The COBATEST network: monitoring and evaluation of HIV community-based practices in Europe, 2014-2016.

OBJECTIVE: The objective of this paper is to describe the data collected by the CBVCT services from the Community-based testing (COBATEST) network, from 2014 to 2016, in order to provide an insight into community-based voluntary counselling and testing (CBVCT) services' testing activity in Europe. METHODS: A descriptive analysis of HIV testing activity in CBVCT services that are using the COBATEST tools was performed for the period 2014-2016. RESULTS: During the study period, a total of 30 329 HIV tests were performed on 27 934 individuals, of which 1.8% were reactive. Of these reactive tests, 75.8% had a confirmatory test, 92.2% of those were confirmed as positive, and 90.38% of the confirmed positives were linked to care. The total number of tests performed over the study period increased 19.31%. The proportion of confirmatory tests increased from 63.0% to 90.0% and proportion linked to care increased from 84.1% to 93.8%. Most of the tested individuals were men (70.6%), aged between 21 and 35 years (58.5%) and non-foreign born (68.1%). A high proportion of individuals tested were men who have sex with men (MSM; 42.2%). The percentage of reactive screening tests was particularly high among transgender people (8.37%) and among male sex workers (6.38%). Repeat testers had a higher percentage of reactive tests (2.02%) than those tested for first time (1.1%). CONCLUSIONS: These results prove the feasibility of collecting standardized data from CBVCT services in different countries across Europe and demonstrate the usefulness of such data.

The COBATEST network: a platform to perform monitoring and evaluation of HIV community-based testing practices in Europe and conduct operational research.

The European project "HIV community-based testing practices in Europe" (HIV-COBATEST) has contributed to the establishment of a network of community-based voluntary counselling and testing services (CBVCTs) that monitors and evaluates HIV testing activity in the communities. The objective of this paper is to describe the data that have been collected during 2014 by the COBATEST network in order to provide an insight into testing activity of CBVCTs in Europe. Members of the CBVCT network share common instruments for data collection and data entry. The network has a common database that allows global data analysis and comparison between different centres. In 2014, 40 CBVCTs of 18 European countries were participating in the network, and, from those, 20 CBVCTs were using the common COBATEST data collection tools. In these 20 CBVCTs, a total of 9266 HIV screening tests were performed on 8554 people, of which 1.58% (135/8554) were reactive and 51.1% (69/135) confirmed positive. Five cases were false positives, and 84.1% (58/69) of the confirmed positive cases were linked to care. Most of the tested individuals were men (70.8%), between 21 and 35 years of age (57.6%) and natives (67.1%). A higher proportion of men who had sex with men (MSM) (38.8%; 3267/8554) were tested compared to heterosexual men (27.7%) and women (23.5%). Rapid blood test was used in 78.5% of the cases and mostly performed in CBVCT offices (88.3%). Among sex workers (SWs), the percentage of reactive screening tests was particularly high (4.0%), especially among male SWs (7.7%) as compared to other risk groups, such as MSM (3.1%). The COBATEST network contributes to the availability of standardized information about the activity and impact of CBVCT centres in Europe. This information and standardized tools can help improve these services and inform decision-makers to better contextualize these interventions within their national HIV-prevention programmes.

Hepatitis C virus infection among pregnant women in Slovenia: study on 31,849 samples obtained in four screening rounds during 1999, 2003, 2009 and 2013.

