Anxiety and depression among women living with HIV in Kazakhstan.

An increase in new HIV infections among women in Kazakhstan has motivated efforts to improve access to comprehensive health services. This study estimates anxiety and depression frequency among women seeking HIV services. A cross-sectional survey was administered to women seen at the Almaty AIDS Center. Bivariable analyses (e.g., Chi-square, means with 95% confidence intervals) were performed to assess the relationship between anxiety (score of 10 or more on the Generalized Anxiety Disorder-7 Scale (GAD-7)), major depression (Patient Health Questionnaire 8 (PHQ-8)), and comorbid anxiety and major depression with sociodemographic characteristics, health functioning, and medication history. Of the 410 participants, 62 (15.1%) had a GAD-7 ≥ 10; 52 (12.7%) met major depression criteria; 35 (8.5%) met both criteria, and 79 (19.3%) met GAD-7, major depression, or both criteria. Women reporting depression or anxiety were more likely to lack food security (p < 0.01), not finish secondary school (p < 0.01), speak Russian at home (p < 0.01), perceive their health to be poor (p < 0.01), and report poorer physical and mental health functioning (p < 0.05). No medications approved for the treatment of anxiety or depression were reported. The considerable number of women reporting major depression and anxiety symptoms suggests a need for improving access to mental health care.

Relationship between day 1 and day 2 Vancomycin area under the curve values and emergence of heterogeneous Vancomycin-intermediate Staphylococcus aureus (hVISA) by Etest® macromethod among patients with MRSA bloodstream infections: a pilot study.

BACKGROUND: In vitro data suggests that suboptimal initial vancomycin exposure may select for heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) infections. However, no clinical studies have evaluated the relationship between initial vancomycin exposure and emergence of hVISA. This pilot study seeks to assess the relationship between day 1 and day 2 vancomycin area under the curve (AUC) and emergence of hVISA bloodstream infections (BSIs) by Etest® macromethod among patients with a non-hVISA BSI at baseline. METHODS: This was a retrospective cohort study of patients with methicillin-resistant Staphylococcus aureus (MRSA) BSIs at Albany Medical Center Hospital (AMCH) between January 2005 and June 2009. The vancomycin AUC exposure variables on day 1 (AUC0-24h) and day 2 (AUC24-48h) were estimated using the maximal a posteriori probability (MAP) procedure in ADAPT 5. RESULTS: There were 238 unique episodes of MRSA BSIs during the study period, 119 of which met inclusion criteria. Overall, hVISA emerged in 7/119 (5.9%) of patients. All 7 cases of hVISA involved patients who did not achieve area under the curve over broth microdilution minimum inhibitory concentration (AUC0-24h/MICBMD) ratio of 521 or an AUC24-48h/MICBMD ratio of 650. No associations between other day 1 and day 2 AUC variables and emergence of hVISA were noted. CONCLUSIONS: Although more data are needed to draw definitive conclusions, these findings suggest that hVISA emergence among patients with non-hVISA MRSA BSIs at baseline may be partially explained by suboptimal exposure to vancomycin in the first 1 to 2 days of therapy. At a minimum, these findings support further study of the relationship between initial vancomycin exposure and hVISA emergence among patients with MRSA BSIs in a well-powered, multi-center, prospective trial.

Vaccinating my way--use of alternative vaccination schedules in New York State.

OBJECTIVE: To identify children vaccinated following an alternative vaccine schedule using immunization information system data and determine the impact of alternative schedule use on vaccine coverage. STUDY DESIGN: Children born in New York State, outside New York City, between January 1, 2009 and August 14, 2011 were assessed for vaccination patterns consistent with use of an alternative schedule. Children who by 9 months of age had at least 3 vaccination visits recorded in the statewide mandatory immunization information system after 41 days of age were classified as either attempting to conform to the Centers for Disease Control and Prevention published recommended vaccination schedule or an alternative schedule. The number of vaccination visits and up-to-date status at age 9 months were compared between groups. RESULTS: Of the 222 628 children studied, the proportion of children following an alternative schedule was 25%. These children were significantly less likely to be up-to-date at age 9 months (15%) compared with those conforming to the routine schedule (90%, P < .05). Children following an alternative schedule on average had about 2 extra vaccine visits compared with children following a routine schedule (P < .05). CONCLUSIONS: Almost 1 in 4 children in this study appear to be intentionally deviating from the routine schedule. Intentional deviation leads to poor vaccination coverage leaving children vulnerable to infection and increasing the potential for vaccine-preventable disease outbreaks.

