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Estonia: overlaping epidemics of IDU and HIV

Estonia: overlaping epidemics of IDU and HIV. Anneli Uusküla MD, MS, PhD Department of Public Health Department of Dermatology University of Tartu Estonia. EPIDEMIC OUTLOOK. Several overlapping epidemics Drug Use HIV/AIDS Other infectious diseases (t uberculosis , HBV, HCV)

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Estonia: overlaping epidemics of IDU and HIV

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  1. Estonia: overlaping epidemics of IDU and HIV Anneli Uusküla MD, MS, PhD Department of Public Health Department of Dermatology University of Tartu Estonia

  2. EPIDEMIC OUTLOOK Several overlapping epidemics • Drug Use • HIV/AIDS • Other infectious diseases (tuberculosis, HBV, HCV) • [Sexual risk behavior?] Epidemic drivers act regionally and can best be addressed at regional level • Economic and political migration • Trafficking in drugs and people • Sex Work • Prisons Adapted from: Novotny T, 2004

  3. Majority of HIV incidences are related to injection drug use (IDU) • Heterosexual transmission: • High rates of sex risk behavior and inadequate knowledge regarding prevention of disease transmission (Wilson T, 2002) may indicate a risk for an impending sexually and STI driven HIV epidemic. • An estimated 1.1% of the young adult population (aged 15-49) in Estonia are living with HIV infection(UNAIDS, 2003) Adapted from: Lowndes CM, 2003

  4. WOMEN AMONG NEW HIV + CASES http://www.ltkh.ee/?id=1070

  5. MOLECULAR EPIDEMIOLOGY • The Estonian HIVoutbreak was found to be caused by simultaneous introduction of two strains: • minor subtype: A strain verysimilar to the Eastern European subtype A strain (~ 8% of cases), • major strain: CRF06-cpx strain (77% of cases), most closely related to thepreviously described only from African countries • The variability in the two clusters was very low, suggesting point source introductions (Zetterberg V, 2004; Adojaan M, 2005)

  6. OVERLAPPING EPIDEMICSInjection drug use

  7. [INJECTION] DRUG USE Police. State agency of statistics

  8. IDU PREVALENCE Capture–recapture method: administrative data sources • State HIV reference laboratory • IDU definition = HIV positive test results undercategory 102: user of illicit drugs • Police • IDU definition = individuals arrested for the possession of illegal drugs in small quantities • Estonian health insurance fund (EHIF)drug overdose data • IDU definition = life threatening non-fatal drug overdose, ICD-10: T40 T40.0, T40.1, T40.2, F11.0 • EHIF drug treatment data • IDU definition = drug treatment, ICD-10F11.1-F11.9 Uusküla A. 2006

  9. CRC estimates [Estonia, 2004] Uusküla A. 2006

  10. OVERLAPPING EPIDEMICSHIV

  11. By July 2006 the cumulative number of HIV+ cases was 5420 • 0.8% of the adult population (15-49) • Incidence of 550 new infections per million population in 2005

  12. IDU / HIV STUDIES [Estonia] * ETF Estonian Science Foundation

  13. IDU / HIV STUDIES [cont.] 1 Last 90 days; 2 Last 28 days;3 MAK= liquid derivate of opium poppy straw

  14. IDU / HIV STUDIES [cont.] 1HIV incidence estimation assumptions among persons who recently began injecting drugs 1) all of them were HIV seronegative when they began injecting, 2) the HIV seropositives became infected at the midpoint between beginning to inject and the time of blood sample collection, and 3) no HIV seropositives are lost to AIDS or other causes among the new injectors

  15. CRDF FUNDED RESEARCH • August 2004: ESXO-1057-TR-04 “Collaborative response to tackle HIV epidemic in Baltics: international and multidisciplinary workshop to prioritize areas and methods of research”

  16. CRDF FUNDED RESEARCH July 2006: Project agreement ESXO-2722-TA-06 • US PI: Louise-Anne McNutt, SUNY at Albany • Jack Dehovitz, SUNY Downstate • Tracey Wilson, SUNY Downstate • Eurasian PI: Anneli Uuskula, University of Tartu, Estonia • Ave Talu, National institute for health development • Krista Fischer, University of Tartu • Igor Sobolev, NGO Convictus, Tallinn • Aleksander Laanemann, NGO MAS, Kohtla-Jarve

  17. CRDF FUNDED RESEARCH July 2006: ESXO-2722-TA-06 Sex partners of IDUs both non-/IDU are at substantial risk for HIV, particularly if they engage in sexual intercourse without using condoms, and / or share needles with sexual partners. The objectives of the study: • to describe IDUs HIV-risk (injecting, sexual) behavior with sex partners (primary and other); • to assess HIV prevalence among IDUs and their sexual partners; • to conduct a short educational intervention with pre and post test.

  18. CRDF FUNDED RESEARCH July 2006: ESXO-2722-TA-06 Study design: (1) Rapid assessment (2) Quantiative study 2.1. Cross/sectional study 2.2 Recruitment: IDUs (index cases) will be recruited using respondent driven sampling, and will thereafter requested to bring in their sexual partners. 2.3 Measurements: (i) risk (IDU, sexual) behavior survey; (ii) biological sample collection (HIV ab testing); (iii) post intervention test.

  19. Thank you

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