20th International AIDS Conference - Melbourne, Australia


THAC0402 - Oral Abstract

Trends in HIV-1 incidence during an outbreak among injecting drug users in Athens, Greece: results of a serobehavioral survey (ARISTOTLE program)

Presented by Vana Sypsa (Greece).

V. Sypsa1, G. Nikolopoulos2, D. Paraskevis1, A. Katsoulidou1, M. Kantzanou1, M. Psichogiou3, A. Pharris4, L. Wiessing5, M. Donoghoe6, S. Friedman7, D. Des Jarlais8, M. Malliori3, A. Hatzakis1

1University of Athens, Dept. of Hygiene, Epidemiology and Medical Statistics, Athens, Greece, 2IAS/NIDA Fellow, Hellenic Center for Diseases Control and Prevention, Athens, Greece, 3University of Athens, Athens, Greece, 4European Centre for Disease Prevention and Control, Stockholm, Sweden, 5European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal, 6World Health Organization-Regional Office for Europe, Copenhagen, Denmark, 7National Development and Research Institutes, New York, United States, 8Beth Israel Medical Center, New York, United States

Background: The “ARISTOTLE” program was implemented in response to the HIV-1 outbreak documented among injecting drug users (IDUs) in Athens, Greece, in 2011. The serobehavorial data collected during the program have been used to assess the trends in HIV-1 incidence and discuss the impact of the intervention.
Methods: During August 2012-December 2013, respondent driven sampling was used to recruit IDUs in Athens, Greece. We conducted five rounds recruiting approximately 1,400 IDUs per round. In total, 3,320 unique IDUs participated; approximately half of them participated in multiple rounds. The program consisted of collection of behavioral data, access to provision of prevention materials and information, HIV testing and linkage to ART and opioid substitution treatment (OST). Trends in HIV-1 incidence during the program were assessed both by assessing seroconversions among IDUs with multiple samples (N=1517) and by testing HIV(+) samples with LAg-Avidity EIA to identify recent infections.
Results: During the program, there were 45 seroconversions. It is estimated that HIV-1 incidence declined by 75%-90%. During the same period, there was a scale-up of OST services in Athens. The proportion of participants who reported being on OST increased from 10.4% in round A to 20.7% in round E. In all rounds, OST coverage was higher among IDUs who had participated in ARISTOTLE in the past as compared to first-time participants (e.g. in round E: 22.3% vs. 15.1%, respectively, p=0.006). During that period, there was no scale-up of needle and syringe programs (% of IDUs who reported having received free syringes in the previous 30 days: 50.7% in round A vs. 36.8% in round E, p< 0.001).
Conclusions: During ARISTOTLE program, a large decline in HIV-1 incidence was observed. Multiple factors may have played a role including scale-up of HIV-testing and OST, and reductions in risk behavior as IDUs learned about the epidemic. The program was specifically designed to promote these factors and achieved a high coverage of the target population. Although separating out the effect of ARISTOTLE is not straightforward, data corroborate its impact on preventing transmission.

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