Stine Nielsen

Concordance between self-reported and measured HIV and hepatitis C virus infection status among people who inject drugs in Germany

BackgroundPeople who inject drugs (PWID) are disproportionately affected by both HIV and hepatitis C infection (HCV). Awareness of infection status is essential to ensure linkage to appropriate healthcare for those infected, who need treatment and regular follow-up, as well as for uninfected individuals, who need access to targeted testing and counselling services. In this paper we compare self-reported HIV and HCV status with serological markers of infection among PWID recruited through respondent driven sampling.MethodsFrom 2011 through 2014, biological and behavioural data was collected from 2,077 PWID in Germany. Dried blood spots from capillary blood samples were collected and screened for HCV antibodies, HCV RNA and HIV-1/-2 antibodies. HIV reactive samples were confirmed by Western blot.ResultsLaboratory testing revealed that 5 % were infected with HIV and 81 % were aware of being infected. Chronic HCV infection was detected in 41 % of the participants, 2 % had an acute HCV infection, 22 % had a cleared infection, and 34 % were unexposed to HCV. The concordance between self-reported and measured HCV status was lower than for HIV, with 73 % of those with chronic HCV infection being aware of their infection.ConclusionsWe found a relatively high awareness of HIV and HCV infection status among PWID. Nevertheless, access to appropriate testing, counselling and care services targeted to the needs of PWID should be further improved, particularly concerning HCV.Trial registrationEthical approval was received from the ethics committee at the medical university of Charité, Berlin, Germany in May 2011 and with an amendment approved retrospectively on 19/11/2012 (No EA4/036/11). The German Federal Commissioner for Data Protection and Freedom of Information approved the study protocol retrospectively on 29/11/2012 (III-401/008#0035).

Angebote der Beratungsstellen zu sexuell übertragbaren Infektionen und HIV und diesbezügliche Datenerhebung in deutschen Gesundheitsämtern im Jahr 2012

In Germany, local health authorities (LHA) offering counseling and testing for sexually transmitted infections or human immunodeficiency virus (STI/HIV) routinely collect data. The studys objective was to get an overview of the activities and data collected by the LHA so as to investigate the possibility of harvesting these data at a national level. We performed a cross-sectional survey among all LHA with STI/HIV counseling and testing by using an electronic questionnaire with information on the type of STI/HIV services offered, groups reached, and data collected. Among the 374 LHA, 250 (67 %) responded. Half of them offered common counseling for STI and HIV; 20% conducted outreach work among sex workers and other groups. While HIV tests were available in all LHA, 62 and 56 % also offered hepatitis B and C testing, respectively. Other available tests included syphilis (56 %), gonorrhea (28 %), and chlamydia (27 %). Only 13 % of LHA offer gynecological examinations. While 98 % of LHA reported collecting data, two thirds of these records were paper-based. Although 77 % analyzed their data, 58 % reported their data to the regional level. Standardization of the STI/HIV data seems feasible for most of the LHA. This would allow annual statistics to be compiled at municipal, regional, and national levels.

What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease?

We performed a systematic literature review to assess the effectiveness of chemoprophylaxis for contacts of sporadic cases of invasive meningococcal disease (IMD) in educational settings. No studies directly compared IMD risk in contacts with/without chemoprophylaxis. However, compared to the background incidence, an elevated IMD risk was identified in settings without a general recommendation for chemoprophylaxis in pre-schools [pooled risk difference (RD) 58·2/10⁵, 95% confidence interval (CI) 27·3-89·0] and primary schools (pooled RD 4·9/10⁵, 95% CI 2·9-6·9) in the ~30 days after contact with a sporadic IMD case, but not in other educational settings. Thus, limited but consistent evidence suggests the risk of IMD in pre-school contacts of sporadic IMD cases is significantly increased above the background risk, but lower than in household contacts (pooled RD for household contacts with no chemoprophylaxis vs. background incidence: 480·1/10⁵, 95% CI 321·5-639·9). We recommend chemoprophylaxis for pre-school contacts depending on an assessment of duration and closeness of contact.

