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 care centre for addiction and
therefore known, the other part is unknown. Presently, approximately 300 hard
drug users are in active follow-up who are voluntary screened for HIV,
Hepatitis B & C at a yearly basis since 2003.

a) Database of patients of Mondriaan care centre
The anonimysed database of patients will be used to conduct descriptive
analyses (for example number of drug users screened and corresponding results,
etc.) This electronic database however, is not fully updated since regular
health care is using written medical files. Therefore, due to the incompletion
of this database, we will include an additional form filled in by the
nurse/doctor on the infectious disease status of the participant (see protocol).

b) Data collection by the questionnaire study
Hard drug users in care at Mondriaan addiction centre will be approached at the
following locations by the nurse/doctor for participating in the questionnaire
study:
- methadone substitution treatment: 80 drug users will be included in the study
- herion distribution: 20 drug users will be included in the study
The nurse/doctor will start by explaining the objectives, the procedures and
the content of the study. The information letter will be handed out and
discussed to the drug user before signing written informed consent. If the drug
user decides to participate the questionnaire is handed out and the
nurse/doctor fills in the form. After completion of the questionnaire the
participant receives 10 euros payment.

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.