The majority of people infected with hepatitis C virus (HCV) are unaware of their infection. Assessment of the prevalence of HCV infection in the general population and in key populations at increased risk is needed for evidence-based testing policies. Our objectives were to estimate the prevalence of antibodies to HCV (anti-HCV), the prevalence of HCV viraemia (HCV RNA), and to describe HCV genotype distribution among pregnant women in Slovenia. Unlinked anonymous testing was performed on residual sera obtained from 31,849 pregnant women for routine syphilis screening during 1999, 2003, 2009, and 2013. Anti-HCV reactive specimens were tested for HCV RNA and HCV genotypes were determined. Annual prevalence of anti-HCV ranged between 0.09% (95% confidence interval (CI): 0.03­0.18) in 2009 and 0.21% (95% CI: 0.12­0.34) in 2003 and HCV RNA positivity between 0.06% (95% CI: 0.02­0.14) in 2009 and 0.14% (95% CI: 0.07­0.25) in 2003. We observed no statistically significant differences in anti-HCV or HCV RNA prevalence between age groups (<20, 20­29 and ≥30 years) in any year and no trend in time. Of 29 HCV active infections, 19 were with genotype 1 and 10 with genotype 3. HCV infection among pregnant women was rare suggesting a low burden in the Slovenian general population. Antenatal screening for HCV in Slovenia could not be recommended.

Methicillin-resistant Staphylococcus aureus (MRSA) in Europe: which infection control measures are taken?

BACKGROUND: The prevalence of hospital-acquired Methicillin-resistant Staphylococcus aureus (MRSA) infections shows a huge variety across Europe. Some countries reported a reduction in MRSA frequency, while in others countries increasing MRSA rates have been observed. To reduce the spread of MRSA in the healthcare setting, a sufficient MRSA management is essential. In order to reflect the MRSA management across Europe, MRSA prevention policies were surveyed in ten countries. MATERIALS AND METHODS: The survey was performed by questionnaires in European intensive care units (ICUs) and surgical departments (SDs) in 2004. Questionnaires asked for availability of bedside alcohol hand-disinfection, isolation precautions, decolonization and screening methods. The study was embedded in the Hospital in Europe Link for Infection Control through Surveillance (HELICS) Project, a European collaboration of national surveillance networks. HELICS was initiated in order to harmonize the national surveillance activities in the individual countries. Therefore, HELICS participants developed surveillance modules for nosocomial infections in ICUs and for surgical site infections (SSI). The coordination of this surveillance has now been transferred to the European Centre for Disease Prevention and Control (ECDC). RESULTS: A total of 526 ICUs and 223 SDs from ten countries sent data on organisational characteristics and policies, demonstrating wide variations in care. Substantial variation existed in availability of bedside alcohol hand-disinfection, which was much higher in participating ICUs rather than in SDs (86 vs. 59%). Surveillance cultures of contact patients were obtained in approximately three-fourths of all SDs (72%) and ICUs (75%). Countries with decreasing MRSA proportions showed especially strict implementation of various prevention measures. CONCLUSION: The data obtained regarding MRSA prevention measures should stimulate infection control professionals to pursue further initiatives. Particularly, the vigorous MRSA management in countries with decreasing MRSA proportions should encourage hospitals to implement preventive measures in order to reduce the spread of MRSA.

Sexual behaviour and HIV/sexually transmitted infection risk behaviours in the general population of Slovenia, a low HIV prevalence country in central Europe.

OBJECTIVES: To describe sexual and HIV/sexually transmitted infection (STI) risk behaviours in Slovenia. METHODS: A nationally representative cross-sectional survey of the general population aged 18-49 years in 1999-2001 was conducted. The data were collected by face-to-face interviews and anonymous self-administered questionnaires. Statistical methods for complex survey data were used. RESULTS: 849 men and 903 women were interviewed. In the past 5 years, both men and women reported a median of one heterosexual partner (means 3.2, 1.5, respectively), concurrent heterosexual partnerships were reported by 24.4% of men and 8.2% of women, heterosexual sex with non-Slovenian partners by 12.6% of men and 12.2% of women, forced sex by 4.8% of women, paid heterosexual sex by 2.6% of men, sex with another man by 0.6% of men and heterosexual sex with an injecting drug user by 1.2% of men and 1.3% of women. In the past year, 22.7% of men and 9.5% of women reported forming at least one new heterosexual partnership. The mean numbers of episodes of heterosexual sex in the previous 4 weeks were 6.1 for men and 6.0 for women. Consistent and inconsistent condom use was reported more frequently among men reporting multiple female partners and those not married or cohabiting. CONCLUSIONS: Recent patterns of reported sexual behaviour are consistent with a low risk of HIV and STI transmission in Slovenia. The results will inform Slovenian sexual health policies including HIV/STI prevention, and are particularly valuable because population-based data on HIV/STI risk behaviour have not previously been available in low HIV prevalence countries of central Europe.