STI tests and proportion of positive tests in female sex workers attending local public health departments in Germany in 2010/11

BackgroundIn Germany, local public health departments (LPHD) are required to offer low-threshold access to confidential counselling and testing for sexually transmitted infections (STI) for sex workers. We collected data from LPHD in Germany to estimate the number of performed STI tests and the proportion of positive STI tests among attending female sex workers (FSW) in order to formulate recommendations for improving STI testing and care for FSW in Germany.MethodsWe recruited LPHD across Germany to collect aggregated data on attending FSW between January 2010 and March 2011. Baseline characteristics, the number of attending FSW, STI tests (HIV, Chlamydia trachomatis, Neisseria gonorrhoea, syphilis and Trichomonas vaginalis) and the number of positive results were provided by participating LPHD. We described the number of STI tests per FSW visit and the proportion of positive test results, including interquartile range (IQR). We tested whether baseline characteristics of LPHD were associated with the proportion of positive test results.ResultsOverall, 28 LPHD from 14 of the 16 federal states reported 9284 FSW visits over the study period, with a median of 188 FSW visits (IQR 45–440) per LPHD. Overall, a median of 77.1% (IQR 60.7–88.0) of visiting FSW received a test for Neisseria gonorrhoea, followed by HIV (66.0%, IQR 47.9–86.8), Chlamydia trachomatis (65.4%, IQR 50.7–83.6) and syphilis (61.6, IQR 48.6–78.6). In total, 22,914 STI tests were performed. The proportion of positive tests was 3.1% (IQR 1.3–4.8), with the highest proportion of positive tests for Chlamydia trachomatis (6.8%, IQR 2.5–10.4), followed by Neisseria gonorrhoea (3.2%, IQR 0.0–5.3), Trichomonas vaginalis (3.0%, IQR 0.0–15.4), syphilis (1.1%, IQR 0.0–1.3) and HIV (0.2%, IQR 0.0–0.4). The proportion of positive tests varied between 0 and 13.9% between LPHD, with a higher variation of proportion of positive tests in LPHD with a smaller number of reported STI tests.ConclusionsParticipating LPHD varied in terms of performed STI tests and FSW visits. The proportion of positive STI tests was low, but varied between LPHD. This variation likely reflects different testing strategies. Existing testing guidelines should be used by all LPHD to ensure high quality care for FSW.

[Activities related to STIs and HIV and data collection in German local health authorities, 2012 : can we harvest the data?].

In Germany, local health authorities (LHA) offering counseling and testing for sexually transmitted infections or human immunodeficiency virus (STI/HIV) routinely collect data. The studys objective was to get an overview of the activities and data collected by the LHA so as to investigate the possibility of harvesting these data at a national level. We performed a cross-sectional survey among all LHA with STI/HIV counseling and testing by using an electronic questionnaire with information on the type of STI/HIV services offered, groups reached, and data collected. Among the 374 LHA, 250 (67 %) responded. Half of them offered common counseling for STI and HIV; 20% conducted outreach work among sex workers and other groups. While HIV tests were available in all LHA, 62 and 56 % also offered hepatitis B and C testing, respectively. Other available tests included syphilis (56 %), gonorrhea (28 %), and chlamydia (27 %). Only 13 % of LHA offer gynecological examinations. While 98 % of LHA reported collecting data, two thirds of these records were paper-based. Although 77 % analyzed their data, 58 % reported their data to the regional level. Standardization of the STI/HIV data seems feasible for most of the LHA. This would allow annual statistics to be compiled at municipal, regional, and national levels.

P1-S2.07 STI rates and risk factors among female sex workers attending STI testing sites in Germany, January–December 2010