Migrant Workers in Kazakhstan: Gender Differences in HIV Knowledge and Sexual Risk Behaviors.

This study compares sexual risk behaviors among male and female migrant market vendors in Almaty, Kazakhstan. From the Barakholka Market, 209 male and 213 female market vendors were randomly recruited. Self-reported data were collected through standardized face-to-face interviews. Dry blood spot was used as specimen for syphilis testing. Propensity score stratification was used to estimate adjusted prevalence or rate ratios by gender. Compared to male migrant workers, females had lower HIV knowledge and were less likely to have multiple sexual partners. There was no evidence of a gender difference for prevalence of syphilis, condom use with unsteady partners, and safe sex communication between couples. Associations between mobility patterns and engagement in multiple sexual partnerships were stronger among women than men. Efforts should be made to mitigate the gender differential in HIV knowledge among migrants, especially women. Such efforts need to be implemented in both home and host countries.

Seatbelt and child-restraint use in Kazakhstan: attitudes and behaviours of medical university students.

Traffic fatalities in Kazakhstan increased from 15 to more than 30 per 100 000 between 2001 and 2006. Mortality remains high compared with developed nations. Safety-restraint laws have been enacted, but little data exist regarding usage of seatbelts, particularly among children and passengers. This cross-sectional study surveyed medical university students about attitudes and behaviours regarding seatbelt and child safety-restraint usage. Seatbelts are widely used in the front seat (81%) but not in the back seat (79% 'never' or 'rarely' use a seatbelt in the back seat). Fewer than half reported 'always' or 'almost always' providing restraint for children under 7 years and 24% reported children secure the seatbelts themselves. Safety in the back seat merits attention. Adults generally do not buckle in the back seat despite a law requiring seatbelt use. Promotion of child safety restraints should be prioritised in prevention education for physicians and the community.

Incidence and Clinical Predictors of Nonresponse to Hepatitis B Vaccination among Patients Receiving Hemodialysis: Importance of Obesity.

OBJECTIVES: The objectives of this study were to quantify the incidence of hepatitis B virus (HBV) vaccine nonresponse and identify clinical characteristics associated with vaccine nonresponse. METHODS: A retrospective cohort study was conducted among patients undergoing hemodialysis (HD) receiving the HBV vaccine. Study inclusion criteria were age 18 years and older, receipt of HD treatment for ≥ 1 month, receipt of ≥ 1 dose of HBV vaccine, availability of anti-HB surface antibody (anti-HBs) laboratory values ≥ 2 weeks after last HBV vaccine, and prevaccine anti-HBs value <10 mIU/mL. Clinical data were abstracted from patients' medical records. The outcome of interest was vaccine nonresponse, defined as anti-HBs values <10 IU/mL. Multivariate regression was used to determine variables independently associated with vaccine nonresponse. Kaplan-Meier estimates were constructed for determining HBV vaccine response retention. RESULTS: Of the 119 patients evaluated, nonresponse was observed in 58%. Mean age at first vaccination for vaccine responders and nonresponders was 58.8 ± 16.5 and 65.9 ± 14.1 (P = 0.01), respectively. Variables independently associated with nonresponse were age 58 years and older (adjusted relative risk, 95% confidence interval 1.62, 1.06-2.46; P = 0.02) and body mass index ≥ 36.4 kg/m(2) (adjusted relative risk, 95% confidence interval 1.66, 1.34-2.07; P < 0.01). Among the 50 patients who achieved an initial vaccine response, 26% were not able to maintain vaccine response upon subsequent anti-HBs measurement. The probability of retaining vaccine response over time was significantly modified by body mass index ≥ 25 kg/m(2). CONCLUSIONS: The frequency of nonresponse to the HBV vaccine was high among patients undergoing HD. The clinical covariates most predictive of vaccine nonresponse were advanced age at the time of vaccination and excess body weight.

