High Levels of HCV Transmission and a New Outbreak of HIV Infection During the COVID-19 Pandemic Among People Who Inject Drugs in Thessaloniki, Greece

Author: Sotirios Roussos Efrosini Tsirogianni Despoina Trafali Dimitra Tsiagka Athina Gavalaki Zafeiris Papanikolaou Ioanna Papagiouvanni Athina Tampaki Chrysa Tsiara Dimitra Paraskeva Dimitrios Paraskevis George Kalamitsis Chrysa Ioannis Goulis Angelos Hatzakis Vana Sypsa

Theme: Epidemiology & Public Health Research Year: 2022

Thessaloniki is the second-largest city in Greece with approximately 1,200 People Who Inject
Drugs (PWID) (2016 estimate). Anti-HCV and HIV prevalence among PWID accessing drug
treatment programs in 2018 was 57% and 0.7%, respectively. We aim to assess the
prevalence and the levels of transmission of HCV and HIV in community-recruited PWID
during 2019-2021.
ALEXANDROS was a “seek-test-treat” community-based program where PWID were
recruited through Respondent-Driven Sampling over five consecutive recruitment rounds
during September 2019–July 2021. Individuals could participate in multiple rounds but only
once in each round. Participation included interviewing, HIV/HCV testing, counselling and
support for linkage and retention to HCV/HIV treatment. Anti-HCV and HIV prevalence were
estimated using the number of PWID found positive at any participation. To estimate HCV
and HIV incidence, we analysed data from 131 and 379 initially seronegative PWID with ≥2
available samples, respectively. The seroconversion time was estimated as the midpoint
between the last negative and first positive test date.
In total, 1,101 unique PWID were recruited. Participants had a mean (SD) age of 40.1 (8.5)
years; 54.0% were current PWID (injection in the past 30 days), 79.7% were not linked to
opioid substitution treatment programs and 15.0% were homeless. Anti-HCV and HIV
prevalence (95% CI) was 62.9% (60.1%-65.8%) and 7.0% (5.48%-8.50%), respectively. HCV
and HIV incidence rates (95% CI) were 16.0 (10.1-25.4) and 7.0 (4.8-10.2) new infections/100
person-years, respectively. Two-thirds of the identified HIV cases were newly diagnosed.
ALEXANDROS was successful in reaching rapidly a large number of PWID most in need
despite the difficulties posed by the COVID-19 pandemic. Apart from the high levels of HCV
transmission, we documented a high HIV incidence indicating the emergence of an HIV
outbreak that coincides with the COVID-19 pandemic and the implementation of social
distancing measures.
Disclosure of Interest Statement:
ALEXANDROS program was supported by the Conquering Hepatitis via Micro-Elimination
(CHIME) grant, Gilead Sciences. Additional support was provided by the Organization Against
Drugs (OKANA) and Hellenic Scientific Society for the Study of AIDS, STDs and Emerging
DParaskevis has received grants by Gilead, GSK, Janssen, and MSD.
GK has received a grant by Gilead Sciences.
AH has participated in advisory boards for Gilead, AbbVie, BMS and received unrestricted
grants: from AbbVie, BMS, Gilead, MSD, Novartis. He is Co-Chair of Hepatitis B & C Public
Policy Association funded by AbbVie, Gilead, and MSD.
VS has received a grant by Gilead Sciences and AbbVie for the submitted work. She has
served as a lecturer for Gilead, AbbVie, and Janssen.
SR, ET, DT, DT, AG, ZP, IP, AT, CT, DParaskeva, and IG have no conflict of interest to declare.

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