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. 2023 Jul:117:104073.
doi: 10.1016/j.drugpo.2023.104073. Epub 2023 May 22.

A new outbreak of HIV infection among people who inject drugs during the COVID-19 pandemic in Greece

Vana Sypsa  1 , Sotirios Roussos  2 , Efrossini Tsirogianni  3 , Chrissa Tsiara  4 , Dimitra Paraskeva  4 , Theofilos Chrysanthidis  5 , Dimitrios Chatzidimitriou  6 , Evaggelia Papadimitriou  6 , Dimitrios Paraskevis  2 , Ioannis Goulis  7 , George Kalamitsis  8 , Angelos Hatzakis  9
Affiliations

A new outbreak of HIV infection among people who inject drugs during the COVID-19 pandemic in Greece

Vana Sypsa et al. Int J Drug Policy. 2023 Jul.

Abstract

Background: Multiple HIV outbreaks have been recorded among people who inject drugs (PWID) since 2010. During an intervention for PWID in 2019-2021 in Thessaloniki, Greece, an increasing number of HIV cases was documented. Here, we provide an analysis of this new outbreak.

Methods: ALEXANDROS was a community-based program and participation included interviewing, rapid HIV/HCV tests, counselling and linkage to care. PWID were recruited through Respondent-Driven Sampling (RDS) in five sampling rounds. Crude and RDS-weighted HIV prevalence estimates were obtained. HIV incidence was estimated from data on 380 initially seronegative PWID with at least two tests. Multivariable Cox proportional hazards model was used to assess risk factors for HIV seroconversion.

Results: In total, 1,101 PWID were recruited. At first participation, 53.7% were current PWID, 20.1% homeless, 20.3% on opioid substitution treatment and 4.8% had received syringes in the past 12 months. HIV prevalence (95% CI) was 7.0% (5.6-8.7%) and an increasing trend was observed over 2019-2021 (p = 0.002). Two-thirds of the cases (67.5%) were new diagnoses. HIV incidence was 7.0 new infections/100 person-years (95% CI:4.8-10.2). Homelessness in the past 12 months (HR:2.68; 95% CI:1.24-5.81) and receptive syringe sharing (HR:3.86; 95% CI:1.75-8.51) were independently associated with increased risk of seroconversion. By the end of the program, 67.3% of the newly diagnosed cases initiated antiretroviral treatment.

Conclusions: A new HIV outbreak among PWID was documented in Greece during the COVID-19 pandemic with homelessness and syringe sharing being associated with increased risk of HIV acquisition. Peer-driven programs targeting the population of high-risk underserved PWID can be used to early identify emerging outbreaks and to improve linkage to HIV care.

Keywords: HIV; Outbreak; PWID; Respondent-driven sampling.

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Conflict of interest statement

Declarations of Interest GK has received grants from Gilead. DParaskevis has received research or travel grants from Gilead Sciences, Glaxo Welcome, and Merck. AH has received unrestricted grants from AbbVie, Gilead, and MSD. He is Co-Chair of the Hepatitis B & C Public Policy Association funded by AbbVie, Gilead, and MSD. VS has received grants from Gilead and AbbVie. She has served as a lecturer for Gilead and AbbVie. IG has received grants from Gilead. He has served as a lecturer for Gilead and AbbVie. TC has received grants from AbbVie, Gilead, and MSD. SR, DParaskeva, CT, DC, EP and ET have nothing to declare

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