Surveillance of HIV, Hepatitis B and Hepatitis C, and related (risk) behavior among hard drug users under addictive care at Mondriaan centre in Heerlen

Since 1994, the national institute of public health and the environment (RIVM)
has conducted several HIV surveys among (injecting) hard drug users in several
cities in the Netherlands. These surveys have been accomplished under the
authority of the Ministry of Health, Welfare and Sports with the purpose to
increase the knowledge of the HIV epidemic among injecting drug users in the
Netherlands.
In 2001, the Advisory Council on Health Research (RGO) betrayed advice about
HIV surveillances in the Netherlands. One suggestion was to precede HIV surveys
among (injecting) hard drug users every 5 years in different regions within the
country. Moreover, the RGO also recommended expanding surveys toward specific
risk groups, like sex workers and migrants from HIV endemic countries. The most
recent survey among IDU was in 2002 in Rotterdam.

In 2007, the methods and objectives of HIV surveys among risk groups have been
evaluated by the RIVM. One of the main recommendations of this evaluation was
to improve utilization of regular surveillance systems to facilitate monitoring
of national HIV data among these groups.
Data of the HIV surveys and data of the Amsterdam Cohort Studies show that
injecting drug has decreased and is less popular nowadays. National
registration data of HIV in care at one of the HIV treatment centers showed
that the contribution of hard drug users to the general HIV epidemic has
decreased in the last years. In 1996, only 1% of all newly diagnosed HIV
patients within HIV treatment centers could be attributed to injecting drug
use, compared to 11% in 1992. However, results on HIV prevalence from HIV
surveys show high prevalences.

Regular infectious diseases screening among hard drug users in care for their
addiction in different regions in the Netherlands is needed to enlarge insights
in the prevalence and its risk factors of viral infectious diseases among this
group. Therefore, data from the questionnaires will be matched with data on
infectious diseases screening from already existing registration systems among
hard drug users in care in Mondriaan carecentre in Heerlen.
Data from studies and available data from registration systems of infectious
diseases among hard drug users is reported at a yearly basis to the European
Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in Lisbon by the Focal
Point for Netherlands (Trimbosinstituut).

To assess the prevalence of HIV, hepatitis C and B, and (related) risk behavior
among hard drug users in care at Mondriaan carecentre for addiction in Heerlen.

The number of people using hard drugs in Heerlen is currently estimated to be
800. About 400 are in care at the Mondriaan carecentre for addiction and
therefore known, the other part is unknown. Presently, approximately 300 hard
drug users known at Mondriaan centre are in active follow-up.
Since 2003, regular voluntary infectious diseases screening on HIV, Hepatitis B
and Hepatitis C is implemented. Results of this screening (e.g. test results,
vaccination status, antibody information etc) from Mondriaan carecentre and
laboratories within this region have been documented into a structured
database.

Firstly, as part of the voluntary routine infectious diseases screening
process, information on HIV, HCV and HBC screening from the database will be
used to better understand prevalences. In addition, data on demographics,
sexual behaviour, risk behaviour etc will be collected by means of an anonymous
structured self-administered questionnaire to assess potential determinants and
risk factors.


All drug users in the database and all participants in the study will receive a
unique study number. This number gives us the opportunity to match anonymous
data from the questionnaires with anonymous data on infectious diseases
screening from already existing registration systems. Analyses will be carried
out on this matched study database.

During the supply of methadone and heroin at Mondriaan centre, hard drug users
will be asked to participate in the questionnaire study. The study will be
explained by a healthcare worker (doctor or nurse), written informed consent
will be asked. They will be asked to fill out the questionnaire themselves.
Filling out the questionnaire will take approximately 20 minutes.