in both programmes, HIV prevalence (95% CI) increased from 14.2% (11.7–17.1%) in 2012–13 to 22.0% (19.0–25.3%) in 2018–20 (P |
| doi_str_mv | 10.1111/add.15812 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2659968126</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2659968126</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3882-b2d43e6f20f4d1a8ef03dc4d797d995d5e38817fc2fc7223acc0e7158351fe833</originalsourceid><addsrcrecordid>eNp1kEtOwzAQhi0EglJYcAFkiQ2VSPEjLy-r8igSUjfANnLtcUhJ42InqthxB27ISXAJsGM2o7E__aP5EDqhZExDXUqtxzTJKdtBA8pTEpE45rtoQESaRIzG5AAder8khGS5iPfRAU9IxpgQA2TnTWmrpsSzuyfcOtn4VeV9ZRtsbF3bzfZL4lq6ErDt2oUD-YLlyobnNdh1DXjzbHHVLEG1WLuu9GHAk_YZGn-Bbx2AAnzOCI0_3z8YGR2hPSNrD8c_fYgeb64fprPofn57N53cR4rnOYsWTMccUsOIiTWVORjCtYp1JjItRKITCBjNjGJGhUu4VIpAFhzwhBrIOR-isz537exrB74tlrZzTVhZsDQRIg220kCNeko5670DU6xdtZLuraCk2KotgtriW21gT38Su8UK9B_56zIAlz2wqWp4-z-pmFxd9ZFfPFyB6w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2659968126</pqid></control><display><type>article</type><title>Ongoing HIV transmission following a large outbreak among people who inject drugs in Athens, Greece (2014–20)</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Sociological Abstracts</source><creator>Roussos, Sotirios ; Paraskevis, Dimitrios ; Psichogiou, Mina ; Kostaki, Evangelia Georgia ; Flountzi, Eleni ; Angelopoulos, Theodoros ; Chaikalis, Savvas ; Papadopoulou, Martha ; Pavlopoulou, Ioanna D. ; Malliori, Meni ; Hatzitheodorou, Eleni ; Pylli, Magdalini ; Tsiara, Chrissa ; Paraskeva, Dimitra ; Beloukas, Apostolos ; Kalamitsis, George ; Hatzakis, Angelos ; Sypsa, Vana</creator><creatorcontrib>Roussos, Sotirios ; Paraskevis, Dimitrios ; Psichogiou, Mina ; Kostaki, Evangelia Georgia ; Flountzi, Eleni ; Angelopoulos, Theodoros ; Chaikalis, Savvas ; Papadopoulou, Martha ; Pavlopoulou, Ioanna D. ; Malliori, Meni ; Hatzitheodorou, Eleni ; Pylli, Magdalini ; Tsiara, Chrissa ; Paraskeva, Dimitra ; Beloukas, Apostolos ; Kalamitsis, George ; Hatzakis, Angelos ; Sypsa, Vana</creatorcontrib><description>Background and Aims
The human immunodeficiency virus (HIV) outbreak among people who inject drugs (PWID) in Athens, Greece in 2011–13 was the largest recent epidemic in Europe and North America. We aimed to assess trends in HIV prevalence, drug use and access to prevention among PWID in Athens to estimate HIV incidence and identify risk factors and to explore HIV‐1 dispersal using molecular methods during 2014–20.
Methods
Two community‐based HIV/hepatitis C programmes on PWID were implemented in 2012–13 (n = 3320) and 2018–20 (n = 1635) through consecutive respondent‐driven sampling (RDS) rounds. PWID were uniquely identified among rounds/programmes. We obtained RDS‐weighted HIV prevalence estimates per round for 2018–20 and compared them to 2012–13. We assessed changes in HIV status, behaviours and access to prevention in PWID participating in both periods. We estimated HIV incidence in a cohort of seronegative PWID as the number of HIV seroconversions/100 person‐years during 2014–20 and used Cox regression to identify associated risk factors. Molecular sequencing and phylogenetic analysis were performed in HIV seroconverters.
