Bethany White

HIV education in a Siberian prison colony for drug dependent males

AimTo evaluate the effectiveness of an HIV peer training program conducted in a colony for drug dependent male prisoners in Siberia, Russia.MethodQuestionnaires were used to collect data pre and post peer training sessions. Three peer training sessions were conducted between questionnaires. Fifteen to twenty inmates were trained as peer educators at each week-long health education training session.ResultsIn 2000 and 2001, 153 and 124 inmates completed the questionnaire respectively. Respondents in both years reported similar health and injecting histories and comparable levels of sexual activity. Respondents in 2001 were significantly more likely to correctly identify both how HIV can and cannot be transmitted compared to respondents in 2000. The prevalence of tattooing in prison decreased significantly between questionnaires. However, there was virtually no reported use of bleach to clean tattooing or injecting equipment in either 2000 or 2001. Access to condoms increased significantly between questionnaires.ConclusionsWhile this training program was associated with improved HIV knowledge, the Ministry of Justice should consider improved and additional harm reduction strategies. These include increased availability of bleach and condoms and the introduction of methadone treatment and syringe exchange in prison.

Self reported risk behaviour among injecting drug users: Self versus assisted questionnaire completion

Abstract The current study aimed to compare self-reported injecting and sexual risk behaviour among Needle and Syringe Program (NSP) attendees who self-completed a questionnaire to that of those who received assistance in completing the questionnaire. Information on demographic, injecting and sexual risk behaviour was collected via a self-completed questionnaire for an annual cross-sectional survey of injecting drug users (IDUs) recruited from sentinel NSPs around Australia. Assistance was provided when necessary and recorded. Of 2,035 participants, 1,452 (71%) reported completing the questionnaire without assistance. Being male and nominating a language other than English spoken at home was independently associated with receiving assistance with questionnaire completion. Participants who reported heroin as the drug last injected were also more likely to receive assistance. Multivariate analyses revealed those who received assistance with questionnaire completion were less likely to report re-using a syringe after someone else and less likely to report sex work in the past month. The current findings suggest self-completion of risk behaviour questionnaires should be considered as an alternative to interviewer administered questionnaires to maximise accuracy of self-reports.

Establishing a linked sentinel surveillance system for blood-borne viruses and sexually transmissible infections: methods, system attributes and early findings

OBJECTIVE To describe the attributes and key findings from implementation of a new blood-borne virus (BBV) and sexually transmissible infection (STI) sentinel surveillance system based on routine testing at clinical sites in Victoria, Australia. METHODS The Victorian Primary Care Network for Sentinel Surveillance (VPCNSS) on BBV and STI was established in 2006 at 17 sites. Target populations included men who have sex with men (MSM), young people and injecting drug users (IDU). Sites collected demographic and risk behaviour information electronically or using paper surveys from patients undergoing routine HIV or STI (syphilis, chlamydia (Chlamydia trachomatis)) or hepatitis C virus (HCV) testing. These data were linked with laboratory results. RESULTS Between April 2006 and June 2008, data were received for 67 466 tests and 52 042 questionnaires. In clinics providing electronic data, >90% of individuals tested for HIV, syphilis and chlamydia had risk behaviour information collected. In other clinics, survey response rates were >85% (HIV), 43.5% (syphilis), 42.7-66.5% (chlamydia) and <20% (HCV). Data completeness was >85% for most core variables. Over time, HIV, syphilis and chlamydia testing increased in MSM, and chlamydia testing declined in females (P = 0.05). The proportion of positive tests among MSM was 1.9% for HIV and 2.1% for syphilis. Among 16-24-year-olds, the proportion positive for chlamydia was 10.7% in males and 6.9% in females. Among IDU, 19.4% of HCV tests were antibody positive. CONCLUSIONS The VPCNSS has collected a large, rich dataset through which testing, risk behaviours and the proportion positive can be monitored in high-risk groups, offering a more comprehensive BBV and STI surveillance system for Victoria. Building system sustainability requires an ongoing focus.

Experience of hepatitis C testing among injecting drug users in Sydney, Australia.

Abstract Testing injecting drug users (IDUs) for HIV and hepatitis C virus (HCV) provides a useful opportunity for health promotion, risk-reduction assessment and counselling, and increases opportunities for treatment assessment, yet little is known about IDUs’ experience of testing. This study aimed to examine the experiences of testing among IDUs recruited through primary healthcare and drug treatment services. Almost all the 229 participants recruited had been previously tested for HIV (96%) and HCV (97%), a median of five and four times respectively. Reasons for seeking testing were similar for both HIV and HCV, the most common being to protect others (72 and 74%, respectively), blood/needle exposure (66 and 70%, respectively) and to receive early treatment (66%, both). The most common locations for testing were general medical practices (GPs) (53%), specialised clinics (45%) and methadone clinics (43%). Preferred locations were similar for HIV and HCV testing: methadone clinics (47 and 48%, respectively), GPs (42%, both), specialised clinics (32%, both). The most common reasons for delaying testing were being anxious about waiting for results (66%), scared or afraid of finding out results (65%) and having trouble keeping appointments (64%). The majority of participants (HIV 62%; HCV 59%) reported that they would prefer pre-test counselling to be delivered in person rather than receiving written information and would prefer test results to be delivered face-to-face (HIV 83%; HCV 80%). High prevalence of testing suggests good uptake and high acceptability among this population in Australia. Specialised services for drug users such as methadone clinics and primary healthcare are suitable locations to provide access to testing.

Hepatitis B virus among injecting drug users in Sydney, Australia: prevalence, vaccination and knowledge of status.

