1. No category

Blood-borne infections and characteristics of
current injectors in Germany
Preliminary results from a multicentre sero-behavioural survey
among PWID 2011-2015
Dr. Ruth Zimmermann MPH
Department for Infectious Disease Epidemiology
HIV/ AIDS, STI &Hepatitis Unit
Robert Koch Institute Berlin
DRUCK-Study
(Drogen und chronische Infektionskrankheiten)
Objectives
Design
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• To determine HIV, HBC, HCV and HTLV prevalence among
current PWID in selected German cities
• Collection of representative KABP data, determining risk
profiles
• To improve prevention of HIV and hepatitis among PWID in
Germany
• Multicentre cross-sectional study 2011-15
• Sero- and behavioural survey
• Calculated sample size: 2,034 PWID
Study sites
• Mapping of drug
scene in cities
• Close co-operation
with local lowthreshold drug
services
• Respondent driven
sampling
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3
Zimmermann et al, BMC Public Health 2014
Data
 Capillary dried blood spots (DBS)*
• HIV: anti HIV Elisa/Blot
• HCV: anti HCV Elisa/Blot + HCV-RNA + genotyping
• HBV: AntiHBs (titre) + AntiHBc + HBV-DNA + (HBsAg)
• Anti HTLV
 Questionnaire-assisted interviews
• trained interviewers
• sociodemographics, used substances, unsafe use, sex
imprisonment, knowledge, health status, testing history
• 30-45 min. interview
• anonymised
3/16
*Ross et al, Virology Journal 2013
Preliminary descriptive results
Total study population: 2,077 PWID
 Current injectors (having injected drugs during last 12 m,
consuming in the study city, aged 16y+)
 8 cities (130 – 337 participants per city)
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General characteristics (1)
%
5/16
95% CI /
range
n
Women
Median age, range
Not born in Germany
23.1%
38.5 y
22.1%
[21.3;25.0]
[20.3;23.9]
459
living without a steady home/ on
the streets/ hostel/ shelter
 main living situation last 12m
15.1%
[13.6;16.7]
311
 ever
66.1%
[64.1;68.1]
1,369
480
18-66
General characteristics (2)
%
6/16
95% CI / range
n
Median age at first injection
20 y
11-55
new injectors
(less than 2y since first injection)
3.6 %
[2.7; 4.4]
74
young injectors
(< 25y)
6.6%
[5.5-7.6]
136
heroine users currently in OST
52.4 % [50.2; 54.6]
1,011
heroine users ever in OST
73.9 % [71.9; 75.8]
1,426
substance use
(selection)
74
Heroine
17
Buprenorphine*
Heroine: 79%
Cocaine: 64%
Crack: 7%
Methadone: 13%
Buprenorphine: 8%
Fentanyl: 10%
BZD: 10%
49
Cocaine
25
Crack
14
Amphetamines
6
Crystal meth
50
Benzodiazepine
4
9
Lyrica
0%
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Last 30 days
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Proportion
injected:
38
Methadone*
Fentanyl
n=2,077
Last 6 months
Alcohol 74%, Marijuna 66% (last 30d)
> 6 months
Never
Unsafe use
last 30 d
In the last 30 days
%
95% CI
1,731
83%
[81.8-85.0]
269
15%
[13.2-16.6]
81
(needles)
[71.2-91.3]
64
(syringes)
[57.9-71.7]
sharing injecting paraphernalia other than n/s
(receiving or passing on)
635
37%
[34.4-38.9]
sharing any (n/s/other paraphernalia)
(receiving or passing on)
697
40%
[37.9-42.5]
injecting once per day or more
sharing used n/s
(receiving or passing on)
Mean no of sterile n/s obtained
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n
Imprisonment
n=2,077
 80.8% [79.1-82.5] have ever been in prison*
duration:
5 years (mean)
3,5 years (median); range 1 m – 30 years)
mean times imprisoned: 5.6
 29.5% [27.3-31.7] of ever imprisoned PWID injected
in prison
 11.0% [8.2-13.8] of ever imprisoned PWID started
injecting in prison
In Germany: 1 prison with NSP
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* All types of imprisonment
Sexual risks
81,5%
72,5%
sexual intercourse during last 12 m
use of a condom at last sexual
intercourse in last 12 m
having been paid for sex in last 12 m
28,9%
41,2%
28,5%
10,5%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
women
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men
Knowledge
% Not sure/new to me
HIV, HBV and HCV can be transmitted by sharing n/s
2%
HCV can by transmitted by...
