Design and baseline findings of a large-scale rapid response to an HIV outbreak in people who inject drugs in Athens, Greece: the ARISTOTLE programme

Abstract

Aims: To (i) describe an intervention implemented in response to the HIV-1 outbreak among people who inject drugs (PWIDs) in Greece (ARISTOTLE programme), (ii) assess its success in identifying and testing this population and (iii) describe socio-demographic characteristics, risk behaviours and access to treatment/prevention, estimate HIV prevalence and identify risk factors, as assessed at the first participation of PWIDs.

Design: A 'seek, test, treat, retain' intervention employing five rounds of respondent-driven sampling.

Setting: Athens, Greece (2012-13).

Participants: A total of 3320 individuals who had injected drugs in the past 12 months.

Intervention: ARISTOTLE is an intervention that involves reaching out to high-risk, hard-to-reach PWIDs ('seek'), engaging them in HIV testing and providing information and materials to prevent HIV ('test') and initiating and maintaining anti-retroviral and opioid substitution treatment for those testing positive ('treat' and 'retain').

Measurements: Blood samples were collected for HIV testing and personal interviews were conducted.

Findings: ARISTOTLE recruited 3320 PWIDs during the course of 13.5 months. More than half (54%) participated in multiple rounds, resulting in 7113 visits. HIV prevalence was 15.1%. At their first contact with the programme, 12.5% were on opioid substitution treatment programmes and the median number of free syringes they had received in the preceding month was 0. In the multivariable analysis, apart from injection-related variables, homelessness was a risk factor for HIV infection in male PWIDs [odds ratio (OR) yes versus no = 1.89, 95% confidence interval (CI) = 1.41, 2.52] while, in female PWIDS, the number of sexual partners (OR for > 5 versus one partner in the past year = 4.12, 95% CI = 1.93, 8.77) and history of imprisonment (OR yes versus no = 2.76, 95% CI = 1.43, 5.31) were associated with HIV.

Conclusions: In Athens, Greece, the ARISTOTLE intervention for identifying HIV-positive people among people who inject drugs (PWID) facilitated rapid identification of a hidden population experiencing an outbreak and provided HIV testing, counselling and linkage to care. According to ARISTOTLE data, the 2011 HIV outbreak in Athens resulted in 15% HIV infection among PWID. Risk factors for HIV among PWID included homelessness in men and history of imprisonment and number of sexual partners in women.

Keywords: HIV outbreak; PWIDs; intervention; prevalence; respondent-driven sampling; risk factors.

Conflict of interest statement

Declaration of interests

None.

© 2015 Society for the Study of Addiction.

Figures

Figure 1

Graphical depiction of the ARISTOTLE programme1 1 created using PaT Plot tool

Figure 2

Map of Athens marked with the areas where people who inject drugs (PWIDs) reported that they live at their first participation in the programme (green circles). The size of the circles is proportional to the number of participants reporting that area. The blue symbol indicates the location of the ARISTOTLE site, where questionnaires and blood samples were collected and coupons were distributed to participants