Background Epidemiological studies on female sex workers (FSW) in Europe are limited. Since January 2010, selected German local health departments (LHD) offering STI testing services, have collected test results and behavioural data among FSW attendees. Using the data collected from January to December 2010, we asses STI positivity rates and identify risk factors for acquiring STIs among FSW tested at LHDs in Germany. Methods 30 LHDs throughout Germany voluntary submit quarterly reports with the number of FSW tested and found positive for any of the following STIs—HIV, Chlamydia (CT), Gonorrhoea (GC), Syphilis, Trichomoniasis (Tvag) and bacterial vaginosis (BV). Physicians provide basic demographic data, medical history relating to STI and information on where the FSW meet clients. In a separate questionnaire FSW provide information on for example, number of clients per week, sexual practices and drug use. Data for the in total 123 variables is consolidated and validated at the Robert Koch Institute. Uni- and multi-variable logistic regressions were used to identify relevant risk factors for being infected with CT, GC, Syphilis and/or Tvag (STI positive) and OR with 95% CIs were calculated. Results In 2010, 6675 FSW were seen and a total of 19 557 STI tests were performed. Physicians provided background data for 1142 (17%) of all FSW seen and of these 399 provided additional behavioural data. Median age was 30 (range—15–77 years), 72% were born outside Germany. Overall 7% of all tests were positive. The most common diagnoses were—BV (32.1% of 2770 tests), CT (6.8% of 3807), Tvag (3.3% of 2529) and GC (3.0% of 4223). 1.3% (of 3191) were positive for Syphilis and 0.2% (of 3037) HIV positive. Risk factors associated with a higher chance of testing STI positive included—poor knowledge of German language, OR=3.6 (2.5 to 5.0), meeting clients on the street, OR=3.5 (2.3 to 5.3) and increased number of clients per week. The risk of STI decreased with year of age, OR=0.95 (0.93 to 0.97), and was lower among FSW meeting clients on the internet, OR=0.5 (0.3 to 0.7) and FSW with health insurance, OR=0.4 (0.3 to 0.5) see Abstract P1-S2.07 Table 1. Abstract P1-S2.07 Table 1 Association between selected risk factors and being “STI positive” (testing positive for Chlamydia, Gonorrhoea, Syphilis and/or Trichomoniasis) among female sex workers attending STI testing sites in Germany, 2010 (N=1142) STI positive (Chlamydia, Gonorrhoea, Syphilis and/or Trichomoniasis), N=233 NTotal NPositive OR (95% CI) p Value German language  Fluent (R) 437 59 1  Medium 301 34 0.82 (0.52 to 1.30) 0.376  Very poor / None 375 135 3.60 (2.55 to 5.10) 0.000 Age  Range 15–77 years 1142 233 0.95 (0.93 to 0.97) 0.000 Health insurance  No (R) 450 138 1  Yes 648 87 0.35 (0.26 to 0.47) 0.000 Meet clients on the street  No (R) 995 173 1  Yes 101 43 3.52 (2.30 to 5.40) 0.000 Meet clients through internet or adds  No (R) 908 195 1 0.002  Yes 188 21 0.46 (0.28 to 0.74) Number of clients per week  Range 1–75 270 37 1.02 (1.00 to 1.04) 0.028 Explanatory factor included as continuous variable in logistic regression. (R), Reference group. Conclusions STI positivity rates, especially for HIV and syphilis seem relatively low among the FSW attending STI testing sites in Germany in 2010. FSW are a heterogeneous group and public health efforts should target those most at risk such as the young, migrant, uninsured and street-based women who sell sex.

A large proportion of people who inject drugs are susceptible to hepatitis B: Results from a bio-behavioural study in eight German cities

BACKGROUND People who inject drugs (PWID) are at high risk of hepatitis B virus (HBV) infection by sharing needles and drug use paraphernalia. In Germany, no routine surveillance of HBV prevalence and vaccination coverage among PWID exists. METHODS Socio-demographic and behavioural data were collected between 2011 and 2014 through face-to-face interviews, during a bio-behavioural survey of PWID recruited in eight German cities. Dried blood spots (DBS) prepared with capillary blood were tested for HBV markers. Factors associated with past/current HBV infection and vaccination status were analysed by univariable and multivariable analysis using logistic regression. The validity of self-reported HBV infection and vaccination status was analysed by comparison to the laboratory results. RESULTS Among 2077 participants, the prevalence of current HBV infection was 1.1%, of past HBV infection was 24%, and of vaccine-induced HBV antibodies was 32%. No detectable HBV antibodies were found in 43%. HBV infection status was significantly associated with study city, age, years of injecting, use of stimulants, migration status, and homelessness; HBV vaccination status was significantly associated with study city, age, and level of education. Correct infection status was reported by 71% and correct vaccination status by 45%. CONCLUSIONS HBV seroprevalence among PWID was about five times higher than in the general population in Germany, confirming PWID as an important risk group. Targeted information campaigns on HBV and HBV prevention for PWID and professionals in contact with PWID need to be intensified. Routinely offered HBV vaccination during imprisonment and opioid substitution therapy would likely improve vaccination rates among PWID.

