Estimates of HIV incidence among drug users in St. Petersburg, Russia: continued growth of a rapidly expanding epidemic
Estimates of HIV incidence among drug users in St. Petersburg, Russia: continued growth of a rapidly expanding epidemic
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DOI：
10.1093/eurpub/ckq115
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发表时间：
2011-10-01
影响因子：
4.4
通讯作者：
Heimer, Robert
中科院分区：
文献类型：
--
作者：
Niccolai, Linda M.;Verevochkin, Sergei V.;Heimer, Robert
背景：俄罗斯是世界上艾滋病毒流行增长最快的国家之一，主要集中在注射吸毒者（IDU）中。圣彼得堡是俄罗斯第二大城市，也是该国受艾滋病疫情影响最严重的地区之一。为了监测目前的流行病情况，我们试图估计圣彼得堡注射吸毒者中最近的艾滋病毒发病率。方法：在一项2005-08年期间招募的691名IDU的横断面研究中，通过两种方法估计HIV发病率：回顾性队列分析和BED捕获酶免疫测定（EIA）结果。研究了事件感染和空间模式的社会人口统计学和行为相关性。结果：在回顾性队列分析中，发病率估计为14.1/100人年[95%置信区间（CI） 10.7-17.6]。使用BED EIA的结果和两个已知错误分类的校正公式，发病率估计为每100人年23.9 （95% CI 17.8-30.1）和25.5 （95% CI 18.9-32.0）。最近感染的独立相关因素包括目前失业（P = 0.004）和过去30天内没有注射毒品（P = 0.03）。除一个地区外，该市所有地区都发现了艾滋病毒病例，据观察，传播的重点地区正在扩大。结论：圣彼得堡注射吸毒者中艾滋病毒的高发病率证明了该流行病的持续增长。迫切需要扩大针对整个城市弱势群体的艾滋病毒预防干预措施。这些结果还表明，即使在校正了低特异性后，BED EIA也可能高估了发病率。
Background: Russia has one of the world's fastest growing HIV epidemics and it has been largely concentrated among injection drug users (IDU). St Petersburg, Russia's second largest city, is one of the country's regions that has been most affected by the HIV epidemic. To monitor the current epidemic situation, we sought to estimate recent HIV incidence among IDU in St Petersburg. Methods: In a cross-sectional study of 691 IDU recruited during 2005-08, HIV incidence was estimated by two methods: a retrospective cohort analysis and BED capture enzyme immunoassay (EIA) results. Socio-demographic and behavioural correlates of incident infections and spatial patterns were examined. Results: In the retrospective cohort analysis, the incidence rate was estimated to be 14.1/100 person-years [95% confidence interval (CI) 10.7-17.6]. Using results of BED EIA and two correction formulas for known misclassification, incidence estimates were 23.9 (95% CI 17.8-30.1) and 25.5 (95% CI 18.9-32.0) per 100 person-years. Independent correlates of being recently infected included current unemployment (P = 0.004) and not having injected drugs in the past 30 days (P = 0.03). HIV incident cases were detected in all but one district in the city, with focal areas of transmission observed to be expanding. Conclusions: High HIV incidence among IDU in St Petersburg attests to continued growth of the epidemic. The need for expansion of HIV prevention interventions targeted to vulnerable populations throughout the city is urgent. These results also suggest that the BED EIA may over-estimate incidence even after correction for low specificity.