National influences on catheter-associated bloodstream infection rates: practices among national surveillance networks participating in the European HELICS project.

This study was performed to evaluate associations between organisational characteristics, routine practices and the incidence densities of central venous catheter-associated bloodstream infections (CVC-BSI rates) in European intensive care units (ICUs) as part of the HELICS project (Hospitals in Europe Link for Infection Control through Surveillance). Questionnaires were sent to ICUs participating in the national nosocomial infection surveillance networks in 2004. The national networks were asked for the CVC-BSI rates of the ICUs participating for the time period 2003--2004. Univariate and multivariate risk factor analyses were performed to identify which practices had the greatest impact on CVC-BSI rates. A total of 526 ICUs from 10 countries sent data on organisational characteristics and practices, demonstrating wide variation in care. CVC-BSI rates were also provided for 288 ICUs from five countries. This made it possible to include 1383444 patient days, 969897 CVC days and 1935 CVC-BSI cases in the analysis. Adjusted logistic regression analysis showed that the categorical variables of country [odds ratio (OR) varying per country from OR: 2.3; 95% confidence interval (CI): 0.5-10.2; to OR: 12.8; 95% CI: 4.4-37.5; in reference to the country with the lowest CVC-BSI rates] and type of hospital 'university' (OR: 2.08; 95% CI: 1.02-4.25) were independent risk factors for high CVC-BSI rates. Substantial variation existed in CVC-BSI prevention activities, surveillance methods and estimated CVC-BSI rates among the European countries. Differences in cultural, social and legal perspectives as well as differences between healthcare systems are crucial in explaining these differences.

Disproportionate and increasing burden of HIV infection among men who have sex with men in Slovenia: surveillance data for 1999-2008.

The report presents data on HIV infection among men who have sex with men (MSM) in Slovenia during 1999-2008. HIV surveillance was based on universal mandatory reporting of HIV/AIDS cases, monitoring HIV infection prevalence among sentinel populations of MSM and STI patients and selected behaviour indicators in a sentinel population of MSM. Among 48 newly diagnosed HIV cases reported for 2008, 34 were MSM. Since 1999, the annual reported rate of HIV diagnoses in MSM rose from 7.1 to 46.8 per million men aged 15-64 years (an increase of more than six times). During 1999-2008, the proportion of MSM diagnosed with AIDS within three months of HIV diagnosis declined from 60% to 21%, however, the corresponding rate per million men aged 15-64 increased from 4.3 to 9.6. During 1999-2008, HIV prevalence among male clients of STI outpatient services tested for syphilis (including a substantial proportion of MSM) increased from 0% to 3.4%, and it remained below 5% in a sentinel population of MSM in Ljubljana. In the same sentinel population of MSM, the proportion reporting HIV test last year increased from 29% in 2003 to 38% in 2008 while the proportion reporting condom use at last anal intercourse decreased from 81% in 2004 to 66% in 2008. The burden of HIV among MSM in Slovenia is disproportionately high and increasing fast. Promotion of safer sexual behaviour and HIV testing among MSM as well as positive prevention among MSM with diagnosed HIV infection are urgently needed.

Male circumcision in Slovenia: results from a national probability sample survey.

