AFISE Description of Findings of the VCT for HIV and Hep

Description of Findings of the Voluntary Counseling and Testing Program (VCT) for HIV and Viral Hepatitis in Constanța County, România during 2010-2012 Introduction Baylor Romania has been developing in Constanta and Tulcea the only Voluntary Counseling and Testing program for HIV, Hepatitis B and C in Romania for the past 3 years. Its goal is to increase the access to testing and early diagnosis to these infections diseases and also to provide through mandatory counseling sessions preventive messages for people otherwise not targeted by IEC activities. Objectives To use the general demographic data (age, occupation, area of provenience, etc) and information about their perceived and evaluated risks that have been collected to perform an analysis about the characteristics of the people that accessed the testing services in Constanta city. Materials and methods For the analysis the data collected in the VCT data base were used as well as the information provided by the patients in the Risks self-evaluation file. Only the data of the people tested in the 2 VCT testing offices from Constanta city was used, at the COE and at Constanta County Hospital, between January 2010 and December 2012. 80.00 70.00 60.00 80.00 50.00 70.00 40.00 HBV 60.00 30.00 HCV Results HIV 50.00 20.00 HBV 40.00 10.00 HCV 30.00 0.00 20.00 10.00 medical cosmetic IV drugs Sexual Patients exposure exposure exposure with STI Abuse Medical staff medical cosmetic IV drugs Sexual Patients exposure exposure exposure with STI Abuse Medical staff HIV 0.00 30 25 20 30 15 25 10 20 5 15 0 10 5 0 Fig. 1: Main occupation of people tested 50 45 40 35 50 30 45 25 40 20 35 15 30 10 25 5 20 0 15 10 medical exposure cosmetic exposure IV drug use sexual exposure patients with medical staff STI medical exposure cosmetic exposure IV drug use sexual exposure patients with medical staff STI 5 0 Fig. 2: Risks identified by the counselor Conclusions 50 45 40 35 30 25 20 15 10 5 0 The data collected remained within the limits of the VCT project: it targets the entire population (not specific risk groups) and the two centers are located in Constanta city so they were mainly accessed by people from urban areas. HBV HCV HIV Medical exposure Cosmetic exposure IV drugs Sexual exposure 8022 people tested for HIV, HBS and HCV 3.72% were confirmed with HBV, 1.58% confirmed with HCV and 0.19% with HIV; 62,5% were females and 37,4 were males; 11.66% of the people tested came from rural areas while 86.08% from urban areas; There were no specific occupations among the people accessing testing, the numbers being influenced also by other factors: availability of time (pensioners, housewives), job re- quirements (medical staff, sailors), interest (students, pupils), etc. People representing high risk categories were poorly represented: 0.13% IDU, 0.21% MSM, 0.02% sex workers; lack of self-identification as being part of such a vulnerable group might also explain these percentages The risks identified by the counselor for the entire group of people tested are consistent with known ways of transmission for HIV, HBV and HCV. The same identified risks but among people who were diagnosed with HIV, HVB or HCV show that medical exposure is much more relevant for people with HBV and HCV and sexual exposure is more relevant for people diagnosed with HIV. These confirms other recent epidemiological trends (such as sexual transmission of HIV instead of parenteral transmission or medical transmission of hepatitis instead of transmission through blood transfusions) By comparison, for the same group of people, the self-identified risks are higher for medical exposure as well as for sexual exposure for both HBV and HCV even if, the sexual risk for HIV remains the highest. We consider this relevant since it shows that at the level of common knowledge people tend to recognize the link between unprotected sex and transmission of infectious diseases. The age distribution of the cases diagnosed with HIV through the VCT program shows an uneven gender distribution, the males being more present in older categories (starting with 35 years of age). By comparing our data with the data available at the national level at 31 December 2012 we conclude that the male population is more affected by HIV than the female at this stage. The feminization of the disease, observed worldwide is not yet present in our group. Patients with ITS The risks identified by the counselor or by the patients are consisted with either the ways of transmission (sexual behavior, medical exposure, IV drugs), with professional groups that have to get tested in accordance to the Romanian law (medical staff, sailors, etc), or with other risks identified locally (transfusions or medical interventions before 1995 for HCV), etc. There is a difference between the risks identified by the counselor and the ones presented by the client after the self-evaluation. The completion of this file is made be- tween the pre and post counseling session and thus the client has time to reconsider the risk of the exposure in the personal history. Medical staff Fig. 3: Risks identified by the counselor among people with positive results 80.00 70.00 60.00 50.00 HBV 40.00 HCV 30.00 HIV 20.00 The percentages of reactive and then confirmed cases are consistent with the HIV numbers for Romania and, for HBV and HCV, close to the ones estimated for Romania, although the percentages are higher for HCV for the entire VCT program which includes also Tulcea county and testing in rural areas (2.86% in 2010, 3.16% in 2011 and 2.85% in 2012). Therefore the extension of testing to rural areas also provided opportunities for more people from these areas to access testing and medical care if needed. While providing VCT services to general population the mandatory counseling part represents an important