Integration of community-based testing data into national HIV surveillance in Poland, Serbia and Slovakia within the framework of INTEGRATE project.

BACKGROUND: Community-based voluntary counselling and testing contributes to early HIV diagnoses among key populations. Testing data from such decentralized services is however often not standardized nor linked to national surveillance systems. This study aimed to support the integration of community testing data into respective national surveillance and monitoring and evaluation systems for those infections. We present results from three national pilots, focused on improved data collection and transfer. METHODS:  Within the Joint Action INTEGRATE different pilot activities were planned and implemented according to the local context. In Slovakia, standardised data collection tools were implemented in three community testing services. The data generated was used to calculate the proposed indicators. In Poland, positive test results from the community testing database were linked to the national case-based surveillance database using confirmatory test number, to improve the completeness of behavioural data in the national database. In Serbia, voluntary counselling and testing forms were improved enabling identification of community-based testing. A system to generate unique client identifiers was initiated in the National registry of HIV cases to monitor linkage to care. RESULTS: All three sites were able to estimate most of the agreed indicators. In Slovakia during the study period 675 people were tested for HIV, 410 for hepatitis C and 457 for syphilis, with reactivity rates of 0.4, 2.5 and 1.8%, respectively. For HIV, 66.7% of reactive cases were confirmed and linked to care. In Poland, 28.9% of the community testing sites' records were linked to the national surveillance database (and accounted for 14.3% of all new diagnoses registered here during 2017-2018). Reactivity rate ranged between 1.9% and 2.1%. In Serbia, 80 persons were tested at community sites, from which two had a reactive HIV test result. By linking unique client identifiers from voluntary counselling and testing and National Registry of HIV cases databases, linkage to care within a two-month period was observed for one of two people with reactive HIV test result. CONCLUSIONS:  Pilot activities in the three countries demonstrate that integration of community-based testing data into surveillance systems is feasible and can help improve national surveillance data by providing key information.

HIV and AIDS in Poland in 2018.

AIM: The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases and death among AIDS cases in Poland in 2018 in comparison to the changes in preceding years. MATERIALS AND METHODS: Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. RESULTS: In 2018 there were 1,209 HIV cases newly diagnosed in Poland (diagnosis rate: 3.15 per 100,000), including 100 among non-Polish citizens. The frequency of newly detected HIV infections decreased by nearly 14.8% compared to the previous year and was higher by almost 6.8% compared to the median in 2012-2016 years. The total number of AIDS cases was 110 (incidence 0.29 per 100,000), and 23 people died from AIDS disease (0.06 per 100,000). New HIV diagnoses were reported mainly among people in age 30 to 39 years (37.8%) and among men (86.8%). Among cases with known transmission route, 77.0% concerned among men who had sexual contact with men (MSM). However, compared to the previous year, there was a significant decrease in the percentage of infected people in all key populations, related to higher risk of HIV infection. In addition, we observe the drop in total number of infected people in 2018 compared to the previous year. Whether these observations represent just fluctuations or a stable tendency, related to decreasing incidence in different key populations can only be assessed in the following years. The percentage of AIDS cases diagnosed at the same time with HIV diagnosis decreased by 4% percent points in comparison to 2017 (from 75.7% to 71.84% of all incident AIDS cases). CONCLUSIONS: Despite the decreasing total number of new HIV diagnoses overall and among different key populations compared to the previous year, it is too early to conclude that these are the results of positive preventive measures. Still, all actions should be taken to ensure timely linkage to care, considering the growing number of infected people among foreigners residing in Poland, and to improve the low frequency of testing towards HIV in the whole population.

Genital Chlamydia trachomatis infections in young adults - a school-based bio-behavioural study in urban areas, Poland, 2012 to 2015.

Context and AimOne of the most common sexually transmitted pathogens disproportionately affecting young people is Chlamydia trachomatis (CT). This study aimed to assess prevalence of CT among sexually active students (aged 18-19 years) in their final years of high school education in Warsaw and Krakow. Methods: The sample was selected from 61 clusters, each cluster representing one school. We described city, sex, type of school and their association with CT prevalence. To account for non-responders we applied inverse probability weighting. Results: Our study population consisted of 3,136 young adults eligible for CT screening, of whom 2,326 reported having had sexual intercourse within past 12 months. Of the 950 students who agreed to be tested, 39 were infected with CT. Weighted prevalence of CT was 3.9% (95% confidence interval (CI): 2.7-5.1); however, prevalence in the students in Warsaw (6.6%; 95% CI: 3.5-12.4) was six times higher (prevalence ratio (PR) = 5.9; 95% CI: 2.0-17.3) than in Krakow (1.1%; 95% CI: 0.5-2.6). In both settings, female students attending vocational-technical schools were most affected; the prevalence in this group was more than five times higher (PR = 5.2; 95% CI: 1.7-15.6) compared with female peers in high schools and more than three times higher (PR = 3.3; 95% CI: 1.0-10.7) compared with male peers attending vocational-technical schools. Conclusion: Our study suggested prevalence of CT infection among young people in Poland comparable with the European average, supporting implementation of a CT control programme as recommended in international guidelines.

Socio-demographic Characteristics, Sexual and Test-Seeking Behaviours Amongst Men Who have Sex with Both Men and Women: Results from a Bio-behavioural Survey in 13 European Cities.

Within the MSM population, men who have sex with both men and women (MSMW) are identified as a high-risk group both worldwide and in Europe. In a multi-centred bio-behavioural cross-sectional study, we aimed to assess the relationship(s) between socio-demographic factors, stigma, sexual behavioural patterns, test seeking behaviour and sero-status amongst MSMW. A multi-level analysis was conducted to identify factors associated with being MSMW versus Men who have Sex with Men Only (MSMO). A total of 4901 MSM were enrolled across the 13 study sites. Participants were categorised as MSMW in the 12.64% of the cases. Factors such as educational status, perceived homonegativity, testing facilities knowledge and HIV testing lifetime seem to be relevant factors when characterising the MSMW group. The results highlight the vulnerability of MSMW and the wide spectrum of risky behavioural and psycho-social patterns, particularly in terms of HIV testing, 'outness', and perceived stigma.