Non-Fatal Overdoses & Related Risk Factors among People Who Inject Drugs in St. Petersburg, Russia & Kohtla-Järve, Estonia

Background

This study seeks to identify the prevalence of, and risk factors associated with, non-fatal overdose among people currently injecting drugs (PWID) in St. Petersburg (Russia) and in Kohtla-Järve (Estonia).

Methods

Five hundred eighty-eight study participants in Kohtla-Järve (in 2012) and 811 in St. Petersburg (in 2012–2013) were recruited using respondent driven sampling for interviewing and HIV testing.

Results

Three-quarters (76 %) of the current PWID were male. Participants from St. Petersburg were older (mean age 32.1 vs. 29.6 years, p < 0.0001) and reported a longer average duration of injecting drugs (mean duration: 13.3 vs. 10.9 years, p < 0.0001). Main drugs injected were opioids (fentanyl in Kohtla-Järve, heroin in St Petersburg). HIV prevalence was 63 % (95 % CI 59–67 %) in Kohtla-Järve and 56 % (95 % CI 52–59 %) in St. Petersburg. Two thirds of the PWID in Kohtla-Järve and St. Petersburg reported ever having experienced a drug overdose involving loss of consciousness or stopping breathing. In Kohtla-Järve, 28 % (95 % CI 24–31 %) of participants and, in St Petersburg, 16 % (95 % CI 14–19 %) of participants reported an overdose within the previous 12 months. Characteristics of injection drug use practice (longer duration of injection drug use, main drug injected), correlates of high-risk injection behaviour (higher injecting frequency, sharing), and problem alcohol use were associated with the risk of overdose within the previous 12 months. The significant factors effects did not differ between the sites.

Conclusions

PWID are at high risk for overdose. Effective overdose prevention efforts at the public health scale are therefore warranted.

Table 1

Socio-demographic, injection drug use, HIV prevalence and care and environmental characteristics of current injection drug users participating and the prevalence of self-reported non lethal overdose within the last 12 months from cross sectional studies in Kohtla-Järve, Estonia (in 2012) and St Petersburg, Russia (in 2012 – 2013)

	Kohtla-Järve (Estonia), N = 588			St Petersburg (Russia), N = 811
Characteristics	n	%	Overdose last 12 months (%)	n	%	Overdose last 12 months (%)
Socio-demographi indicators
Age			p = 0.134			p = 0.337
29 or less	295	50 %	25 %	245	30 %	18 %
30 or more	293	50 %	30 %	566	70 %	15 %
Gender			p = 0.833			p = 0.423
Male	435	74 %	27 %	631	78 %	16 %
Female	152	26 %	28 %	180	22 %	18 %
Main source of income (last 6 months)			p = 0.239			p = 0.021
Work (full/part time)	192	33 %	23 %	590	73 %	14 %
Social benefits	263	45 %	30 %	22	3 %	14 %
Other	127	22 %	31 %	199	25 %	23 %
Drug use characteristics
Duration of injecting			p < 0.001			p = 0.008
< = 9 years	230	39 %	16 %	170	21 %	9 %
= > 10 years	356	61 %	35 %	640	79 %	18 %
Frequency of injecting (last 4 weeks)			p < 0.001			p < 0.001
< Daily	447	76 %	24 %	524	65 %	11 %
Daily +	139	24 %	40 %	287	35 %	26 %
Main drug injected (last 4 weeks)			p < 0.001			p = 0.116
Amphetamine	195	35 %	14 %	27	3 %	4 %
Fentanyl	350	62 %	34 %	4	0 %	25 %
Heroin	1	0 %		563	69 %	18 %
Methadone	0	0 %		217	27 %	14 %
Injecting multiple drugs (last 4 weeks)			p = 0.124			p = 0.003
No	378	64 %	25 %	495	61 %	8 %
Yes	210	36 %	31 %	316	39 %	21 %
Non-injecting drug use (last 4 weeks)			p = 0.575			p = 0.037
No	324	57 %	27 %	755	93 %	15 %
Yes	246	43 %	29 %	56	7 %	27 %
Sharing (last 4 weeks)			p < 0.001			p < 0.001
No	492	85 %	24 %	277	34 %	7 %
Yes	88	15 %	49 %	534	66 %	21 %
Problem alcohol use			p = 0.009			p < 0.001
No	247	42 %	22 %	275	34 %	8 %
Yes	341	58 %	32 %	536	66 %	21 %
Mental health (MHI 5)			p = 0.003			p < 0.001
> = 52	362	62 %	23 %	536	66 %	13 %
<52	221	38 %	35 %	275	34 %	23 %
Structural (environmental) characteristics
Homelessness (current)			p = 0.619			p = 0.454
No	583	99 %	27 %	798	98 %	16 %
Yes	5	1 %	40 %	13	2 %	14 %
Ever been in prison			p < 0.001			p = 0.368
No	266	45 %	19 %	537	66 %	17 %
Yes	322	55 %	35 %	274	34 %	15 %
Main source of syringes (last 4 weeks)			p = 0.0018			p = 0.0121
Needle and syringe program (NSP)	445	77 %	30 %	119	15 %	11 %
Pharmacy	76	13 %	16 %	615	76 %	19 %
Other	26	5 %	35 %	30	4 %	10 %
None	29	5 %	7 %	46	6 %	4 %
Currently receiving drug treatment			p > 0.9			p = 0.133
No	216	68 %	32 %	563	97 %	18 %
Yes	102	32 %	32 %	19	3 %	32 %
HIV infection and care
HIV infected			p = 0.013			p = 0.021
No	218	37 %	22 %	359	44 %	13 %
Yes	370	63 %	31 %	452	56 %	19 %
Currently on ART			p = 0.342			p = 0.051
No	247	67 %	33 %	403	90 %	20 %
Yes	123	33 %	28 %	47	10 %	9 %