BACKGROUND Despite the availability of an inexpensive and safe vaccine, injecting drug users (IDUs) remain at risk of hepatitis B virus (HBV) infection. This paper aimed to measure HBV prevalence and vaccination coverage and to assess knowledge and concordance of status among IDUs. METHODS Participants were recruited through a primary health care and a drug treatment service and via street press in Sydney, Australia. Face-to-face interviews were conducted and serology collected. All received

Using ethnographic fieldwork to inform hepatitis C vaccine preparedness studies with people who inject drugs

30 for participation. RESULTS 229 participants were recruited, serology was available for 209. Almost all those interviewed had been tested for HBV (95%) a median of four (IQR 2-10) times and 61% had been tested in the preceding year. Fifty-four percent had evidence of previous infection (anti-HBc) and 5% were HBsAg positive. Only 27% had serological evidence of vaccination immunity; however, 43% of the sample recalled having being told by a health professional that they were vaccinated against HBV. Although only three participants reported they did not understand the results of their last HBV test, confusion was evident based on self-reported status. CONCLUSIONS Levels of understanding and vaccination coverage were low while evidence of prior infection was high among this IDU sample. This is cause for concern given the majority of participants were recruited through primary care and treatment services. Strategies to bolster vaccination among this group will be discussed.

Acceptability of hepatitis C virus testing methods among injecting drug users

BACKGROUND Feasibility studies are an important component of preparations for field trials of biomedical prevention interventions, including vaccines. METHODS We conducted ethnographic fieldwork to assess feasibility, including eligibility and willingness to participate, prior to recruitment of a prospective observational study of hepatitis C negative people who inject drugs (PWID) in Sydney, Australia. Five staff conducted ethnographic fieldwork in 16 locations during 2008. Observations and interactions with PWID were recorded as field notes and data were used iteratively to guide targeting of locations and the follow-up of networks and individuals. RESULTS Findings informed the development of the study protocol, resulting in changes in the amount and type of participant reimbursement and the quantity of blood collected at screening, as well as highlighting the need for increased emphasis on communicating eligibility and exclusion criteria and study remuneration procedures. CONCLUSION Results illustrate the value of ethnographic research in facilitating consultation and discussion with potential participants in natural settings, identifying motivations and concerns prior to study commencement and providing affected community input into the development of research protocols.

Candidate hepatitis C vaccine trials and people who inject drugs: Challenges and opportunities

INTRODUCTION AND AIMS The acceptability of testing methods and procedures has implications for uptake of blood-borne virus screening in sentinel samples of injecting drug users (IDUs) likely to participate in surveillance. The aim of the current study was to determine the acceptability of three methods of hepatitis C virus (HCV) testing among injecting drug users (IDUs): oral fluid, capillary blood and venous blood sampling. DESIGN AND METHODS A cross-sectional survey of IDUs was conducted in inner-city Sydney in 2005 for a laboratory validation study of HCV antibody testing. Participants were tested using the three different specimen collection methods and asked about the acceptability of each method and a particular preference documented. RESULTS Two-hundred and twenty-nine IDUs participated in the study. Before and after specimen collection, the acceptability of all three collection methods for HCV testing was high (> 85%). Oral fluid remained the preferred method after sample collection, with females (65%) significantly more likely than males (49%) to report a preference (unadjusted odds ratio 2.0; 95% confidence interval 1.1-3.5, p = 0.03) for that method. DISCUSSION AND CONCLUSIONS Findings suggest that oral fluid testing is an acceptable and preferred alternative for HCV testing among IDUs. However, concerns reported by participants in the study indicate that information and education regarding the nature and diagnostic value of oral fluid testing is necessary prior to its implementation for surveillance purposes among this population.

Motivators and barriers influencing willingness to participate in candidate HCV vaccine trials: Perspectives of people who inject drugs

People who inject drugs (PWID) are at high risk of HCV. Limited evidence of the effectiveness of prevention interventions and low uptake of treatment in this group highlight the need for increased investment in biomedical interventions, notably safe and efficacious vaccines. While several candidates are currently in development, field trials in PWID present challenges, including ethical issues associated with trial literacy, informed consent and standards of care. Significant biological and social factors and differences between HIV and HCV suggest that HCV warrants targeted vaccine preparedness research to lay the groundwork for successful implementation of future trials.

Ongoing susceptibility to hepatitis B virus infection among people who inject drugs in Sydney

BACKGROUND A safe and efficacious vaccine may be the most efficient and cost-effective strategy for controlling the hepatitis C virus (HCV) epidemic among people who inject drugs (PWID) and several candidates are in development. However, little is known about the factors that influence willingness to participate (WTP) in candidate HCV vaccine trials among this group. METHODS HCV seronegative PWID recruited between 2008 and 2010 as part of a prospective observational cohort study in Sydney, Australia were asked whether they would be willing to participate in a future candidate hepatitis C vaccine trial and to provide reasons to explain their decision. RESULTS Of 113 participants, 74% indicated WTP, 15% were unwilling to participate and 11% reported WTP that was contingent on vaccine characteristics and trial design issues. The most commonly reported motivator for hypothetical trial participation was altruism, followed by potential health benefits, financial remuneration, and knowledge gain. Barriers to hypothetical participation included fears about possible harms to health, such as concerns about vaccine safety, side effects, and acquiring HCV from the vaccine; other barriers included mistrust of biomedical research and time constraints. CONCLUSIONS These results may be useful in designing strategies to enhance HCV vaccine trial recruitment and retention and have ethical implications for developing informed consent processes and standards of care.