Carmen Koschollek

Konzeption einer Studie zu sexueller Gesundheit bei in Deutschland lebenden Afrikanern

ZusammenfassungHintergrundMigranten aus Subsahara Afrika (MiSSA) machen ca. 10–15 % aller HIV-Erstdiagnosen in Deutschland aus, von denen in den letzten Jahren etwa ein Drittel vermutlich in Deutschland erworben wurde. Zur Prävalenz von Virushepatitiden (HEP) in dieser Zielgruppe liegen bisher keine Daten vor. Zudem gibt es nur punktuelle Informationen zu Wissen, Einstellungen und Verhalten von MiSSA in Bezug auf HIV/HEP und andere sexuell übertragbare Infektionen (STI). Diese Informationen wiederum sind für die Entwicklung von Präventionsmaßnahmen unabdingbar.Ziel der ArbeitZiel der Arbeit war es, ein angemessenes Studiendesign zur Erfassung der Bedarfe und Bedürfnisse von MiSSA im Bereich der HIV/HEP/STI-Prävention zu entwickeln.Material und MethodenEingesetzt wurde 1. ein strukturiertes Expertengespräch mit Schlüsselpersonen aus MiSSA-Communities, Praktikern und Forschern, die in der HIV/STI-Prävention bzw. Forschung tätig sind. Aus diesem Kreis wurde 2. eine Arbeitsgruppe gebildet, die Vorschläge für ein Studiendesign entwickelte. Diese Empfehlungen wurden 3. im Rahmen von Fokusgruppen mit MiSSA in vier deutschen Großstädten diskutiert.ErgebnisseFolgende Grundsätze wurden für den Forschungsprozess festgelegt: Der Nutzen der Forschungsergebnisse aus der Perspektive der MiSSA ist prioritär, unabdingbar ist ein partizipatives Vorgehen (Einbeziehung der Zielgruppe); Entscheidungen werden von einem Advisory Board und Community-Vertretern diskutiert. Als Studiendesign wurde eine multizentrische Befragung mit begleitendem optionalem Angebot zur niedrigschwelligen HIV/HEP/STI-Testung vorgeschlagen. Die Rekrutierung von Studienteilnehmer erfolgte durch Peer Researcher. Fragebögen wurden partizipativ entwickelt und in mehreren Sprachen angeboten. Die Teilnehmer der vier Fokusgruppen unterstützen prinzipiell das Studiendesign.SchlussfolgerungFür die Planung und Umsetzung von HIV/HEP/STI-Forschung mit MiSSA ist ein partizipatives Vorgehen unter Einbeziehung der Zielgruppen entscheidend.AbstractBackgroundMigrants from sub-Saharan Africa (MiSSA) are a relevant subgroup for HIV transmission in Germany; 10–15 % of all newly diagnosed cases are MiSSA, and of those diagnosed in recent years approximately one third acquired HIV in Germany. There is limited information on prevalence of viral hepatitis (HEP), other sexual transmitted infections (STI) and on knowledge, attitudes, behaviors and practices (KABP) regarding sexual health.ObjectivesTo gain a better understanding of MiSSAʼs HIV/HEP/STI prevention needs and to develop an appropriate study design, a research process was initiated.Materials and methodsAn expert meeting took place to define specific research needs as well as a research approach. Experts were defined as persons working in HIV/STI prevention with MiSSA, key persons from MiSSA communities, and HIV/STI researchers. A working group was established to draft a potential study design for a KABP survey of MiSSA. Recommendations of the working group were appraised by four focus groups (FG) with MiSSA in different cities.ResultsExperts defined principles for the research: participatory research approach (involvement of MiSSA in all stages of the process with decision-making powers), all decisions were evaluated by community members and an advisory board, and research should benefit MiSSA communities. The agreed research design was a multicenter KABP study on sexual health with recruitment by trained peer researchers and free and optional HIV/HEP/STI testing, which were offered to participants. Questionnaires will be available in multiple languages and multimodal administration is possible (self-completion/interview). FG results generally supported the suggested research design.ConclusionTo conduct HIV/STI/HEP research that is meaningful to MiSSA, it is crucial to involve community partners in the research process. This will help to address the specific needs of MiSSA and also assure a better reception of the study within the community.