Results
HIV prevalence per round ranged between 12.0 and 16.2% in 2012–13 and 10.7 and 11.3% in 2018–20 with overlapping 95% confidence intervals (95% CI). Among PWID participating in both programmes, HIV prevalence (95% CI) increased from 14.2% (11.7–17.1%) in 2012–13 to 22.0% (19.0–25.3%) in 2018–20 (P < 0.001). There was a deterioration in socio‐economic characteristics such as homelessness [from 16.2% (95% CI = 13.5–19.2%) to 25.6% (22.3–29.0%)], a shift in cocaine use [16.6% (13.9–19.6%) versus 28.1% (24.7–31.7%], reduced access to free syringes [51.8% (48.0–55.7%) versus 44.5% (40.7–48.3%)] and a decrease in daily injecting [36.2% (32.6–39.9%) versus 28.5% (25.2–32.1%)]. HIV incidence (95% CI) in 2014–20 was 1.94 (1.50–2.52) new cases/100 person‐years and younger age, lower educational level, larger injection network and daily injecting were risk factors. Almost 9% of HIV seroconversions occurred within a newly expanding phylogenetic cluster.
Conclusions
In Athens, Greece, compared with the period 2012–13, in the period 2018–20 there was a deterioration in socio‐economic conditions among people who inject drugs, an increase in the use of cocaine, reduced access to needle and syringe programmes and stable low levels of human immunodeficiency virus testing. Ongoing human immunodeficiency virus transmission was documented during 2014–20 in existing as well as new transmission clusters.</description><identifier>ISSN: 0965-2140</identifier><identifier>EISSN: 1360-0443</identifier><identifier>DOI: 10.1111/add.15812</identifier><identifier>PMID: 35072299</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Academic achievement ; Access ; Behavior change ; Blood diseases ; Cocaine ; Deterioration ; Disease Outbreaks ; Disease transmission ; Drug abuse ; Drug Users ; Drugs ; Economic conditions ; Educational attainment ; Epidemics ; Epidemiology ; Greece ; Greece - epidemiology ; Hepatitis C ; HIV ; HIV Infections - epidemiology ; HIV Infections - prevention & control ; HIV Seropositivity - epidemiology ; Homeless people ; Human immunodeficiency virus ; Humans ; Immune system ; incidence ; Needle exchange programs ; outbreak ; Outbreaks ; Phylogenetics ; Phylogeny ; Prevalence ; Prevention programs ; PWID ; Risk factors ; Risk-Taking ; Substance Abuse, Intravenous - epidemiology ; Syringes ; Viruses</subject><ispartof>Addiction (Abingdon, England), 2022-06, Vol.117 (6), p.1670-1682</ispartof><rights>2022 Society for the Study of Addiction</rights><rights>2022 Society for the Study of Addiction.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3882-b2d43e6f20f4d1a8ef03dc4d797d995d5e38817fc2fc7223acc0e7158351fe833</citedby><cites>FETCH-LOGICAL-c3882-b2d43e6f20f4d1a8ef03dc4d797d995d5e38817fc2fc7223acc0e7158351fe833</cites><orcidid>0000-0003-2347-0817 ; 0000-0001-5639-0528 ; 0000-0002-9430-7614</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fadd.15812$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fadd.15812$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,33753,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35072299$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Roussos, Sotirios</creatorcontrib><creatorcontrib>Paraskevis, Dimitrios</creatorcontrib><creatorcontrib>Psichogiou, Mina</creatorcontrib><creatorcontrib>Kostaki, Evangelia Georgia</creatorcontrib><creatorcontrib>Flountzi, Eleni</creatorcontrib><creatorcontrib>Angelopoulos, Theodoros</creatorcontrib><creatorcontrib>Chaikalis, Savvas</creatorcontrib><creatorcontrib>Papadopoulou, Martha</creatorcontrib><creatorcontrib>Pavlopoulou, Ioanna D.