Vancomycin exposure in patients with methicillin-resistant Staphylococcus aureus bloodstream infections: how much is enough?

BACKGROUND: Contemporary vancomycin dosing schemes are designed to achieve an area under the curve (AUC) to minimum inhibitory concentration (MIC) ratio of ≥400. However, scant clinical data exist to support this target and available data relied on pharmacokinetic formulas based on daily vancomycin dose and estimated renal function (demographic pharmacokinetic model) to estimate AUCs. METHODS: A cohort study of hospitalized, adult, nondialysis patients with methicillin-resistant Staphylococcus aureus bloodstream infections treated with vancomycin was performed to quantitatively evaluate the relationship between vancomycin exposure and outcomes. Bayesian techniques were used to estimate vancomycin exposure profile for day 1 and 2 of therapy for each patient based on their dosing schedule and collected concentrations. Classification and Regression Tree (CART) analysis was used to identify day 1 and 2 exposure thresholds associated with an increased risk of failure. Failure was defined as 30-day mortality, bacteremia was ≥7 days, or recurrence. RESULTS: During the study period, 123 cases met criteria. Failure was uniformly less pronounced (approximately 20% less in absolute value) in patients who achieved the CART-derived day 1 and 2 thresholds for AUC/MIC by broth microdilution and AUC/MIC by Etest. In the multivariate analyses, all risk ratios were approximately 0.5 for all CART-derived AUC/MIC exposure thresholds, indicating that achievement of CART-derived AUC/MIC exposure thresholds was associated with a 2-fold decrease in failure. CONCLUSIONS: These findings establish the critical importance of daily AUC/MIC ratios during the first 2 days of therapy. As with all observational studies, these findings should be interpreted cautiously and validated in a multicenter randomized trial before adoption into practice.

United States private schools have higher rates of exemptions to school immunization requirements than public schools.

OBJECTIVE: To compare medical, religious, and personal belief immunization exemption rates between private and public schools in US. STUDY DESIGN: Exemption rates were calculated using the Centers for Disease Control and Prevention School Immunization Assessment Surveys for the 2009-2010 school year excluding states with incomplete survey data. Standardized exemption rates weighted on enrollments in public and private schools were calculated. Differences in exemption rates between public and private schools were tested using Wilcoxon signed rank test. RESULTS: The overall state exemption rate was higher in US private than public schools, 4.25% (SD 4.27) vs 1.91% (1.67), P = .0001 and private schools had higher exemption rates for all types of exemptions; medical 0.58% (0.71) vs 0.34% (0.34) respectively (P = .0004), religious 2.09% (3.14) vs 0.83% (1.05) respectively (P = .0001), and personal belief 6.10% (4.12) vs 2.79% (1.57), respectively (P = .006). Overall exemption rates were significantly higher in states that allowed personal belief exemptions. CONCLUSIONS: Exemption rates were significantly higher in US private than in public schools. Children attending private schools may be at higher risk of vaccine-preventable diseases than public school children.

Substance abuse treatment utilization, HIV risk behaviors, and recruitment among suburban injection drug users in Long Island, New York.

