Pediatric Research Laboratory, National and Kapodistrian University of Athens, Faculty of Nursing, Athens, Greece.
Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
BMC Public Health. 2020 Jan 28;20(1):105. doi: 10.1186/s12889-020-8178-y.
Aristotle was a seek-test-treat intervention during an outbreak of human immunodeficiency virus (HIV) infection among people who inject drugs (PWID) in Athens, Greece that started in 2011. The aims of this analysis were: (1) to study changes of drug injection-related and sexual behaviors over the course of Aristotle; and (2) to compare the likelihood of risky behaviors among PWID who were aware and unaware of their HIV status.
Aristotle (2012-2013) involved five successive respondent-driven sampling rounds of approximately 1400 PWID each; eligible PWID could participate in multiple rounds. Participants were interviewed using a questionnaire, were tested for HIV, and were classified as HIV-positive aware of their status (AHS), HIV-positive unaware of their status (UHS), and HIV-negative. Piecewise linear generalized estimating equation models were used to regress repeatedly measured binary outcomes (high-risk behaviors) against covariates.
Aristotle recruited 3320 PWID (84.5% males, median age 34.2 years). Overall, 7110 interviews and blood samples were collected. The proportion of HIV-positive first-time participants who were aware of their HIV infection increased from 21.8% in round A to 36.4% in the last round. The odds of dividing drugs at least half of the time in the past 12 months with a syringe someone else had already used fell from round A to B by 90% [Odds Ratio (OR) (95% Confidence Interval-CI): 0.10 (0.04, 0.23)] among AHS and by 63% among UHS [OR (95% CI): 0.37 (0.19, 0.72)]. This drop was significantly larger (p = 0.02) among AHS. There were also decreases in frequency of injection and in receptive syringe sharing in the past 12 months but they were not significantly different between AHS (66 and 47%, respectively) and UHS (63 and 33%, respectively). Condom use increased only among male AHS from round B to the last round [OR (95% CI): 1.24 (1.01, 1.52)].
The prevalence of risky behaviors related to drug injection decreased in the context of Aristotle. Knowledge of HIV infection was associated with safer drug injection-related behaviors among PWID. This highlights the need for comprehensive interventions that scale-up HIV testing and help PWID become aware of their HIV status.
亚里士多德是在希腊雅典爆发人类免疫缺陷病毒（HIV）感染期间对注射吸毒者（PWID）实施的一项寻求-检测-治疗干预措施，该干预始于 2011 年。本分析的目的是：（1）研究亚里士多德干预期间，PWID 的药物注射相关行为和性行为的变化；（2）比较知晓和不知晓 HIV 状况的 PWID 发生危险行为的可能性。
亚里士多德（2012-2013 年）涉及五轮连续的应答驱动抽样，每轮约有 1400 名 PWID 参加；合格的 PWID 可以参加多轮。参与者接受了问卷调查，接受了 HIV 检测，并分为 HIV 阳性知晓其状况（AHS）、HIV 阳性不知晓其状况（UHS）和 HIV 阴性。分段线性广义估计方程模型用于回归重复测量的二项结局（高危行为）与协变量。
亚里士多德招募了 3320 名 PWID（84.5%为男性，中位年龄 34.2 岁）。共收集了 7110 次访谈和血样。首轮 HIV 阳性初次参与者中知晓其 HIV 感染状况的比例从 A 轮的 21.8%上升到最后一轮的 36.4%。与首轮相比，AHS 参与者用他人已用过的注射器分药的比例从 A 轮到 B 轮下降了 90%[比值比（OR）（95%置信区间-CI）：0.10（0.04，0.23）]，UHS 下降了 63%[OR（95%CI）：0.37（0.19，0.72）]。AHS 中降幅显著更大（p=0.02）。在过去 12 个月中，注射频率和接受注射器共享的频率也有所下降，但 AHS（分别为 66%和 47%）和 UHS（分别为 63%和 33%）之间没有显著差异。仅在 B 轮到最后一轮期间，男性 AHS 的 condom 使用有所增加[比值比（OR）（95%CI）：1.24（1.01，1.52）]。
在亚里士多德干预的背景下，与药物注射相关的危险行为的流行率有所下降。HIV 感染知识与 PWID 更安全的药物注射相关行为有关。这凸显了需要全面干预措施，扩大 HIV 检测，并帮助 PWID 知晓其 HIV 状况。