</creatorcontrib><creatorcontrib>Malliori, Meni</creatorcontrib><creatorcontrib>Hatzitheodorou, Eleni</creatorcontrib><creatorcontrib>Pylli, Magdalini</creatorcontrib><creatorcontrib>Tsiara, Chrissa</creatorcontrib><creatorcontrib>Paraskeva, Dimitra</creatorcontrib><creatorcontrib>Beloukas, Apostolos</creatorcontrib><creatorcontrib>Kalamitsis, George</creatorcontrib><creatorcontrib>Hatzakis, Angelos</creatorcontrib><creatorcontrib>Sypsa, Vana</creatorcontrib><title>Ongoing HIV transmission following a large outbreak among people who inject drugs in Athens, Greece (2014–20)</title><title>Addiction (Abingdon, England)</title><addtitle>Addiction</addtitle><description>Background and Aims
The human immunodeficiency virus (HIV) outbreak among people who inject drugs (PWID) in Athens, Greece in 2011–13 was the largest recent epidemic in Europe and North America. We aimed to assess trends in HIV prevalence, drug use and access to prevention among PWID in Athens to estimate HIV incidence and identify risk factors and to explore HIV‐1 dispersal using molecular methods during 2014–20.
Methods
Two community‐based HIV/hepatitis C programmes on PWID were implemented in 2012–13 (n = 3320) and 2018–20 (n = 1635) through consecutive respondent‐driven sampling (RDS) rounds. PWID were uniquely identified among rounds/programmes. We obtained RDS‐weighted HIV prevalence estimates per round for 2018–20 and compared them to 2012–13. We assessed changes in HIV status, behaviours and access to prevention in PWID participating in both periods. We estimated HIV incidence in a cohort of seronegative PWID as the number of HIV seroconversions/100 person‐years during 2014–20 and used Cox regression to identify associated risk factors. Molecular sequencing and phylogenetic analysis were performed in HIV seroconverters.
Results
HIV prevalence per round ranged between 12.0 and 16.2% in 2012–13 and 10.7 and 11.3% in 2018–20 with overlapping 95% confidence intervals (95% CI). Among PWID participating in both programmes, HIV prevalence (95% CI) increased from 14.2% (11.7–17.1%) in 2012–13 to 22.0% (19.0–25.3%) in 2018–20 (P < 0.001). There was a deterioration in socio‐economic characteristics such as homelessness [from 16.2% (95% CI = 13.5–19.2%) to 25.6% (22.3–29.0%)], a shift in cocaine use [16.6% (13.9–19.6%) versus 28.1% (24.7–31.7%], reduced access to free syringes [51.8% (48.0–55.7%) versus 44.5% (40.7–48.3%)] and a decrease in daily injecting [36.2% (32.6–39.9%) versus 28.5% (25.2–32.1%)]. HIV incidence (95% CI) in 2014–20 was 1.94 (1.50–2.52) new cases/100 person‐years and younger age, lower educational level, larger injection network and daily injecting were risk factors. Almost 9% of HIV seroconversions occurred within a newly expanding phylogenetic cluster.
