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 sociodemographic 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 (2012-2013).
PARTICIPANTS: 3,320 persons 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 antiretroviral 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 3,320 PWIDs over the course of 13.5 months. More than half (54%) participated in multiple rounds, resulting in 7,113 visits. HIV prevalence was 15%. 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 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 [(OR (95%CI) yes vs. no: 1.89 (1.41,2.52)] while, in female PWIDS, the number of sexual partners [OR (95%CI) for >5 vs. 1 partner in the past year: 4.12 (1.93,8.77)] and history of imprisonment [(OR (95%CI) yes vs. no: 2.76 (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.
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, 110 (9), 1453-1467. doi: 10.1111/add.12999. PMCID: PMC4854521.