Full article at:   http://goo.gl/3bJM3D

By:   Anneli Uusküla, Mait Raag, Sigrid Vorobjov, Kristi Rüütel, Alexandra Lyubimova, Olga S. Levina, and Robert Heimer

Department of Public Health, University of Tartu, Ravila st 19, 50409 Tartu, Estonia

Infectious Diseases and Drug Monitoring Department, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia

NGO Stellit, St Petersburg, Russian Federation

Department of Epidemiology of Microbial Diseases and the Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, 60 College St, New Haven, CT 06510 USA

Anneli Uusküla, Phone: + 3727374195, Email: ee.tu@aluksuu.ilenna.

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HIV Infection in Migrant Populations in the European Union and European Economic Area in 2007-2012: An Epidemic on the Move

Migrants are considered a key group at risk for HIV infection. This study describes the epidemiology of HIV and the distribution of late HIV presentation among migrants within the European Union/European Economic Area during 2007-2012.

HIV cases reported to European Surveillance System (TESSy) were analyzed. Migrants were defined as people whose geographical origin was different than the reporting country. Multiple logistic regression was used to model late HIV presentation.

Overall, 156,817 HIV cases were reported, of which 60,446 (38%) were migrants. Of these, 

• 53% were from Sub-Saharan Africa, 
• 12% from Latin America, 
• 9% from Western Europe, 
• 7% from Central Europe, 
• 5% from South and Southeast Asia, 
• 4% from East Europe, 
• 4% from Caribbean, and 
• 3% from North Africa and Middle East. 

Male and female migrants from Sub-Saharan Africa and Latin America had higher odds of late HIV presentation than native men and women. Migrants accounted for 40% of all HIV notifications in 2007 versus 35% in 2012. HIV cases in women from Sub-Saharan Africa decreased from 3725 in 2007 to 2354 in 2012. The number of HIV cases from Latin America peaked in 2010 to decrease thereafter. HIV diagnoses in migrant men who have sex with men increased from 1927 in 2007 to 2459 in 2012.

Migrants represent two-fifths of the HIV cases reported and had higher late HIV presentation. HIV epidemic in migrant populations in European Union/European Economic Area member states is changing, probably reflecting the global changes in the HIV pandemic, the impact of large-scale ART implementation, and migration fluctuations secondary to the economic crisis in Europe.

Purchase full article at: http://goo.gl/1GDUIx

By: Hernando V1, Alvárez-Del Arco D, Alejos B, Monge S, Amato-Gauci AJ, Noori T, Pharris A, Del Amo J.

• 1*Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; †CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; ‡Department of Surgery, Medical and Social Sciences, Universidad Alcalá, Alcalá de Henares, Spain; and §Surveillance and Response Section, European Centre for Disease Prevention and Control, Stockholm, Sweden.  

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