Conclusions
In Athens, Greece, compared with the period 2012–13, in the period 2018–20 there was a deterioration in socio‐economic conditions among people who inject drugs, an increase in the use of cocaine, reduced access to needle and syringe programmes and stable low levels of human immunodeficiency virus testing. Ongoing human immunodeficiency virus transmission was documented during 2014–20 in existing as well as new transmission clusters.</description><subject>Academic achievement</subject><subject>Access</subject><subject>Behavior change</subject><subject>Blood diseases</subject><subject>Cocaine</subject><subject>Deterioration</subject><subject>Disease Outbreaks</subject><subject>Disease transmission</subject><subject>Drug abuse</subject><subject>Drug Users</subject><subject>Drugs</subject><subject>Economic conditions</subject><subject>Educational attainment</subject><subject>Epidemics</subject><subject>Epidemiology</subject><subject>Greece</subject><subject>Greece - epidemiology</subject><subject>Hepatitis C</subject><subject>HIV</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - prevention & control</subject><subject>HIV Seropositivity - epidemiology</subject><subject>Homeless people</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Immune system</subject><subject>incidence</subject><subject>Needle exchange programs</subject><subject>outbreak</subject><subject>Outbreaks</subject><subject>Phylogenetics</subject><subject>Phylogeny</subject><subject>Prevalence</subject><subject>Prevention programs</subject><subject>PWID</subject><subject>Risk factors</subject><subject>Risk-Taking</subject><subject>Substance Abuse, Intravenous - epidemiology</subject><subject>Syringes</subject><subject>Viruses</subject><issn>0965-2140</issn><issn>1360-0443</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BHHNA</sourceid><recordid>eNp1kEtOwzAQhi0EglJYcAFkiQ2VSPEjLy-r8igSUjfANnLtcUhJ42InqthxB27ISXAJsGM2o7E__aP5EDqhZExDXUqtxzTJKdtBA8pTEpE45rtoQESaRIzG5AAder8khGS5iPfRAU9IxpgQA2TnTWmrpsSzuyfcOtn4VeV9ZRtsbF3bzfZL4lq6ErDt2oUD-YLlyobnNdh1DXjzbHHVLEG1WLuu9GHAk_YZGn-Bbx2AAnzOCI0_3z8YGR2hPSNrD8c_fYgeb64fprPofn57N53cR4rnOYsWTMccUsOIiTWVORjCtYp1JjItRKITCBjNjGJGhUu4VIpAFhzwhBrIOR-isz537exrB74tlrZzTVhZsDQRIg220kCNeko5670DU6xdtZLuraCk2KotgtriW21gT38Su8UK9B_56zIAlz2wqWp4-z-pmFxd9ZFfPFyB6w</recordid><startdate>202206</startdate><enddate>202206</enddate><creator>Roussos, Sotirios</creator><creator>Paraskevis, Dimitrios</creator><creator>Psichogiou, Mina</creator><creator>Kostaki, Evangelia Georgia</creator><creator>Flountzi, Eleni</creator><creator>Angelopoulos, Theodoros</creator><creator>Chaikalis, Savvas</creator><creator>Papadopoulou, Martha</creator><creator>Pavlopoulou, Ioanna D.</creator><creator>Malliori, Meni</creator><creator>Hatzitheodorou, Eleni</creator><creator>Pylli, Magdalini</creator><creator>Tsiara, Chrissa</creator><creator>Paraskeva, Dimitra</creator><creator>Beloukas, Apostolos</creator><creator>Kalamitsis, George</creator><creator>Hatzakis, Angelos</creator><creator>Sypsa, Vana</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QG</scope><scope>7TK</scope><scope>7U3</scope><scope>8BJ</scope><scope>BHHNA</scope><scope>FQK</scope><scope>JBE</scope><scope>K9.</scope><scope>NAPCQ</scope><orcidid>https://orcid.org/0000-0003-2347-0817</orcidid><orcidid>https://orcid.org/0000-0001-5639-0528</orcidid><orcidid>https://orcid.org/0000-0002-9430-7614</orcidid></search><sort><creationdate>202206</creationdate><title>Ongoing HIV transmission following a large outbreak among people who inject drugs in Athens, Greece (2014–20)</title><author>Roussos, Sotirios ; Paraskevis, Dimitrios ; Psichogiou, Mina ; Kostaki, Evangelia Georgia ; Flountzi, Eleni ; Angelopoulos, Theodoros ; Chaikalis, Savvas ; Papadopoulou, Martha ; Pavlopoulou, Ioanna D. ; Malliori, Meni ; Hatzitheodorou, Eleni ; Pylli, Magdalini ; Tsiara, Chrissa ; Paraskeva, Dimitra ; Beloukas, Apostolos ; Kalamitsis, George ; Hatzakis, Angelos ; Sypsa, Vana</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3882-b2d43e6f20f4d1a8ef03dc4d797d995d5e38817fc2fc7223acc0e7158351fe833</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Academic achievement</topic><topic>Access</topic><topic>Behavior change</topic><topic>Blood diseases</topic><topic>Cocaine</topic><topic>Deterioration</topic><topic>Disease Outbreaks</topic><topic>Disease transmission</topic><topic>Drug abuse</topic><topic>Drug Users</topic><topic>Drugs</topic><topic>Economic conditions</topic><topic>Educational attainment</topic><topic>Epidemics</topic><topic>Epidemiology</topic><topic>Greece</topic><topic>Greece - epidemiology</topic><topic>Hepatitis C</topic><topic>HIV</topic><topic>HIV Infections - epidemiology</topic><topic>HIV Infections - prevention & control</topic><topic>HIV Seropositivity - epidemiology</topic><topic>Homeless people</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Immune system</topic><topic>incidence</topic><topic>Needle exchange programs</topic><topic>outbreak</topic><topic>Outbreaks</topic><topic>Phylogenetics</topic><topic>Phylogeny</topic><topic>Prevalence</topic><topic>Prevention programs</topic><topic>PWID</topic><topic>Risk factors</topic><topic>Risk-Taking</topic><topic>Substance Abuse, Intravenous - epidemiology</topic><topic>Syringes</topic><topic>Viruses</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Roussos, Sotirios</creatorcontrib><creatorcontrib>Paraskevis, Dimitrios</creatorcontrib><creatorcontrib>Psichogiou, Mina</creatorcontrib><creatorcontrib>Kostaki, Evangelia Georgia</creatorcontrib><creatorcontrib>Flountzi, Eleni</creatorcontrib><creatorcontrib>Angelopoulos, Theodoros</creatorcontrib><creatorcontrib>Chaikalis, Savvas</creatorcontrib><creatorcontrib>Papadopoulou, Martha</creatorcontrib><creatorcontrib>Pavlopoulou, Ioanna D.</creatorcontrib><creatorcontrib>Malliori, Meni</creatorcontrib><creatorcontrib>Hatzitheodorou, Eleni</creatorcontrib><creatorcontrib>Pylli, Magdalini</creatorcontrib><creatorcontrib>Tsiara, Chrissa</creatorcontrib><creatorcontrib>Paraskeva, Dimitra</creatorcontrib><creatorcontrib>Beloukas, Apostolos</creatorcontrib><creatorcontrib>Kalamitsis, George</creatorcontrib><creatorcontrib>Hatzakis, Angelos</creatorcontrib><creatorcontrib>Sypsa, Vana</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Animal Behavior Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Social Services Abstracts</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>Sociological Abstracts</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Addiction (Abingdon, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Roussos, Sotirios</au><au>Paraskevis, Dimitrios</au><au>Psichogiou, Mina</au><au>Kostaki, Evangelia Georgia</au><au>Flountzi, Eleni</au><au>Angelopoulos, Theodoros</au><au>Chaikalis, Savvas</au><au>Papadopoulou, Martha</au><au>Pavlopoulou, Ioanna D.</au><au>Malliori, Meni</au><au>Hatzitheodorou, Eleni</au><au>Pylli, Magdalini</au><au>Tsiara, Chrissa</au><au>Paraskeva, Dimitra</au><au>Beloukas, Apostolos</au><au>Kalamitsis, George</au><au>Hatzakis, Angelos</au><au>Sypsa, Vana</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ongoing HIV transmission following a large outbreak among people who inject drugs in Athens, Greece (2014–20)</atitle><jtitle>Addiction (Abingdon, England)</jtitle><addtitle>Addiction</addtitle><date>2022-06</date><risdate>2022</risdate><volume>117</volume><issue>6</issue><spage>1670</spage><epage>1682</epage><pages>1670-1682</pages><issn>0965-2140</issn><eissn>1360-0443</eissn><abstract>Background and Aims
The human immunodeficiency virus (HIV) outbreak among people who inject drugs (PWID) in Athens, Greece in 2011–13 was the largest recent epidemic in Europe and North America. We aimed to assess trends in HIV prevalence, drug use and access to prevention among PWID in Athens to estimate HIV incidence and identify risk factors and to explore HIV‐1 dispersal using molecular methods during 2014–20.