Migrationshintergrund in der infektionsepidemiologischen Surveillance in Deutschland

ZusammenfassungHintergrundMigration beeinflusst die Epidemiologie von Infektionskrankheiten. Sich daraus ergebende Risikogruppen und Präventionsbedarfe zu identifizieren, ist Grundlage für eine adäquate Gestaltung von Public-Health-Maßnahmen. Es stellt sich die Frage, inwieweit sich migrationsspezifische Informationen hierfür direkt aus der infektionsepidemiologischen Surveillance ableiten lassen.Ziel der ArbeitZiel ist eine systematische Darstellung von Indikatoren zur Operationalisierung des Migrationshintergrundes in der infektionsepidemiologischen Surveillance in Deutschland sowie die Einschätzung bestehender Einschränkungen.MethodikFür meldepflichtige Krankheiten bzw. Erregernachweise werden die jeweils erhobenen Indikatoren für Migration und deren Grundlage im Infektionsschutzgesetz dargestellt. Für Tuberkulose (TB), HIV und Syphilis werden Meldedaten für 2002–2013 deskriptiv analysiert.ErgebnisseBei fünf Infektionskrankheiten wurden – unterschiedlich operationalisiert – Informationen zum Migrationshintergrund erhoben. Bei TB (Geburtsland) und HIV (Herkunftsland) war eine nicht-deutsche Herkunft deutlich häufiger als bei Syphilis (Herkunftsland) mit 46, 30 bzw. 13 % der Fälle mit entsprechenden Angaben. Bei allen drei betrachteten Infektionskrankheiten ergaben sich Hinweise auf migrationsspezifische Risikoprofile.DiskussionEinheitliche Indikatoren für Migration in der infektionsepidemiologischen Surveillance würden die internationale und erregerübergreifende Vergleichbarkeit der Daten ermöglichen. Die Surveillance erlaubt aktuell teilweise migrationssensible Analysen, jedoch bedarf es zusätzlicher Studien, um die komplexen Zusammenhänge von Migration und Infektionskrankheiten richtig interpretieren und Public-Health-Maßnahmen bedarfsgerecht gestalten zu können.AbstractBackgroundMigration is an important factor impacting on infectious disease epidemiology. The timely identification of groups at risk and prevention needs resulting from migration is indispensable to adequately design and implement public health measures. It remains to be assessed to which extent surveillance data for notifiable diseases can directly generate meaningful migration-specific information.ObjectivesThe objectives of this study are to review indicators of migration background utilized in the German infectious disease surveillance, as well as to assess their limitations.MethodsWe describe the indicators of migration used for mandatorily notifiable diseases and pathogens and their legal basis in the Protection against Infection Act and conduct a descriptive analysis of surveillance data for tuberculosis (TB), HIV and syphilis from 2002–2013.ResultsMigration status is collected only for five infectious diseases and operationalization varies. For TB (country of birth) and HIV (country of origin) a foreign origin was more frequent than for syphilis (country of origin); namely 46, 30 and 13 % of cases with available information, respectively. In all three examples, there are indications of risk profiles that are specific for particular groups of migrants.DiscussionA standardization of indicators of migration in infectious disease surveillance is important to enhance data comparability between diseases and pathogens as well as across countries. Routine surveillance already partly allows migration sensitive analyses, yet further research is needed to guide interpretation of the complex relationship between migration and infectious diseases and plan public health measures adequately.BACKGROUND Migration is an important factor impacting on infectious disease epidemiology. The timely identification of groups at risk and prevention needs resulting from migration is indispensable to adequately design and implement public health measures. It remains to be assessed to which extent surveillance data for notifiable diseases can directly generate meaningful migration-specific information. OBJECTIVES The objectives of this study are to review indicators of migration background utilized in the German infectious disease surveillance, as well as to assess their limitations. METHODS We describe the indicators of migration used for mandatorily notifiable diseases and pathogens and their legal basis in the Protection against Infection Act and conduct a descriptive analysis of surveillance data for tuberculosis (TB), HIV and syphilis from 2002-2013. RESULTS Migration status is collected only for five infectious diseases and operationalization varies. For TB (country of birth) and HIV (country of origin) a foreign origin was more frequent than for syphilis (country of origin); namely 46, 30 and 13% of cases with available information, respectively. In all three examples, there are indications of risk profiles that are specific for particular groups of migrants. DISCUSSION A standardization of indicators of migration in infectious disease surveillance is important to enhance data comparability between diseases and pathogens as well as across countries. Routine surveillance already partly allows migration sensitive analyses, yet further research is needed to guide interpretation of the complex relationship between migration and infectious diseases and plan public health measures adequately.

