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

Angelos Hatzakis, Vana Sypsa, Dimitrios Paraskevis, Georgios Nikolopoulos, Chrissa Tsiara, Katerina Micha, Anastasios Panopoulos, Meni Malliori, Mina Psichogiou, Anastasia Pharris, Lucas Wiessing, Marita van de Laar, Martin Donoghoe, Douglas D. Heckathorn, Samuel R. Friedman, Don Des Jarlais

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1453-1467
Number of pages15
JournalAddiction
Volume110
Issue number9
DOIs
StatePublished - Jan 1 2015

Fingerprint

Greece
Disease Outbreaks
HIV
Pharmaceutical Preparations
Opiate Substitution Treatment
Homeless Persons
Sexual Partners
Odds Ratio
Confidence Intervals
HIV Infections
Syringes
Risk-Taking
Population
HIV-1
Counseling
Demography
Interviews
Injections

Keywords

  • HIV outbreak
  • Intervention
  • Prevalence
  • PWIDs
  • Respondent-driven sampling
  • Risk factors

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

Cite this

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. / Hatzakis, Angelos; Sypsa, Vana; Paraskevis, Dimitrios; Nikolopoulos, Georgios; Tsiara, Chrissa; Micha, Katerina; Panopoulos, Anastasios; Malliori, Meni; Psichogiou, Mina; Pharris, Anastasia; Wiessing, Lucas; van de Laar, Marita; Donoghoe, Martin; Heckathorn, Douglas D.; Friedman, Samuel R.; Des Jarlais, Don.

In: Addiction, Vol. 110, No. 9, 01.01.2015, p. 1453-1467.

Research output: Contribution to journalArticle

Hatzakis, A, Sypsa, V, Paraskevis, D, Nikolopoulos, G, Tsiara, C, Micha, K, Panopoulos, A, Malliori, M, Psichogiou, M, Pharris, A, Wiessing, L, van de Laar, M, Donoghoe, M, Heckathorn, DD, Friedman, SR & Des Jarlais, D 2015, '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', Addiction, vol. 110, no. 9, pp. 1453-1467. https://doi.org/10.1111/add.12999
Hatzakis, Angelos ; Sypsa, Vana ; Paraskevis, Dimitrios ; Nikolopoulos, Georgios ; Tsiara, Chrissa ; Micha, Katerina ; Panopoulos, Anastasios ; Malliori, Meni ; Psichogiou, Mina ; Pharris, Anastasia ; Wiessing, Lucas ; van de Laar, Marita ; Donoghoe, Martin ; Heckathorn, Douglas D. ; Friedman, Samuel R. ; Des Jarlais, Don. / 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. In: Addiction. 2015 ; Vol. 110, No. 9. pp. 1453-1467.
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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.",
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T1 - Design and baseline findings of a large-scale rapid response to an HIV outbreak in people who inject drugs in Athens, Greece

T2 - The ARISTOTLE programme

AU - Hatzakis, Angelos

AU - Sypsa, Vana

AU - Paraskevis, Dimitrios

AU - Nikolopoulos, Georgios

AU - Tsiara, Chrissa

AU - Micha, Katerina

AU - Panopoulos, Anastasios

AU - Malliori, Meni

AU - Psichogiou, Mina

AU - Pharris, Anastasia

AU - Wiessing, Lucas

AU - van de Laar, Marita

AU - Donoghoe, Martin

AU - Heckathorn, Douglas D.

AU - Friedman, Samuel R.

AU - Des Jarlais, Don

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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.

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KW - Intervention

KW - Prevalence

KW - PWIDs

KW - Respondent-driven sampling

KW - Risk factors

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