Concordance between Self-Reported and Measured HIV and Hepatitis C Virus Infection Status among People Who Inject Drugs in Germany

Author: Nielsen S, Gassowski M, Wenz B, Bannert N, Bock CT, Kücherer C, Ross RS, Hamouda O, Bremer V, Marcus U and Zimmermann R

Theme: Epidemiology & Public Health Research Year: 2016


Nielsen S1,2, Gassowski M1, Wenz B1, Bannert N3, Bock CT4, Kücherer C3, Ross RS5, Hamouda O1, Bremer V1, Marcus U1 and Zimmermann R1

1 Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Berlin, Germany
2 Charité University Medicine, Berlin, Germany
3 Department for Infectious Diseases, Division for HIV and other Retroviruses, Robert Koch Institute, Berlin, Germany.
4 Department for Infectious Diseases, Division for Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Robert Koch Institute, Berlin, Germany.
5 Institute of Virology, National Reference Centre for Hepatitis C, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.

Background: People who inject drugs (PWID) are disproportionately affected by both HIV and hepatitis C (HCV) infection. Awareness of infection status is essential to ensure linkage to appropriate healthcare for those infected as well as for uninfected individuals who need access to targeted testing and counselling services. Also awareness of infection status can lead to reduced transmission. In this study we compare self-reported HIV and HCV status with serological and molecular markers of infection among PWID.

Methods: Biological and behavioural data were collected from 2,077 PWID recruited through respondent-driven sampling in eight German cities in 2011-2014. Dried blood spots from capillary blood samples were tested for anti-HCV antibodies, HCV RNA and HIV-1/-2 antibodies. HIV reactive samples were confirmed by Western blot.

Results: Laboratory testing revealed that 5% were infected with HIV and 80% were aware of being infected. Chronic HCV was detected in 41% of participants, 2% had acute HCV, 22% had a cleared infection, and 34% were unexposed to HCV. The concordance between self-reported and measured HCV status was 71% among those with infectious (chronic or acute) HCV, 38% among those with a cleared infection and 47% among those unexposed to HCV. Most participants (89%) saw a doctor in the last year and 54% were in opioid substitution therapy (OST).

Conclusion: The majority of our study population was aware of their infection status, however, nearly one-third with infectious HCV and one-fifth of HIV infected PWID did not know their status, although often attached to OST or other harm reduction services. Access to testing, counselling and treatment targeted to the needs of PWID should be further improved, particularly for HCV. In the era of highly effective antiviral HCV-treatment options the opportunity to clear infections exists, if infected persons become aware of their infection and are linked to appropriate care settings.

Disclosure of interest statement: The study was funded by the Robert Koch Institute and the German Ministry of Health (Bundesministerium für Gesundheit). All authors declare that they do not have any conflict of interest.

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