OBJECTIVES: To estimate the prevalence of male circumcision and to explore its association with demographic characteristics and self-reported sexually transmitted infection (STI) diagnosis in Slovenia. METHODS: Data were collected over 1999-2001 from a national probability sample of the general population aged 18-49 years at respondents' homes by a combination of face-to-face interviews and anonymous self-administration of questionnaires. Statistical methods for complex survey data were used to account for stratification, clustered sampling and weighting. RESULTS: Overall, 4.5% (95% CI 3.2 to 6.5) of Slovenian male citizens reported being circumcised. Major variations in the prevalence of circumcision were observed across religious groups, with 92.4% (95% CI 59.8 to 99.0) of Muslims being circumcised, 1.7% (95% CI 0.9 to 3.1) of Roman Catholics, 0% of other religious affiliations (Evangelic, Serbian Orthodox, other), and 7.1% (95% CI 4.4 to 11.2) of those with no religious affiliation (p<0.001). The prevalence of circumcision did not vary across age groups. There were no significant differences in the proportion of circumcised and uncircumcised Slovenian men reporting ever being diagnosed with bacterial STI or viral STI. CONCLUSIONS: The prevalence of circumcision among Slovenian men is low. No evidence was found for an association between STI diagnosis and circumcision status, which may be due to the low prevalence of both STI and circumcision in this population as well as a small sample size. In Slovenia, where HIV prevalence is <1/1000 citizens and HIV infection is concentrated in men who have sex with men, promoting male circumcision in the general population may not be effective for HIV prevention purposes.

An increase in newly diagnosed HIV cases reported among men who have sex with men in Europe, 2000-6: implications for a European public health strategy.

OBJECTIVE: To present HIV surveillance data on men who have sex with men (MSM) in the European Union (EU) and European Free Trade Association (EFTA) countries for the period 2000-6. METHODS: Data from three sources, HIV reporting, AIDS reporting and HIV prevalence studies, were collated by EuroHIV and analysed for 27 EU and three EFTA countries. RESULTS: In 2006, 7693 newly diagnosed HIV infections among MSM were reported (56.7 per million men aged 15-64 years). In 23 countries with data for 2000-6, the number of new HIV diagnoses increased by 86% from 3003 to 5571. In 20 countries reporting individual HIV cases between 2000 and 2006, the median age at HIV diagnosis remained unchanged (36 years), whereas the proportion of MSM presenting with an AIDS-defining illness at the time of HIV diagnosis declined from 25% in 2000 to 10% in 2006 (chi2 = 85.7, p<0.001). In 30 countries reporting AIDS, incidence among MSM decreased by 40% from 2422 in 2000 to 1445 in 2006 and the number of deaths decreased by 57% from 876 to 373. Reported HIV prevalence ranged between 8% and 68% among MSM with sexually transmitted infections, between 10% and 18% among those recruited in community settings, but remained <10% in central Europe and Ireland. CONCLUSIONS: Whereas the decreasing rates of AIDS diagnoses and AIDS deaths reflect relatively good access to therapy, the increasing numbers of new HIV diagnoses and relatively high prevalence of HIV among MSM suggest the need for Europe-wide HIV prevention among MSM.

The burden of genital warts in Slovenia: results from a national probability sample survey.

The objective of this study was to estimate the lifetime age-specific cumulative incidence of self-reported genital warts diagnosis in Slovenia and to explore the association with demographic characteristics and self-reported sexual behaviour. Data were collected in the period from November 1999 to February 2001 from a national probability sample of the general population aged 18-49 years through a combination of face-to-face interviews at the respondents' homes and anonymous self-completed questionnaires. In total, 849 men and 903 women were interviewed (response: 63.3% men, 70.9% women). Among sexually experienced respondents with available information (752 men and 842 women), previous diagnosis of genital warts was reported by 0.3% of men (95% confidence interval (CI): 0.0%-1.3%) and 0.4% of women (95% CI: 0.1%-1.1%), and in the age group of 40-49 year-olds by 0.5% of men (95% CI:0.0-3.2) and 0.7% of women (95% CI: 0.2%-2.9%). In comparison to women with fewer than 10 lifetime male partners, those who reported to have had at least 10 male partners were more likely to have a previous diagnosis of genital warts (adjusted odds ratio: 7.2 (95% CI: 1.1%-47.8%). The lifetime cumulative incidence of self-reported genital warts diagnosis among Slovenians was relatively low in comparison to other published estimates from probability sample surveys in the general population in European countries. Our findings will inform the Slovenian vaccination policy against human papillomaviruses (HPV) and contribute to a better understanding of the differences between European countries regarding the burden of genital warts.

