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Independent of injecting drug use, being a foreign national is associated with risk of reactive HCV screening in European community-based testing services 2017

Authors:
  • Coalition PLUS / CEEISCAT
  • Centre for Epidemiological Studies on Sexually Transmitted infections and HIV/AIDS of Catalonia (CEEISCAT)

Abstract

HIV testing in CBVCTs has proven to be cost effective (1) have high user satisfaction (2) and identify patients at an earlier stage of HIV infection than testing in clinical settings (3). The HCV epidemic in Europe is concentrated in PWID (4). On-site testing with pre-test counselling and education in health settings has been identified as an intervention to enhance HCV testing among PWID (5). As CBVCTs are increasingly offering HCV screening, more investigation is required to understand if services are reaching populations at higher risk of HCV. The COBATEST Network collects standardised testing data from community-based voluntary counselling and testing (CBVCTs) services in Europe, allowing the estimation of indicators for the monitoring and evaluation of services. COBATEST has been recognised as an example of good practice in the public health response to HIV by both the WHO and the ECDC. The network promotes the incorporation of CBVCT data into national surveillance systems. In 2017, 38 CBVCT services in 20 European countries submitted data to the network. Methods Data collected using COBATEST data collection tool and disaggregated data submission from 14 CBVCTs performing HCV screening in 7 countries in the period 1 January 2017-31 December 2017. The standardised questionnaire collects sociodemographic and epidemiological information and is completed by counsellor in consultation. The study population described, proportion of reactive tests calculated, risk factors associated with and calculated the proportion of reactive tests for each sociodemographic variable. We then identified risk factors for a reactive test result using univariate and multivariate logistic regression with 95% CIs and p values. ACASC (Spain) SOMOS LGBT (Spain) AVACOS-H (Spain) Lambda (Spain) CAS/ARD Lluis Companys (Spain) CASDA (Spain) GaisPositius (Spain) OMSIDA (Spain) Ambit prevenció (Spain) ARAS (Romania) Demetra (Lithuania) LilaMilano (Italy) AIDS Hilfe Wien (Austria) AIDS Fondet (Denmark) Baltic HIV (Estonia) Figure 1: Proportion of HCV tests from each centre COBATEST Network 2017
INDEPENDENT OF INJECTING DRUG USE, BEING A FOREIGN
NATIONAL IS ASSOCIATED WITH RISK OF REACTIVE HCV
SCREENING IN EUROPEAN COMMUNITY-BASED TESTING
SERVICES 2017
Background
HIV testing in CBVCTs has proven to be cost effective (1) have high user satisfaction (2) and identify
patients at an earlier stage of HIV infection than testing in clinical settings (3). The HCV epidemic in
Europe is concentrated in PWID (4). On-site testing with pre-test counselling and education in
health settings has been identified as an intervention to enhance HCV testing among PWID (5). As
CBVCTs are increasingly offering HCV screening, more investigation is required to understand if
services are reaching populations at higher risk of HCV. The COBATEST Network collects
standardised testing data from community-based voluntary counselling and testing (CBVCTs)
services in Europe, allowing the estimation of indicators for the monitoring and evaluation of
services. COBATEST has been recognised as an example of good practice in the public health
response to HIV by both the WHO and the ECDC. The network promotes the incorporation of CBVCT
data into national surveillance systems. In 2017, 38 CBVCT services in 20 European countries
submitted data to the network.
Methods
Data collected using COBATEST data collection tool and
disaggregated data submission from 14 CBVCTs performing
HCV screening in 7 countries in the period 1 January 2017
31 December 2017. The standardised questionnaire collects
sociodemographic and epidemiological information and is
completed by counsellor in consultation. The study
population described, proportion of reactive tests calculated,
risk factors associated with and calculated the proportion of
reactive tests for each sociodemographic variable. We then
identified risk factors for a reactive test result using univariate
and multivariate logistic regression with 95% CIs and p
values.
ACASC (Spain)
SOMOS LGBT (Spain)
AVACOS-H (Spain)
Lambda (Spain)
CAS/ARD Lluis Companys (Spain)
CASDA (Spain)
GaisPositius (Spain)
OMSIDA (Spain)
ARAS (Romania)
Demetra (Lithuania)
LilaMilano (Italy)
AIDS Hilfe Wien (Austria)
AIDS Fondet (Denmark)
Baltic HIV (Estonia)
Figure 1: Proportion of HCV tests from each centre COBATEST Network 2017
Acknowledgements
We thank CBVCT service users. We are grateful to all colleagues from the CBVCT services who are members of the
COBATEST Network for their collaboration. Those in bold contributed data to this study: Asociación AntiSIDA Lleida