Risk behaviours and viral infections among drug injecting migrants from the former Soviet Union in Germany: Results from the DRUCK-study

BACKGROUND High prevalence of drug use and injection-related risk behaviours have been reported among former Soviet Union (FSU)-migrants. To investigate hepatitis C (HCV) and HIV seroprevalence and related risk behaviours in this subgroup in Germany, we compared first generation FSU-migrants and native Germans using data from a sero-behavioural survey of people who inject drugs (PWID). METHODS Current injectors were recruited using respondent-driven sampling in eight German cities in 2011-2014. Questionnaire-based interviews were conducted and dried blood spots collected and tested for anti-HCV, HCV-RNA, and anti-HIV1/2. Descriptive and multivariable analyses (MVA) were performed. RESULTS A total of 208 FSU-born and 1318 native German PWID were included in the analysis. FSU-migrants were younger than Germans (median age: 33 vs. 39 years), and more often male (83.1% vs. 75.9%, p = 0.022). HCV seroprevalence was 74.5% in FSU-migrants vs. 64.6% in Germans (p = 0.006), HIV seroprevalence was 5.8% and 4.6%, respectively (p = 0.443). The proportion of FSU-migrants reporting injecting-related risk behaviours was higher than among Germans: injecting daily (39.4% vs. 30.2%, p = 0.015), with friends (39.2% vs. 31.2%, p = 0.038), cocaine (32.7% vs. 23.8%, p = 0.044), more than one drug (18.2% vs. 9.6%, p = 0.006), and sharing filters/cookers (35.5% vs. 28.0%, p = 0.045). No statistically significant differences were observed in HIV/HCV testing rates (range: 50.7%-65.6%), opioid substitution treatment (43.9% vs. 50.5%), and access to clean needles/syringes (89.8% vs. 90.3%). In MVA, risk for HCV-infection was increased in male FSU-migrants compared to German males (OR 3.32, p = 0.006), no difference was identified between female FSU-migrants and German females (OR: 0.83, p = 0.633). CONCLUSION Male FSU-migrants were at highest risk of being HCV infected. Therefore, targeted actions are needed to ensure access and acceptance of harm reduction measures, including HCV-testing and -treatment for this subpopulation of PWID.

Angebote der Beratungsstellen zu sexuell übertragbaren Infektionen und HIV und diesbezügliche Datenerhebung in deutschen Gesundheitsämtern im Jahr 2012@@@Activities related to STIs and HIV and data collection in German local health authorities, 2012: Ist eine einheitliche Datensammlung möglich?@@@Can we harvest the data?

In Germany, local health authorities (LHA) offering counseling and testing for sexually transmitted infections or human immunodeficiency virus (STI/HIV) routinely collect data. The studys objective was to get an overview of the activities and data collected by the LHA so as to investigate the possibility of harvesting these data at a national level. We performed a cross-sectional survey among all LHA with STI/HIV counseling and testing by using an electronic questionnaire with information on the type of STI/HIV services offered, groups reached, and data collected. Among the 374 LHA, 250 (67 %) responded. Half of them offered common counseling for STI and HIV; 20% conducted outreach work among sex workers and other groups. While HIV tests were available in all LHA, 62 and 56 % also offered hepatitis B and C testing, respectively. Other available tests included syphilis (56 %), gonorrhea (28 %), and chlamydia (27 %). Only 13 % of LHA offer gynecological examinations. While 98 % of LHA reported collecting data, two thirds of these records were paper-based. Although 77 % analyzed their data, 58 % reported their data to the regional level. Standardization of the STI/HIV data seems feasible for most of the LHA. This would allow annual statistics to be compiled at municipal, regional, and national levels.