[Migration and infectious disease surveillance in Germany: Analyses of Tuberculosis, HIV and Syphilis surveillance data].

ZusammenfassungHintergrundMigration beeinflusst die Epidemiologie von Infektionskrankheiten. Sich daraus ergebende Risikogruppen und Präventionsbedarfe zu identifizieren, ist Grundlage für eine adäquate Gestaltung von Public-Health-Maßnahmen. Es stellt sich die Frage, inwieweit sich migrationsspezifische Informationen hierfür direkt aus der infektionsepidemiologischen Surveillance ableiten lassen.Ziel der ArbeitZiel ist eine systematische Darstellung von Indikatoren zur Operationalisierung des Migrationshintergrundes in der infektionsepidemiologischen Surveillance in Deutschland sowie die Einschätzung bestehender Einschränkungen.MethodikFür meldepflichtige Krankheiten bzw. Erregernachweise werden die jeweils erhobenen Indikatoren für Migration und deren Grundlage im Infektionsschutzgesetz dargestellt. Für Tuberkulose (TB), HIV und Syphilis werden Meldedaten für 2002–2013 deskriptiv analysiert.ErgebnisseBei fünf Infektionskrankheiten wurden – unterschiedlich operationalisiert – Informationen zum Migrationshintergrund erhoben. Bei TB (Geburtsland) und HIV (Herkunftsland) war eine nicht-deutsche Herkunft deutlich häufiger als bei Syphilis (Herkunftsland) mit 46, 30 bzw. 13 % der Fälle mit entsprechenden Angaben. Bei allen drei betrachteten Infektionskrankheiten ergaben sich Hinweise auf migrationsspezifische Risikoprofile.DiskussionEinheitliche Indikatoren für Migration in der infektionsepidemiologischen Surveillance würden die internationale und erregerübergreifende Vergleichbarkeit der Daten ermöglichen. Die Surveillance erlaubt aktuell teilweise migrationssensible Analysen, jedoch bedarf es zusätzlicher Studien, um die komplexen Zusammenhänge von Migration und Infektionskrankheiten richtig interpretieren und Public-Health-Maßnahmen bedarfsgerecht gestalten zu können.AbstractBackgroundMigration is an important factor impacting on infectious disease epidemiology. The timely identification of groups at risk and prevention needs resulting from migration is indispensable to adequately design and implement public health measures. It remains to be assessed to which extent surveillance data for notifiable diseases can directly generate meaningful migration-specific information.ObjectivesThe objectives of this study are to review indicators of migration background utilized in the German infectious disease surveillance, as well as to assess their limitations.MethodsWe describe the indicators of migration used for mandatorily notifiable diseases and pathogens and their legal basis in the Protection against Infection Act and conduct a descriptive analysis of surveillance data for tuberculosis (TB), HIV and syphilis from 2002–2013.ResultsMigration status is collected only for five infectious diseases and operationalization varies. For TB (country of birth) and HIV (country of origin) a foreign origin was more frequent than for syphilis (country of origin); namely 46, 30 and 13 % of cases with available information, respectively. In all three examples, there are indications of risk profiles that are specific for particular groups of migrants.DiscussionA standardization of indicators of migration in infectious disease surveillance is important to enhance data comparability between diseases and pathogens as well as across countries. Routine surveillance already partly allows migration sensitive analyses, yet further research is needed to guide interpretation of the complex relationship between migration and infectious diseases and plan public health measures adequately.BACKGROUND Migration is an important factor impacting on infectious disease epidemiology. The timely identification of groups at risk and prevention needs resulting from migration is indispensable to adequately design and implement public health measures. It remains to be assessed to which extent surveillance data for notifiable diseases can directly generate meaningful migration-specific information. OBJECTIVES The objectives of this study are to review indicators of migration background utilized in the German infectious disease surveillance, as well as to assess their limitations. METHODS We describe the indicators of migration used for mandatorily notifiable diseases and pathogens and their legal basis in the Protection against Infection Act and conduct a descriptive analysis of surveillance data for tuberculosis (TB), HIV and syphilis from 2002-2013. RESULTS Migration status is collected only for five infectious diseases and operationalization varies. For TB (country of birth) and HIV (country of origin) a foreign origin was more frequent than for syphilis (country of origin); namely 46, 30 and 13% of cases with available information, respectively. In all three examples, there are indications of risk profiles that are specific for particular groups of migrants. DISCUSSION A standardization of indicators of migration in infectious disease surveillance is important to enhance data comparability between diseases and pathogens as well as across countries. Routine surveillance already partly allows migration sensitive analyses, yet further research is needed to guide interpretation of the complex relationship between migration and infectious diseases and plan public health measures adequately.