Prevention and treatment of injection drug use remains a public health concern. We used data from the 2005 Centers for Disease Control and prevention National HIV Behavioral Surveillance system to assess substance abuse treatment utilization, risk behaviors, and recruitment processes in a respondent driven sample of suburban injectors. Twelve service utilization and injection risk variables were analyzed using latent class analysis. Three latent classes were identified: low use, low risk; low use, high risk; and high use, moderate/high risk. In multivariate analysis, annual income <$15,000 (adjusted odds ratio (aOR) = 8.19 [95 % confidence interval (CI), 3.83-17.51]) and self-reported hepatitis C virus infection (aOR = 4.32, 95 % CI (1.84-10.17)) were significantly associated with class membership. Homophily, a measure of preferential recruitment showed that injectors with recent treatment utilization appear a more cohesive group than out-of-treatment injectors. Preferentially reaching injection drug users with high risk behaviors and no recent drug treatment history via respondent driven sampling will require future research.

Prevalence and Predictors of Important Telaprevir Drug Interactions Among Patients Coinfected With Hepatitis C and Human Immunodeficiency Virus.

Background: Among patients with HIV and hepatitis C (HCV) coinfection, drug-drug interactions involving nonstructural protein 3/4 (NS3/4A) serine protease inhibitors for HCV infection are an important concern because these drugs affect cytochrome P450 metabolism and p-glycoprotein transporters. Objectives: The primary objective was to determine the prevalence of clinically significant drug-drug interactions (CSDDIs) in HIV/HCV coinfected patients if telaprevir-based HCV therapy is added to patients' medication regimens. Secondary objectives were to identify antiretroviral therapy (ART) regimens associated with the lowest risk of CSDDI and determine the clinical risk factors. Methods: A cross-sectional study was performed among adult HIV/HCV coinfected patients. Demographics, comorbidities, social history, and medication lists were extracted from medical records. For each patient, CSDDIs were identified by entering all medications and pegylated interferon, ribavirin, and telaprevir into Lexi-Interact drug interaction software. The number and nature of CSDDIs were recorded before and after addition of telaprevir-based therapy. Results: There were 335 patients included. Prior to the addition of telaprevir-based HCV therapy, there was a high frequency (82.1%) of any CSDDI. After the addition of telaprevir-based HCV therapy, the frequency of any CSDDI increased to 97% (P < .001). Contraindicated interactions rose from 20.0% to 38.2% of patients after addition of telaprevir-based therapy. Use of ≥10 non-HIV medications, dyslipidemia, and HIV protease inhibitors were independently associated with the occurrence of a contraindicated interaction. Conclusions: Clinicians considering initiating telaprevir in HIV/HCV coinfected patients should be vigilant of drug-drug interactions, particularly among patients with dyslipidemia, those using ≥10 non-HIV medications, and those using HIV protease inhibitors.

Guillain-Barré syndrome surveillance during National Influenza Vaccination Campaign, New York, U.S.A., 2009.

The New York State Department of Health (NYSDOH) collected information about hospitalized patients with Guillain-Barré syndrome (GBS) during October 2009-May 2010, statewide (excluding New York City), to examine a possible relationship with influenza A(H1N1)pdm09 vaccination. NYSDOH established a Clinical Network of neurologists and 150 hospital neurology units. Hospital discharge data from the Statewide Planning and Research Cooperative System (SPARCS) were used to evaluate completeness of reporting from the Clinical Network. A total of 140 confirmed or probable GBS cases were identified: 81 (58%) from both systems, 10 (7%) from Clinical Network only, and 49 (35%) from SPARCS-only. Capture-recapture methods estimated that 6 cases might have been missed by both systems. Clinical Network median reporting time was 12 days versus 131 days for SPARCS. In public health emergencies in New York State, a Clinical Network may provide timely data, but in our study such data were less complete than traditional hospital discharge data.

An examination of domestic partner violence and its justification in the Republic of Georgia.

