Hiv, hepatitis C and hepatitis B prevalence (and related risk behaviour) among detainees in Sittard, the Netherlands

Previous Dutch cross-sectional sero-surveys in various cities among (injecting)
drug-users (IDU) showed varying HIV prevalence (1-26%), hepatitis B (HBV)
prevalence (35-68%) and hepatitis C (HCV) prevalence (35-74%). It is known that
many drug users have been incarcerated at a point in time (in Rotterdam survey
88% of IDU, Heerlen 75%). International studies show high prevalence of
infectious diseases in prison settings and high injecting drug use. Therefore,
penitentiary settings are an appropriate research setting to study infectious
diseases among drug users and other detainees. Up till now, not much is known
on infectious diseases in Dutch prisons. For that reason, the rationale of this
study is to assess the prevalence of HIV, HBV and HCV among drug users and
non-drug users in a prison setting in Sittard.

Surveillances of infectious diseases among high risk groups in the Netherlands
is of importance for national monitoring. Results from this study may lead to
design appropriate control measures to decrease further spread of infectious
diseases and to decline the incidence of infectious disease on the long run.
Furthermore results from surveys and studies among drug users will be reported
to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in
Lisbon by the Focal Point for Netherlands (Trimbosinstituut) for many years
already. The results of this study will also be reported to the EMCDDA.

To assess the prevalence of (recent) hiv infections, hepatitis B and C, and
(related) risk behaviour among detainees in PI the Geerhorst, Southern Limburg
in the Netherlands.

This study is a voluntary cross-sectional sero-prevalence study

Detainees will be thoroughly informed about the study and about the meaning and
treatment possibilities of HIV, hepatitis B and hepatitis C. After this verbal
explanation, an information leaflet will be handed out to all detainees. This
will be done one week prior to the time that detainees will be approached to
participate into the study. In order to participate, all participants need to
sign the informed consent. This consent will also ascertain whether a person
wants to receive the test results and whether the blood sample can be used for
future investigations on virus transmission. Each participant will receive a
telephone card of ¤ 10,- for his contribution to our study.
Participation includes a structured face-to-face interview, using a
questionnaire, developed in different languages. The questionnaire contains
approximately 70 questions and will take about 20 minutes. The questionnaire
has been developed to collect data on risk factors (demographics, detention,
sexual behaviour, hepatitis, STD (including hiv), (hard)drug use, and methadone
use.
Finally, a blood sample will be taken by a nurse. This will be tested on hiv,
hepatitis B en hepatitis C laboratory of the Erasmus MC in Rotterdam.

Study materials:

1) Questionnaire/interview
The questionnaire contains approximately 70 questions and will be administered
by an interviewer from the RIVM. This interview will last around 20 minutes.
The questionnaires are coded using a study number. An independent researcher of
the GGD Zuid-Limburg will be the only person who has access to the key of the
study numbers.
Questionnaires have been developed based on equivalent preceding hiv surveys
among drug users in different regions in the Netherlands (1994-1999) and
therefore are validated. Moreover, subjects of questions from the questionnaire
have been formulated by the UNAIDS/WHO for *second generation behavioural
surveillance*. This indicates that the subjects have been designed specifically
for hiv behavioural surveys among high risk groups. Finally, the questionnaire
is outvoted with the Focal Point for Netherlands (Trimbosinstituut) and is
compared with several European countries, which conduct similar hiv surveys
among high risk groups (meeting EMCDDA). To conclude, the questionnaire will be
tried out (as a pilot study) among 5 persons before starting the study
definitively.

2) Blood sample
A venous blood sample will be taken by a nurse and will be tested on hiv,
hepatitis B en hepatitis C in the laboratory in Rotterdam. In case a venous
sample is not possible or desirable, a finger print will be used as an
alternative.
Blood donation will be done by coding blood samples with a unique study number.
Test results will only be given to participants who indicated in their informed
consent that they wish to receive test results. As an independent researcher of
the GGD Zuid-Limburg will be the only person accessing the key to link test
results with personal data, he/she will provide test results to the medical
services of PI the Geerhorst. If necessary, the medical services will
subsequently provide treatment in accordance with the detainee.

Number of blood samples: 1
Number of interviews/questionnaires by researcher: 1
Number of visits medical services of PI the Geerhorst for test results (in case
desired): 1

These are the minimum needed visits in order to perform this study as adequate
as possible. We believe that in the light of the study burden, performance is
nevertheless justified for all persons who will participate thanks to their
possibilities to indicate whether they want to receive the test results or not,
and which method for taking blood they prefer. Moreover, all participants will
be included using a unique study number.