Judd Ali, Rhodes Tim, Johnston Lisa G, Platt Lucy, Andjelkovic Violeta, Simić Danijela, Mugosa Boban, Simić Milena, Zerjav Sonja, Parry Ruth P, Parry John V
MRC Clinical Trials Unit, London, UK.
BMC Infect Dis. 2009 Feb 9;9:14. doi: 10.1186/1471-2334-9-14.
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.
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.
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%)).
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.
塞尔维亚和黑山注射吸毒者（IDU）中艾滋病毒（HIV）或丙型肝炎病毒（HCV）的流行情况鲜为人知。我们在贝尔格莱德和波德戈里察社区招募的注射吸毒者中，检测了HIV抗体（抗-HIV）和丙型肝炎病毒抗体（抗-HCV）的流行率以及抗-HCV的危险因素，并确定了一种并行快速HIV检测算法的性能。
采用应答者驱动抽样和音频计算机辅助调查访谈（ACASI）方法。采集干血斑进行不关联匿名抗体检测。为贝尔格莱德的注射吸毒者提供了使用并行检测算法的自愿保密快速HIV检测，并将其性能与标准实验室检测进行比较。计算了抗-HCV阳性的预测因素和快速HIV检测算法的诊断准确性。
在贝尔格莱德（n = 433），注射吸毒者中抗-HIV和抗-HCV的总体人群流行率分别为3%和63%；在波德戈里察（n = 328）分别为0%和22%。每个城市约四分之一的注射吸毒者在过去四周内使用过用过的针头和注射器注射。在两个城市中，抗-HCV阳性都与注射年限增加有关（例如，贝尔格莱德，注射≥10年与0 - 4年相比，调整优势比（AOR）为5.6（95%可信区间3.2 - 9.7）；波德戈里察AOR为2.5（1.3 - 5.1））、每日注射（贝尔格莱德AOR为1.6（1.0 - 2.7），波德戈里察AOR为2.1（1.3 - 5.1））以及曾共用用过的针头/注射器（贝尔格莱德AOR为2.3（1.0 - 5.4），波德戈里察AOR为1.9（1.4 - 2.6））。贝尔格莱德一半（47%）的参与者接受了快速HIV检测，快速检测结果与随后的确认实验室检测完全一致（敏感性100%（95%可信区间59% - 100%），特异性100%（95%可信区间98% - 100%））。
社区招募、ACASI、快速检测和关联诊断准确性研究相结合，为在注射吸毒者中开展血源性病毒血清流行率研究提供了更好的方法。快速检测的相对高接受率表明，在社区环境中引入这种方法可能会增加高危人群的检测人数。HCV的高流行率和注射风险行为的相对高流行率表明，这两个城市的注射吸毒者中可能会进一步发生HIV传播。迫切需要扩大HIV预防干预措施的规模。