Knowledge, Attitude, Behavior, and Practices Regarding HIV, Viral Hepatitis, and Sexually Transmitted Infections Among Migrants From Sub-Saharan Africa Living in Germany: A Multicenter Survey Protocol

Background Migration has an impact on the epidemiology of viral hepatitis B and C (HEP) and HIV in Germany; migrants from sub-Saharan Africa (MisSA) in Germany are disproportionally affected by HIV. In the last 10 years, a total of 10%-15% of all newly diagnosed HIV cases were among MisSA; 20%-30% of them acquired HIV in Germany. Prevalence of HEP among MisSA in Germany is unknown, but Western Africa, from where most MisSA in Germany originate, reports the highest prevalence of hepatitis B worldwide. There is limited information on knowledge, attitudes, behaviors, and practices (KABP) regarding HIV, HEP, and sexually transmitted infections (STIs), as MisSA are not reached with surveys targeting the general population. Objective Our objective was to determine the HIV, HEP, and STI information and prevention needs of MisSA in Germany. Methods We conducted a multicenter, cross-sectional, KABP survey regarding HIV, HEP, and STIs among MisSA living in Germany using convenience sampling. The study design was developed as a community-based participatory health research (CBPHR) project; HIV/STI-prevention specialists, key persons from MisSA communities, and HIV/STI researchers were involved in all steps of the research process. Trained peer researchers recruited participants in six study cities. Potential modes of survey administration were interview or self-completion, and the questionnaire was available in English, French, and German. Questions on knowledge about HIV, HEP, and STIs were presented as true statements; participants were asked if they had known the information before. Focus groups with MisSA were conducted to interpret results. Data collection took place from October 2014 to November 2016. Results Recruitment by peer researchers concluded with 3040 eligible participants. Data collection was completed in November 2016. We are currently analyzing the quantitative data and qualitative data from focus groups. We are conducting working group meetings to discuss the results in the respective study cities and to evaluate the application of participatory health research in epidemiological studies. First results are expected by the end of 2017. Conclusions Working with peer researchers to collect data allowed accessibility to a diverse sample of MisSA and, particularly, allowed us to reach vulnerable subgroups, such as MisSA without legal status. The ability to access hard-to-reach groups is one of the big advantages of CBPHR. The active inclusion of the persons under study in the design of the study resulted in higher acceptance and ownership of the research project in the target community; this ultimately lead to better quality of collected data. Furthermore, the participation of MisSA in the development of study design and data collection assures a better understanding of the interests, needs, and living conditions of this group.