Prevalance of and risk factors for hospital-acquired infections in Slovenia-results of the first national survey, 2001.

A one-day survey was conducted in all (19) Slovenian acute-care hospitals in October 2001 to estimate the prevalence of all types of hospital-acquired infections (HAIs) and to identify predominant micro-organisms and risk factors. Among 6695 patients surveyed, the prevalence of patients with at least one HAI was 4.6%. The prevalence of urinary tract infections was highest (1.2%), followed by pneumonia (1.0%), surgical wound infection (0.7%), and bloodstream infection (0.3%). In intensive care units (ICUs) the prevalence of patients with at least one HAI was 26.9% and the ratio of episodes of HAI per number of patients was 33.3%. One or more pathogens were identified in 55.8% of HAIs episodes. Among these, the most frequently single isolated micro-organisms were Staphylococcus aureus (18.2%) and Escherichia coli (10.2%). Risk factors for HAI included central intravascular catheter (adjusted odds ratio (OR) 3.2; 95% confidence intervals (CI) 2.1-4.9), peripheral intravascular catheter (adjusted OR 1.7; 95% CI 1.2-2.4), urinary catheter (adjuster OR 2.4; 95% CI 1.6-3.4), and hospitalization in ICUs (adjusted OR 2.5; 95% CI 1.4-4.3). The results provide the first national estimates for Slovenia.

Syphilis epidemic in Slovenia influenced by syphilis epidemic in the Russian Federation and other newly independent states.

In 1994 an 18-fold increase in the annually reported incidence rate of early syphilis (to 1.81 cases per 100,000 total population) in comparison to the preceding year was observed in Slovenia. The reported incidence rates remained elevated for a period of five years. The possible link between the evolving syphilis epidemic in the Russian Federation and newly independent States (NIS) during the 1990s and the observed increases in the reported early syphilis incidence rates in Slovenia, was explored. Surveillance data obtained by mandatory reporting of all newly diagnosed syphilis cases between 1994 and 1999 were analysed according to the information on sexual partners, the country of probable source of infection, and occupation. More than half of all reported cases (62%) were directly or indirectly linked to a source of infection abroad. Among these, the majority of cases (73%) were linked to the Russian Federation or NIS. Of these, 68% occurred in males, a high proportion being long-distance lorry drivers.

Feasibility of testing for Chlamydia trachomatis in a general population sexual behaviour survey in Slovenia.

Our objective was to assess the feasibility of integrating first void urine (FVU) specimens testing for Chlamydia trachomatis genitourinary infection into a general population sexual behaviour survey. A total of 752 randomly selected respondents aged 18 to 54 were enrolled into the survey. Face to face interviewing with self-administered sensitive questions was used. Overall survey response rate was 77.4%. A convenience sub-sample of 83 respondents were invited to provide FVU specimens for confidential testing for C. trachomatis genitourinary infection. Fifty-five complied. This resulted in 66% FVU specimen participation rate among targeted respondents. Two specimens tested positive by Amplicor polymerase chain reaction. High feasibility study overall response rate indicated good acceptability of the survey. It proved feasible to collect FVU specimens for C. trachomatis testing in the small sub-sample. Consequently, we proceeded with integration of testing for C. trachomatis into the ongoing main survey.

Factors associated with early sexual debut in Slovenia: results of a general population survey.