(Spain), Abraco (Portugal), ACAS Girona (Spain), ACASC (Spain), ACAVIH (Spain)ACCAS (Spain)Actuavallès
(Spain)Adhara (Spain)AIDES (France), AIDS Fondet (Denmark), AIDS Hilfe Wien (Austria), Alliance Global (Ukraine),
Àmbit Prevenció (Spain), ARAS (Romania), ASM Cyprus (Cyprus), ASOCIACIÓN SOMOS LGT (Spain), Asocijacija
Duga (Serbia)Assexora'Tgn (Spain), Associació Lambda (Spain), AVACOS-H (Spain), CAS/ARD Lluís Companys
(Spain), Baltic HIV Association (Latvia),CASDA (Spain), CCASiPA (Spain)Centre Jove d’Antico (Spain)Checkpoint
Milano (Italy)Creu Roja Tarragona (Spain)Czech AIDS Help (Czech Republic), Demetra (Lithuania), Deutsche AIDS Hilfe
(Germany), Fondazione LILA Milano (Italy), Gais Positius (Spain), GAT Portugal (Portugal)GenderdocM
(Moldova)Health Without Borders (Bulgaria)HERA (Macedonia)HUHIV (Croatia)Iskorak (Croatia)Legebitra
(Slovenia)Mujer Gades (Spain)National AIDS Centre (Poland), OMSIDA (Spain), StopSida (Spain)Switzerland
(Switzerland)
Bibliography
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Conclusions
Although relatively few PWIDs tested in COBATEST CBVCT services,
the high proportion of reactive tests in this population indicates that
CBVCT should be a element of national strategies to increase testing
in PWID. Migrants accessing CBVCT services in the COBATEST
network are at increased risk of a reactive HCV test compared to non-
migrants, independent of intravenous drug use. Given the small
number of cases, this finding should be investigated further using data
from COBATEST Network 2014-18. Using the larger dataset would also
provide an opportunity to investigate screening of HIV+ MSM. The
CBVCT service with the largest number of screening tests does not
collect the minimum set of variables which limited the variables that
could be included in the multivariate analysis. Data on RNA tests
should be improved (information only available for 6/25 reactive tests)
to provide evidence of whether CBVCTs are diagnosing people with an
active HCV infection.
The results demonstrate that CBVCT services are well-placed to
increase HCV screening amongst people at higher risk of HCV who are
not accessing mainstream healthcare. CBVCT services with limited
resources could improve targeting of testing by incorporating a risk
identification tool to decide whether to screen clients for HCV.
Results
In the COBATEST Network in 2017, 1,976 HCV
screening tests were performed in 15 CBVCT
services in 7 countries. Of these services, 9 are
based in Spain representing less than a quarter of all
reported screenings (Fig 1). For this analysis, 18
testers aged under 16 were excluded, and 115
testers with no available test result were excluded.
The proportion of reactive tests between centres
varied, the highest being 22.2% (n=2) in CAS/ARD
Barcelona a service for people who inject drugs
(PWID) (Fig.2). Overall, the proportion of reactive
tests was significantly higher in foreign nationals
than non-foreign nationals and in PWID compared to
non-PWID (Table 1). In the univariate analysis, being
a foreign national or PWID increased risk of a
reactive test. This finding remained after adjusting
for gender, foreign national and PWID (Table 2).
Table 2: Risk Factors for a Reactive HCV Test COBATEST Network 2017
cOR
(95% CI)
p value
aOR*
(95% CI)
p value
Gender
Men
1
1
Women
1.2(0.5;3)
0.696
1.2(0.4;3.2)
0.724
Age group**
<25
1
>=25
1.2(0.5;3)
0.696
Foreign National
No
1
1
Yes
2.5(1.1;5.5)
0.023
2.6(1.1;6.0)
0.022
MSM
No
1
Yes
0.5(0.2;1.1)
0.074
MSM HIV+
No
1
Yes
4.7(0.6;36.8)
0.141
Sex worker**
No
1
Yes
1.2(0.2;9.4)
0.861
Don't know
0.6(0.1;4.7)
0.627
Intravenous Drug User
No
1
1
Yes
43.7 (15.9;120.1)
<0.001
40.1(14.3;112.9)
<0.001
HIV+**
No
1
Yes
3.2(0.4;25.8)
0.284
*Logistic regression model adjusted for gender, foreign national and intravenous drug use
**Not including one centre with no data (n=791)
Authors: A. Conway1,2, N. Lorente1,2, L. Fernàndez López1,2,3, J. Casabona1,2,3, COBATEST
Network Study Group. Institutes: 1Centre Estudis Epidemiologics sobre les Infeccions de
Transmissio Sexual i Sida de Catalunya (CEEISCAT), Departament de Salut, Generalitat
de Catalunya, Badalona, Spain, 2Institute for Health Science Research Germans Trias i
Pujol (IGTP), Badalona, Spain, 3CIBER Epidemiologia y Salud Publica (CIBERESP), Spain
Table 1: HCV tests performed and reactive tests by sociodemographic variables -
COBATEST Network 2017
Total
Reactive Tests
N
n
%
Total
1,844
25
1.4
Gender Missing = 0.2%
Male
1451
19
1.3
Female
382
6
1.6
Trans
8
0
0
Age group Missing=0.3%**
<25
222
3
1.4
>=25
826
11
1.3
Foreign national* Missing=2.2%
Yes
549
13
2.4
No
1254
12
1
MSM
Yes
997
9
0.9
No
847
16
1.9
HIV+ MSM
Yes
17
1
5.9
No
1827
24
1.3
Sex worker Missing=3.4%**
Yes
57
1
1.8
No
820
24
1.3
Don't know
113
1
0.9
Intravenous drug use* Missing=2.9%
Yes
22
7
31.8
No
1705
18
1.1
Don't know
63
0
0
*Signficant different between categories
**Not including one centre with no data (n=791)
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