Ivana Božičević

Slowing of the HIV epidemic in Ukraine: Evidence from case reporting and key population surveys, 2005-2012

Background Ukraine developed Europes most severe HIV epidemic due to widespread transmission among persons who inject drugs (PWID). Since 2004, prevention has focused on key populations; antiretroviral therapy (ART) coverage has increased. Recent data show increases in reported HIV cases through 2011, especially attributed to sexual transmission, but also signs of potential epidemic slowing. We conducted a data triangulation exercise to better analyze available data and inform program implementation. Methods and Findings We reviewed data for 2005 to 2012 from multiple sources, primarily national HIV case reporting and integrated biobehavioral surveillance (IBBS) studies among key populations. Annually reported HIV cases increased at a progressively slower rate through 2011 with recent increases only among older, more immunosuppressed individuals; cases decreased 2.7% in 2012. Among women <25 years of age, cases attributed to heterosexual transmission and HIV prevalence in antenatal screening declined after 2008. Reported cases among young PWID declined by three-fourths. In 2011, integrated biobehavioral surveillance demonstrated decreased HIV prevalence among young members of key populations compared with 2009. HIV infection among female sex workers (FSW) remains strongly associated with a personal history of injecting drug use (IDU). Conclusions This analysis suggests that Ukraines HIV epidemic has slowed, with decreasing reported cases and older cases predominating among those diagnosed. Recent decreases in cases and in prevalence support decreased incidence among young PWID and women. Trends among heterosexual men and men who have sex with men (MSM) are less clear; further study and enhanced MSM prevention are needed. FSW appear to have stable prevalence with risk strongly associated with IDU. Current trends suggest the Ukrainian epidemic can be contained with enhanced prevention among key populations and increased treatment access.

Urine-based testing for Chlamydia trachomatis among young adults in a population-based survey in Croatia : feasibility and prevalence

BackgroundWe assessed the feasibility of collecting urine samples for testing on genital Chlamydia trachomatis infection in a population-based survey, and prevalence of this infection among young people aged 18-25 in Croatia. In Croatia, as in the other countries of Eastern Europe, there is a lack of data on prevalence of C trachomatis in the general population, including young adults.MethodsWe sampled participants using a nationally representative, multi-stage stratified probability sample of young men and women. Detection of C trachomatis DNA in urine samples was performed by using a real-time PCR assay COBAS® TaqMan® CT Test, v2.0.ResultsOverall, 1005 young adults participated in the behavioural part of the survey, and 27.9% men and 37.5% women who were sexually experienced agreed to provide urine samples for testing on C trachomatis. Using multivariate analysis, women were significantly more likely to provide urine samples than men (aOR = 1.53, 95% CI 1.14-2.06) as were those who reported no condom use at last intercourse (aOR = 1.95, 95% CI 1.44-2.62). Prevalence of C trachomatis infection among those who were sexually experienced was 7.3% in men and 5.3% in women.ConclusionsPopulation-based surveys that use probabilistic sampling are a feasible way to obtain population estimates of C trachomatis prevalence among young adults in Croatia, but it is challenging to obtain an adequate response rate. The prevalence of C trachomatis among young adults in Croatia found in this study was higher than that found in other European countries with similar survey response rates.