OBJECTIVES: To investigate time trends in age at first heterosexual intercourse (FHI) and associated factors. METHODS: Data were collected from a national probability sample of the general population aged 18-49 years. RESULTS: Median age at FHI was 17 years for men and 18 years for women, but declined from 18 years to 17 years in men born after the early 1960s and in women born after the early 1970s. Early FHI (before age 16) was reported by 15.2% of men and 7.4% of women, but in recent cohorts (born 1975-82), proportions were similar in both sexes (16.9% and 14.4%, respectively). In women, higher educational level and acquiring most knowledge about sex from parents or in school were associated with later age at FHI. Half the women with early FHI judged the event to have occurred too soon. 4.2% of women with early FHI reported coercion at FHI, compared to 0.9% overall. The main factor associated with early FHI in men was not living with both parents up to the age of 15. Individuals with early FHI were more likely to report higher risk sexual behaviour as well as teenage motherhood and, for men, not having used a condom at FHI and bacterial sexually transmitted infections. Three in four individuals with early FHI thought they had inadequate sexual knowledge at FHI. Many would have liked to have learned more from parents and in school. CONCLUSIONS: Improved sexual education among young Slovenians should aim to delay FHI until a more mature age and to be better prepared for safer sex.

Prevalence of genital Chlamydia trachomatis infection in the general population of Slovenia: serious gaps in control.

OBJECTIVES: One of the objectives of the first national survey of sexual lifestyles, attitudes, and health in Slovenia was to estimate the prevalence of and risk factors for genital Chlamydia trachomatis infection in Slovenian adults aged 18-49 years. METHODS: Data were collected over 1999-2001 from a probability sample of the general population by face to face interviews and anonymous self administered questionnaires. Respondents were invited to provide a first void urine (FVU) specimen for polymerase chain reaction testing for C trachomatis infection. We compared the results to the equivalent British survey. RESULTS: 1447 individuals contributed FVU specimens (82.6% of survey respondents, 55.3% of those eligible). C trachomatis infection was diagnosed in 3.0% of men and 1.6% of women. Prevalence was highest in men and women aged 18-24 years (4.1% for both). Individuals reporting first heterosexual intercourse before the age of 16, unprotected sexual intercourse with at least one heterosexual partner during the preceding year, concurrent heterosexual relationships during the preceding year, and five or more lifetime heterosexual partners had a higher prevalence. The association was statistically significant only for five or more lifetime partners (adjusted OR 3.0; 95% CI 1.3 to 6.9; p = 0.01). CONCLUSIONS: A relatively high prevalence of genital C trachomatis infection among 18-24 year old Slovenians, in the presence of relatively low risk sexual behaviour and low reported incidence rates of chlamydia infection, suggest serious gaps in the diagnosis and treatment of the condition. The results provide support for the introduction of chlamydia screening in Slovenia.

The seroepidemiology of herpes simplex virus type 1 and 2 in Europe.

OBJECTIVES: To describe the seroepidemiology of herpes simplex virus (HSV) types 1 and 2 in the general populations of eight European countries to better understand recent reported changes in disease epidemiology. METHODS: Belgium, Bulgaria, Czech Republic, England and Wales, Finland, Germany, Netherlands, and Slovenia conducted national cross sectional serological surveys for HSV-1 and HSV-2 between 1989 and 2000. Survey sizes ranged from 3000 to 7166 sera. External quality control was ensured through reference panel testing. RESULTS: Large intercountry and intracountry differences in HSV-1 and HSV-2 seroprevalence were observed. Age standardised HSV-1 seroprevalence ranged from 52% in Finland, to 57% in the Netherlands, 67% in Belgium, 81% in Czech Republic, and 84% in Bulgaria. Age standardised (>12 years) HSV-2 seroprevalence ranged from 24% in Bulgaria, to 14% in Germany, 13% in Finland, 11% in Belgium, 9% in Netherlands, 6% in Czech Republic, and 4% in England and Wales. In all countries, probability of seropositivity for both infections increased with age. A large proportion of teenagers and young adults remain HSV-1 susceptible particularly in northern Europe. Women were significantly more likely to be HSV-2 seropositive in six of seven (p<0.05) countries and HSV-1 seropositive in four of seven (p<0.05) countries, particularly in northern Europe. No significant evidence of a protective role of HSV-1 for HSV-2 infection was found adjusting for age and sex (p<0.05). CONCLUSIONS: There is large variation in the seroepidemiology of HSV-1 and HSV-2 across Europe. The observation that a significant proportion of adolescents are now HSV-1 susceptible may have implications for transmission and clinical presentation of HSV-1 and HSV-2.