BACKGROUND: Little research on Intimate Partner Violence (IPV) and social perceptions toward this behavior has been disseminated from Eastern Europe. This study explores the prevalence and risk factors of IPV and the justification of this behavior among women in the Republic of Georgia. It seeks to better understand how IPV and IPV justification relate and how social justification of IPV differs across socio-economic measures among this population of women. METHODS: This study utilizes a national sample of ever-married women from the Republic of Georgia (N = 4,302). We describe the factors that predict IPV justification among these women and the relationship between of the acceptability of IPV and victimization overall and across socio-demographic factors. RESULTS: While the overall lifetime prevalence of IPV in this sample was relatively low (4%), these women were two to four times more likely to justify IPV, Just under one-quarter of the sample agreed that IPV was justified in at least one scenario, namely when the wife was unfaithful, compared with women who had no experience being abused by a partner. Georgian women who were poor, from a rural community, had lower education, were not working and who experienced child abuse or IPV among their parents were more likely to justify this behavior. CONCLUSIONS: These findings begin to fill a gap in our understanding of IPV experienced by women in Eastern Europe. In addition, these findings emphasize the need for researchers, practitioners and policy makers to contextualize IPV in terms of the justification of this behavior among the population being considered as this can play an important role in perpetration, victimization and response.

Comparison of two measures of gestational age among low income births. The potential impact on health studies, New York, 2005.

Recently, the National Association for Public Health Statistics and Information Systems considered changing the definition of gestational age from the current definition based on mother's last normal menstrual period (LMP) to the clinical/obstetric estimate determined by the physician (CE).They determined additional information was needed. This study provides additional insight into the comparability of the LMP and CE measures currently used on vital records among births at risk for poor outcomes. The data consisted of all New York State (NYS) (excluding New York City) singleton births in 2005 among mothers enrolled in the NYS Women Infants and Children (WIC) program during pregnancy. Prenatal WIC records were matched to NYS' Statewide Perinatal Data System. The analysis investigates differences between LMP and CE recorded gestations. Relative risks between risk factors and preterm birth were compared for LMP and CE. Exact agreement between gestation measures exists in 49.6% of births. Overall, 6.4% of records indicate discordance in full term/preterm classifications; CE is full term and LMP preterm in 4.9%, with the converse true for 1.5%. Associations between risk factor and preterm birth differed in magnitude based on gestational age measurement. Infants born to mothers with high risk indicators were more likely to have a CE of preterm and LMP full term. Changing the measure of gestational age to CE universally likely would result in overestimation of the importance of some risk factors for preterm birth. Potential overestimation of clinical outcomes associated with preterm birth may occur and should be studied.

Evaluating the most effective distribution strategies to assure administration of pandemic H1N1 influenza vaccine to New York State children and adolescents: evaluation using the New York State Immunization Information System.

OBJECTIVE: To examine differences in H1N1 influenza vaccine distribution strategies that may impact the ability to rapidly administer vaccine during a pandemic or public health emergency. DESIGN: Retrospective evaluation of immunization data in the New York State Immunization Information System (NYSIIS). SETTING: Analysis of existing NYSIIS data. PARTICIPANTS: Children and adolescents younger than 19 years for whom information on at least 1 H1N1 influenza vaccine was present in NYSIIS. MAIN OUTCOME MEASURE(S): Median time to administer vaccines to children and adolescents younger than 19 years by December 31, 2009, by county; venue of H1N1 vaccine administration (local health department [LHD] or private medical provider); comparison of immunization-seeking behavior for routine childhood vaccinations and H1N1 vaccine. RESULTS: A total of 459 189 first or only doses of H1N1 influenza vaccine were recorded in NYSIIS as being administered to New York State, outside of New York City, children aged less than 19 years, between October 2, 2009, and December 31, 2009. Overall, LHD administered 31% of H1N1 vaccine doses; in counties having population less than 100,000, LHD administered 63% of H1N1 doses compared with 23% in counties having population more than 100,000. Time to median administration was faster for LHD in smaller counties and similar for LHD and private medical providers in larger counties. Children who always received routine childhood immunizations either within or outside of their county of residence often had the same practice for H1N1 vaccine, with 85% of children following these patterns. Children who did not follow these patterns were more likely to receive H1N1 influenza vaccine through LHD. CONCLUSIONS: Local health departments were able to rapidly administer large quantities of H1N1 influenza vaccine, and patterns of health care seeking relying on increased use of LHD needs to be further studied for future public health emergency planning.