Impact of HIV knowledge and stigma on the uptake of HIV testing – Results from a community-based participatory research survey among migrants from sub-Saharan Africa in Germany

Background In 2015, 3,674 new HIV diagnoses were notified in Germany; 16% of those newly diagnosed cases originated from sub-Saharan Africa (sSA). One quarter of the newly diagnosed cases among migrants from sSA (MisSA) are notified as having acquired the HIV infection in Germany. In order to reach MisSA with HIV testing opportunities, we aimed to identify which determinants influence the uptake of HIV testing among MisSA in Germany. Methods To identify those determinants, we conducted a quantitative cross-sectional survey among MisSA in Germany. The survey was designed in a participatory process that included MisSA and other stakeholders in HIV-prevention. Peer researchers recruited participants to complete standardized questionnaires on HIV knowledge and testing. We conducted multivariable analyses (MVA) to identify determinants associated with ever having attended voluntary HIV testing; and another MVA to identify determinant associated with having had the last voluntary HIV test in Germany. Results Peer researchers recruited 2,782 participants eligible for inclusion in the MVA. Of these participants, 59.9% (1,667/2,782) previously had an HIV test. For each general statement about HIV that participants knew prior to participation in the study, the odds of having been tested increased by 19% (OR 1.19; 95%-CI: 1.11–1.27). Participants reporting that HIV is a topic that is discussed in their community had 92% higher odds of having been tested for HIV (OR 1.92; 95%-CI: 1.60–2.31). Migrants living in Germany for less than a year had the lowest odds of having had their last HIV test in Germany (OR 0.17; 95%-CI: 0.11–0.27). Additionally, MisSA 18 to 25 years (OR 0.55; 95%-CI: 0.42–0.73) and participants with varied sexual partners and inconsistent condom use (OR 0.75; 95%-CI: 0.44–0.97) had significantly lower odds of having had their last HIV test in Germany. Discussion Through participatory research, we were able to show that knowledge about HIV and discussing HIV in communities increased the odds of having attended HIV testing among MisSA. However, recent migrants and young sexually active people are among the least reached by testing offers in Germany. Community-based interventions may present opportunities to reach such migrants and improve knowledge and increase discussion about HIV.

Migrationshintergrund in der infektionsepidemiologischen Surveillance in Deutschland@@@Migration and infectious disease surveillance in Germany: Analysen am Beispiel Tuberkulose, HIV und Syphilis@@@Analyses of Tuberculosis, HIV and Syphilis surveillance data