... sharing filters /spoons
19 / 20%
... sharing water
22%
... sharing straws for snorting drugs
48%
HIV transmission risk is lower if effectively treated
16%
65%
53%
HBV-vaccination: you need at least 3 doses
48%
HCV-Reinfection is possible
HIV-PEP is available
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HIV
HCV
HBV
HIV
HIV
Ever tested
Tested in last 12 m
%
93.5
57.7
95% CI
[92.3-94.5]
[55.5-60.0]
n
1913
1147
4.9*
6.5
4.4
0.9
[3.9-5.8]
[4.2-8.7]
[3.4-5.4]
[0.5-1.4]
101
31
70
17
76.7
[67.6-85.8]
66
(HIV+ excluded)
HIV positive
women
men
Newly diagnosed HIVinfections
Ever under ART
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14
*(Leipzig: 0%, Frankfurt: 9.1%)
Hepatitis C
%
95% CI
n
Ever HCV tested
Tested in last 12m
Hepatitis C positive (total)
91.3
[90.0-92.5]
1.818
39.6
[37.4-41.7]
823
65.5 [63.5; 67.6]
1,361
 cleared infection (antiHCV+, RNA-)
 active infection (antiHCV +, RNA+)
 seroconverter (anti HCV -, RNA+)
22.0
41.3
2.3
[20.2-23.8]
[39.4-43.4]
[1.6-2.9]
457
857
47
Newly diagnosed RNA+ infections
(among previously never tested or
never + tested, n=223)
30.9
[62.9-75.2]
69
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Reported HCV treatment experience (IFN based)
among PWID reporting a positive HCV test result
n=1,305
yes, successful
4,2
11,8
I'm currently in treatment
16,3
1,8
5,9
20,8
6,9
16
31,3
1
yes, once without success
yes, several times without
success
no, because… (n=408)
no, was never offered to
me
no (without reason)
Hepatitis B
%
HBV positive (HBsAg/HBV-DNA)
95% CI
1.2
n
22
Resolved infection*
11.6
[10.2-12.3]
240
Hepatitis B vaccinated
32.3
[30.3-34.3]
671
No immunity/ at risk
42.9
[40.7-44.9]
890
*12.2% (n=254) were Anti HBc only + (resolved or non-viremic?)
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Conclusions
• High proportion of unstable living conditions and imprisonment
among current injectors
• High HIV and HCV prevalence
• High testing-levels, but knowledge of status often unclear
• High proportion of negative preconceptions on HCV treatment
• Poor HCV treatment rates
• low proportion of HBV vaccinated though vaccination
recommendation in place
• Detailed knowledge on HCV transmission, knowledge on HIV
treatment/PEP and HBV vaccination not sufficient
• Contact with medical system not sufficiently used (OST/prison)
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Thank you!
Matthias An der Heiden, Norbert Bannert, Claus-Thomas Bock, Johannes Bombeck, Birkenstube Berlin,
Wei Cai, Deutsche AIDS-Hilfe, Serdar Danis, Kerstin Dettmer, Fixpunkt e.V., Maria Friedrich,
Gesundheitsamt Essen, Osamah Hamouda, Claudia Kücherer, Astrid Leicht, Uli Marcus, Bärbel
Marrziniak, Sami Marzougui, Stine Nielsen, Doreen Nitschke, NRZ Hepatitis C, Doris Radun, Stefan Ross,
Claudia Santos-Hövener, Dirk Schäffer, Suchthilfe Essen, Judith Stumm, Andrea Teti, Benjamin Wenz,
Weidong Zhang
cooperating partners in drug services
all study participants
German MOH (financing partner)
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