Condom use and partnership intimacy among drug injectors and their sexual partners in Estonia.

OBJECTIVES: Young age coupled with a high HIV prevalence among injection drug users (IDUs) and the prevalence of drug use in Eastern Europe can lead from an HIV epidemic concentrated among IDU to a self-sustained heterosexual HIV epidemic. Our objective was to explore the contexts of the prevention of sexual transmission of HIV among IDUs and their sexual partners and to provide insight into beliefs and behaviours related to condom use. METHODS: The authors undertook in-depth qualitative interviews to explore narratives about experience of preventing sexual transmission of HIV among 27 individuals (15 current IDUs and 12 main sexual partners of IDUs) in Kohtla-Järve, Estonia. RESULTS: The safe-sex 'norm' was not common and factors that tended to reduce condom use included valuing the relationship above health risks, established gender roles, perceptions that condoms distributed via harm reduction programmes were of low quality and the stigma attached to HIV status disclosure. HIV risk management strategies among participants included consistent condom use and serosorting but were countered by a fatalism that encompassed consciously subjecting oneself to the inevitability of HIV infection in an HIV-discordant sexual partnership. CONCLUSIONS: Qualitative methods can significantly contribute to the prevention of sexual transmission of HIV among and beyond IDUs by improving our understanding of risky behaviours and the reasons for such behaviours that can be incorporated into tailored public health interventions.

Associated factors for recommending HBV vaccination to children among Georgian health care workers.

BACKGROUND: Most cases of hepatitis B virus (HBV) infection and subsequent liver diseases can be prevented with universal newborn HBV vaccination. The attitudes of health care workers about HBV vaccination and their willingness to recommend vaccine have been shown to impact HBV vaccination coverage and the prevention of vertical transmission of HBV. The purpose of this study was to ascertain the factors associated with health care worker recommendations regarding newborn HBV vaccination. METHODS: A cross-sectional study of prevalence and awareness of hepatitis B and hepatitis B vaccine was conducted among randomly selected physicians and nurses employed in seven hospitals in Georgia in 2006 and 2007. Self-administered questionnaires included a module on recommendations for HBV, HCV and HIV. RESULTS: Of the 1328 participants included in this analysis, 36% reported recommending against hepatitis B vaccination for children, including 33% of paediatricians. Among the 70.6% who provided a reason for not recommending HBV vaccine, the most common concern was an adverse vaccine event. Unvaccinated physicians and nurses were more likely to recommend against HBV vaccine (40.4% vs 11.4%, PR 3.54; 95% CI: 2.38, 5.29). Additionally, health care worker age was inversely correlated with recommendations for HBV vaccine with older workers less likely to recommend it. CONCLUSION: Vaccinating health care workers against HBV may provide a dual benefit by boosting occupational safety as well as strengthening universal coverage programs for newborns.

Clinical epidemiology of carbapenem-intermediate or -resistant Enterobacteriaceae.

OBJECTIVES: Despite the increasing incidence of carbapenem-intermediate or -resistant Enterobacteriaceae (CIRE), risk factors associated with CIRE infections have not been well defined. This study characterizes factors associated with CIRE among two different source populations. METHODS: A case-control study was performed at a tertiary care medical centre between January 2005 and December 2009. Cases were adults with a culture-confirmed Enterobacteriaceae infection with reduced susceptibility to meropenem or ertapenem. The CIRE cases were matched 1:1 to patients from two different control series: (i) those with carbapenem-susceptible Enterobacteriaceae (CSE) infections; and (ii) inpatients residing on the same ward within 30 days of CIRE culture date. Logistic regression was used to identify variables independently associated with CIRE among each source population. Restricted multivariate analyses were performed to determine if covariates predictive of CIRE varied by infecting organism or presence of the bla(KPC) gene. RESULTS: There were 102 cases of CIRE during the study period. The only covariate independently associated with CIRE in all multivariate analyses was the cumulative number of prior antibiotic exposures. Compared with CSE controls, the odds ratios (95% confidence interval) were 1.43 (1.19-1.72), 2.05 (1.70-2.47) and 2.93 (2.43-3.53) for 1, 2 and ≥ 3 antibiotic exposures, respectively. The strength of this association was comparable for the hospitalized control group and analyses stratified by organism and presence of the bla(KPC) gene. CONCLUSIONS: A patient's cumulative antibiotic exposure history is likely to be more important than any one specific exposure when determining the likelihood of developing a CIRE infection.