Methods
Two community‐based HIV/hepatitis C programmes on PWID were implemented in 2012–13 (n = 3320) and 2018–20 (n = 1635) through consecutive respondent‐driven sampling (RDS) rounds. PWID were uniquely identified among rounds/programmes. We obtained RDS‐weighted HIV prevalence estimates per round for 2018–20 and compared them to 2012–13. We assessed changes in HIV status, behaviours and access to prevention in PWID participating in both periods. We estimated HIV incidence in a cohort of seronegative PWID as the number of HIV seroconversions/100 person‐years during 2014–20 and used Cox regression to identify associated risk factors. Molecular sequencing and phylogenetic analysis were performed in HIV seroconverters.
Results
HIV prevalence per round ranged between 12.0 and 16.2% in 2012–13 and 10.7 and 11.3% in 2018–20 with overlapping 95% confidence intervals (95% CI). Among PWID participating in both programmes, HIV prevalence (95% CI) increased from 14.2% (11.7–17.1%) in 2012–13 to 22.0% (19.0–25.3%) in 2018–20 (P < 0.001). There was a deterioration in socio‐economic characteristics such as homelessness [from 16.2% (95% CI = 13.5–19.2%) to 25.6% (22.3–29.0%)], a shift in cocaine use [16.6% (13.9–19.6%) versus 28.1% (24.7–31.7%], reduced access to free syringes [51.8% (48.0–55.7%) versus 44.5% (40.7–48.3%)] and a decrease in daily injecting [36.2% (32.6–39.9%) versus 28.5% (25.2–32.1%)]. HIV incidence (95% CI) in 2014–20 was 1.94 (1.50–2.52) new cases/100 person‐years and younger age, lower educational level, larger injection network and daily injecting were risk factors. Almost 9% of HIV seroconversions occurred within a newly expanding phylogenetic cluster.
Conclusions
In Athens, Greece, compared with the period 2012–13, in the period 2018–20 there was a deterioration in socio‐economic conditions among people who inject drugs, an increase in the use of cocaine, reduced access to needle and syringe programmes and stable low levels of human immunodeficiency virus testing. Ongoing human immunodeficiency virus transmission was documented during 2014–20 in existing as well as new transmission clusters.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>35072299</pmid><doi>10.1111/add.15812</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0003-2347-0817</orcidid><orcidid>https://orcid.org/0000-0001-5639-0528</orcidid><orcidid>https://orcid.org/0000-0002-9430-7614</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0965-2140 |
| ispartof | Addiction (Abingdon, England), 2022-06, Vol.117 (6), p.1670-1682 |
| issn | 0965-2140 1360-0443 |
| language | eng |
| recordid | cdi_proquest_journals_2659968126 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Sociological Abstracts |
| subjects | Academic achievement Access Behavior change Blood diseases Cocaine Deterioration Disease Outbreaks Disease transmission Drug abuse Drug Users Drugs Economic conditions Educational attainment Epidemics Epidemiology Greece Greece - epidemiology Hepatitis C HIV HIV Infections - epidemiology HIV Infections - prevention & control HIV Seropositivity - epidemiology Homeless people Human immunodeficiency virus Humans Immune system incidence Needle exchange programs outbreak Outbreaks Phylogenetics Phylogeny Prevalence Prevention programs PWID Risk factors Risk-Taking Substance Abuse, Intravenous - epidemiology Syringes Viruses |
| title | Ongoing HIV transmission following a large outbreak among people who inject drugs in Athens, Greece (2014–20) |
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