DRUCK-study Experiences from implementing user survey, rapid testing and risk counselling, involving trained agency staff

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1 DRUCK-study Experiences from implementing user survey, rapid testing and risk counselling, involving trained agency staff Ruth Zimmermann Department for Infectious disease epidemiology HIV, AIDS STI and Hepatitis unit Robert Koch Institute Berlin

2 Interventionalpartsofthestudy HIV-rapid testing offered to participants -in supplementtodbs testing Targeted counselling in low-threshold drug services - Short and targeted counselling for knowledge gaps during interview - Training of counsellors HIV/ Hepatitis C test results Provided after 2 weeks during study opening hours Posttest-counselling by trained MD 2 DRUCK-Studie des Robert Koch-Instituts

3 Howtocollectdataon knowledge? Presenttruestatementson HBV, HCV, HIV, theirmodesof transmission and prevention Ex: Hepatitis C can be transmitted by sharing filters. o I knewthisalready o wasn tcleartome o thisisnewtome participant can learn something Ifthisfactisnot clearornew: Propose targeted short counselling 3

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5 Training of staff Awareness rising and training of drug facility staff for possible modes of transmission(hcv) Traditional HIV prevention approaches are not sufficient Transmission of HCV via filters, spoons, shared water Training ofstaffforclinicalcourse, therapeuticoptionsofhbv, HCV, HIV Find collaborating partners(local AIDS Hilfe..) Encourage drug facility staff to intervene in a targeted and brief way 5

6 Targeted counselling as short intervention in low threshold drug services targeted counselling % 80% 77% 65% % 43% 0 Leipzig (n=130) Hanover (n=252) Munich (n=235) Frankfurt (n=285) Hamburg (n=319) Cologne (n=322) 6

7 HIV rapid testing offered 4/4 days /week, coop. with localaids Hilfe, +++ engaged staff 46.0 offered 4/4 days /week, +++ Engaged MD offered 2/4 days/week, coop. with localaids Hilfe +++ engaged staff offered 4/4 days/week 2 study sites, Crack scene offered 4/4 days/week, Crack scene offered outside of study hours Leipzig (n=130) 32.0 Hanover (n=252) 23.0 Munich (n=235) 18.0 Frankfurt (n=285) 6.0 Hamburg (n=319) 1.3 Cologne (n=322) 7

8 Conclusions Whatdoesnot workwell? posttest counselling after several days Appointment-based interventions General traditional (risk) counselling Longerinterventions(> 10 minutes) What works well? Knowledge data collection by true statements Brief and targeted interventions(5-10 min) On site and risk related counselling HIV rapid testing(free, anonymous), combined with counselling Integrated and combined approaches, adapted to local conditions 8

9 Whatareyourexperiences? 9

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11 Discussion: how to improve effectiveness of prevention of infectious diseases? Present results to local department of health and drug helping system, discuss further steps Adress drug users with messages HIV: PEP is possible HIV: treatment is primary prevention HCV: look for neglected risks: straws, filters, spoons, HBV: get vaccinated 11

12 Discussion: how to improve effectiveness of prevention of infectious diseases? Adress GPs and low threshold medical care HBV: check, vaccinate, vaccinate, vaccinate (don t forget booster vaccination) Testing combined with counseling: HCV-antibody testing and RNA-testing!

13 Discussion: how to improve effectiveness of prevention of infectious diseases? Adress prisons and drug helping units Access to information and materials (needles, disinfectants,...) Last but not least: Adopt prevention strategies to local conditions

14 DRUCK-Study (DrogenundchronischeInfektionskrankheiten) Objectives TodetermineHIV, HBC, HCV andhtlv prevalenceamong current IDU in selected German cities Collection of representative KABP data, determining risk profiles ToimprovepreventionofHIV andhepatitisamongpwid in Germany Design Multicentre cross-sectional study Sero- and behavioural survey Sample size: 2,034 IVD (reached: IVD in 8 cities) 14

15 Methods Mapping ofdrugscenein cities Close co-operation with local low-threshold drug services Respondent driven sampling Data: Questionnaire-assisted interviews trained interviewers min. interview anonymised Capillary dried blood spots(dbs) Anti HIV Elisa/Blot Anti HCV Elisa/Blot + HCV-RNA + genotyping (HBsAg+) AntiHBs(titre) + AntiHBc+ HBV-DANN Anti HTLV 15

16 Studienstadt Berlin (n=337) Essen (n=197) Leipzig (n=130) Frankfurt a. M. (n=285) Köln (n=322) Hannover (n=252) München (n=235) Hamburg (n=319) HIV-Schnelltest- Angebot Kein Angebot?? An 4 von 4 Studientage n An 4 von 4 Studientagen Nur außerhalb d. Studienzeiten An 4 von 4 Studientagen An 2 von 4 Studientagen An 4 von 4 Studientagen Anzahl der durchgeführten HIV-Schnelltest Anzahl der Beratungen im Rahmen der Studie Kein Angebot?? 60 (46%) 51 (18%) 4 (1,3%) 80 (32%) 53 (23%) 18 (6%) / 5 k. A. 13 (4%) (FG18)???? 93 (72%) 85 (30%) 209 (65%) 201 (80%) 182 (77%) 138 (43%) Anzahl der versandten Befunde???? 115 (88%) 216 (76%) 271 (84%) 193 (77%) 199 (85%) 197 (62%) Anzahl der abgeholten Befunde 10???? k. A. 25 (9%) (bis ) ca. 22 (11%) 60 (30%) (8-10%) 16

17 Studienstadt Leipzig (n=130) Frankfurt a. M. (n=285) Köln (n=322) Hannover (n=252) München (n=235) Hamburg (n=x ) HIV-Schnelltest- Angebot An 4 von 4 Studientagen An 4 von 4 Studientagen Nur außerhalb der Studienzeiten An 4 von 4 Studientagen An 2 von 4 Studientagen An 4 von 4 Studientagen Anzahl der durchgeführten HIV- Schnelltest 60 (46%) 51 (18%) 4 (1,3%) 80 (32%) 53 (23%) XX (XX%) Anzahl der Beratungen im Rahmen der Studie 93 (72%) 85 (30%) 209 (65%) 201 (80%) 182 (77%) 17