Risk factors for relapse of visceral leishmaniasis in Georgia.

The number of relapses in patients treated for visceral leishmaniasis (VL) has increased, thus identifying prognostic factors may aid decisions on treatment. Demographic and clinical information was abstracted from medical records of patients diagnosed and treated in Georgia from 2002 to 2004. The 300 persons with VL were primarily children <5 years (73.3%), and ∼44% had delays in diagnosis of more than 30 days from symptom onset. All patients received standard therapy with pentavalent antimony (20 mg/kg/day), most for 20-25 days. Factors significantly associated with VL relapse were delay in diagnosis for >90 days (RR = 4.21, 95% CI: 1.58, 11.16), haemoglobin level <60 g/l (RR = 11.96, 95% CI: 4.12, 34.76) and age <1 year (RR = 2.36, 95% CI: 0.96, 5.80). Physician and public education is needed to reduce delays in diagnosis. Prolonging treatment for 30 days (e.g. WHO recommendation) or implementing new regimens may reduce the number of relapses.

Characteristics of HIV-infected women and factors associated with HCV seropositivity in the Republic of Georgia.

BACKGROUND: The aim of this study was to describe the extent of the HIV epidemic among women in the Republic of Georgia and to identify factors associated with HCV co-infection in this population. FINDINGS: All women aged ≥18 years who were diagnosed with HIV between 1989 and 2006 were identified through the National HIV/AIDS surveillance database. Medical records were reviewed for demographic characteristics, risk factors and HCV serostatus. A total of 249 women were identified. Only 4% declared injection drug use (IDU); sex work was reported by 9%. Substantial risk factors were identified among the women's sexual partners, nearly 69% of whom were IDUs, 84% were HIV positive and 66% HCV positive. Seventeen percent of women were seropositive for HCV. Factors significantly associated with HCV seropositivity in bivariate analyses among non-IDU women were partner IDU+ [Prevalence ratio (PR): 4.5 (95% CI: 1.4, 14.2)], and partner HCV+ [PR: 7.2 (95% CI: 1.8, 29.5)]. CONCLUSIONS: The HIV epidemic in the Republic of Georgia is closely tied to the IDU community. Evidence-based interventions targeting IDU and partners of IDU are urgently required to halt the spread of the HIV epidemic in the country.

Assessing non-response to a mailed health survey including self-collection of biological material.

BACKGROUND: Collection of biological material via mailed health surveys is an emerging trend. This study was conducted to assess non-response bias in a study of sexually transmitted infection utilizing self-collected, home-obtained specimens. METHODS: Data from a nationwide administrative database on health care utilization together with data from a research study were used. The research study was an outreach screening programme including home-obtained, participant-collected, mail-delivered testing for Chlamydia trachomatis. A random sample of 1690 persons aged 18-35 years from the population registry was selected. Study materials (specimen collection kit, informed consent, questionnaire) were mailed in three waves. RESULTS: The first mailing yielded a response rate of 18.5% (n = 259), the second 10.1% (n = 141) and the third 11.4% (n = 160). Women were more likely to respond than men, and responders were less likely to have had medical care in the past year and more likely to have had a prior sexually transmitted infection than non-responders. Chlamydia trachomatis infection rates tended to be higher in early responders. Late responders appeared more like non-responders in terms of demographic factors, health care utilization patterns and potential disease status. CONCLUSION: Non-response in a health survey including biological material self-collection warrants research as it may differ from non-response in general health questionnaires.