ZusammenfassungHintergrundMigration beeinflusst die Epidemiologie von Infektionskrankheiten. Sich daraus ergebende Risikogruppen und Präventionsbedarfe zu identifizieren, ist Grundlage für eine adäquate Gestaltung von Public-Health-Maßnahmen. Es stellt sich die Frage, inwieweit sich migrationsspezifische Informationen hierfür direkt aus der infektionsepidemiologischen Surveillance ableiten lassen.Ziel der ArbeitZiel ist eine systematische Darstellung von Indikatoren zur Operationalisierung des Migrationshintergrundes in der infektionsepidemiologischen Surveillance in Deutschland sowie die Einschätzung bestehender Einschränkungen.MethodikFür meldepflichtige Krankheiten bzw. Erregernachweise werden die jeweils erhobenen Indikatoren für Migration und deren Grundlage im Infektionsschutzgesetz dargestellt. Für Tuberkulose (TB), HIV und Syphilis werden Meldedaten für 2002–2013 deskriptiv analysiert.ErgebnisseBei fünf Infektionskrankheiten wurden – unterschiedlich operationalisiert – Informationen zum Migrationshintergrund erhoben. Bei TB (Geburtsland) und HIV (Herkunftsland) war eine nicht-deutsche Herkunft deutlich häufiger als bei Syphilis (Herkunftsland) mit 46, 30 bzw. 13 % der Fälle mit entsprechenden Angaben. Bei allen drei betrachteten Infektionskrankheiten ergaben sich Hinweise auf migrationsspezifische Risikoprofile.DiskussionEinheitliche Indikatoren für Migration in der infektionsepidemiologischen Surveillance würden die internationale und erregerübergreifende Vergleichbarkeit der Daten ermöglichen. Die Surveillance erlaubt aktuell teilweise migrationssensible Analysen, jedoch bedarf es zusätzlicher Studien, um die komplexen Zusammenhänge von Migration und Infektionskrankheiten richtig interpretieren und Public-Health-Maßnahmen bedarfsgerecht gestalten zu können.AbstractBackgroundMigration is an important factor impacting on infectious disease epidemiology. The timely identification of groups at risk and prevention needs resulting from migration is indispensable to adequately design and implement public health measures. It remains to be assessed to which extent surveillance data for notifiable diseases can directly generate meaningful migration-specific information.ObjectivesThe objectives of this study are to review indicators of migration background utilized in the German infectious disease surveillance, as well as to assess their limitations.MethodsWe describe the indicators of migration used for mandatorily notifiable diseases and pathogens and their legal basis in the Protection against Infection Act and conduct a descriptive analysis of surveillance data for tuberculosis (TB), HIV and syphilis from 2002–2013.ResultsMigration status is collected only for five infectious diseases and operationalization varies. For TB (country of birth) and HIV (country of origin) a foreign origin was more frequent than for syphilis (country of origin); namely 46, 30 and 13 % of cases with available information, respectively. In all three examples, there are indications of risk profiles that are specific for particular groups of migrants.DiscussionA standardization of indicators of migration in infectious disease surveillance is important to enhance data comparability between diseases and pathogens as well as across countries. Routine surveillance already partly allows migration sensitive analyses, yet further research is needed to guide interpretation of the complex relationship between migration and infectious diseases and plan public health measures adequately.BACKGROUND Migration is an important factor impacting on infectious disease epidemiology. The timely identification of groups at risk and prevention needs resulting from migration is indispensable to adequately design and implement public health measures. It remains to be assessed to which extent surveillance data for notifiable diseases can directly generate meaningful migration-specific information. OBJECTIVES The objectives of this study are to review indicators of migration background utilized in the German infectious disease surveillance, as well as to assess their limitations. METHODS We describe the indicators of migration used for mandatorily notifiable diseases and pathogens and their legal basis in the Protection against Infection Act and conduct a descriptive analysis of surveillance data for tuberculosis (TB), HIV and syphilis from 2002-2013. RESULTS Migration status is collected only for five infectious diseases and operationalization varies. For TB (country of birth) and HIV (country of origin) a foreign origin was more frequent than for syphilis (country of origin); namely 46, 30 and 13% of cases with available information, respectively. In all three examples, there are indications of risk profiles that are specific for particular groups of migrants. DISCUSSION A standardization of indicators of migration in infectious disease surveillance is important to enhance data comparability between diseases and pathogens as well as across countries. Routine surveillance already partly allows migration sensitive analyses, yet further research is needed to guide interpretation of the complex relationship between migration and infectious diseases and plan public health measures adequately.

P3.165 Establishing Second Generation HIV/STI-surveillance For Migrants from Sub-Saharan Africa in Germany - A Participatory Process

Background Migrants from sub-Saharan Africa (MisSA) are a relevant sub-group for HIV-transmission in Germany. 10–15% of all newly diagnosed cases are MisSA, and approximately one third acquired HIV in Germany. Diagnosis is often at a late clinical stage of HIV-infection, potentially due to barriers to HIV-testing or health care in general. There is limited information on prevalence of STIs and on knowledge, attitudes, behaviours and practises (KABP) regarding sexual health. To gain a deeper understanding of MisSA’s HIV/STI-prevention needs a research process was initiated. Methods An expert meeting took place to define specific research needs as well as a research approach. Experts were defined as persons working in HIV/STI-prevention with MisSA, key-persons from MisSA-communities and HIV/STI-researchers. A working group was established to draught a potential study design for a KABP-survey with MisSA. Recommendations of the working group were appraised by four focus groups with MisSA in different cities. Results The following guidelines for the research process were established: The research process will be participatory and MisSA have to be involved in all stages. All decisions will be evaluated by community members and an advisory board. The MisSA-community should benefit from the research. The suggested study design was a multi-centre KABP-study on sexual health. Participants will be recruited by trained peer researchers. Optional HIV/STI-testing will be offered to participants. Questionnaires will be developed in a participatory approach and be available in multiple languages depending on the respective population of MisSA. Focus group results generally supported the suggested research design. A detailed analysis of focus group discussions is still ongoing. Conclusion To conduct HIV/STI-research that is meaningful to MisSA, it is crucial to involve community partners in the research process. This will help to address the specific needs of MisSA and also assure a better reception of the study within the community.