Bio-Behavioral Surveillance Survey among People Who Inject Drugs in 7 cities of Georgia, 2015

Curatio International Foundation continues implementation of Bio-Behavioral Surveillance Surveys (BBS) among Key Affected Populations (KAP’s) with the aim to measure HIV prevalence among KAP’s, monitor risk behaviors among these groups and generate evidence for advocacy and policy-making.

The current study describes the most recent wave of BBS surveys among People Who Inject Drugs (PWIDs) in Georgia (Bio-BBS surveys among PWIDs have been implemented since 2002).  Study also was looking at HCV prevalence among PWIDs. CIF implemented this study together with partner organisations – Bemoni Public Union and Georgian AIDS and Clinical Immunology Research Center.

The study used a cross-sectional study design. A sample of 2037 injecting drug users 18 years and older were recruited using respondent-driven sampling in seven major cities of Georgia: Tbilisi, Gori, Telavi, Zugdidi, Batumi, Kutaisi and Rustavi.

The study was financially supported by the Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM).

Major findings:

Socio-demographic characteristics
  • The vast majority of participants reported being unemployed, and 51% of PWIDs mentioned having a monthly income of less than 300 GEL;
  • The median age of initiating non-injection drug consumption and injection drug use has not changed since 2012 and equals 15-16 years and 18-20 years, respectively.
Drug Scene and other contextual factors
  • Non-injecting drugs consumption has not changed  radically since 2012. About a quarter of young PWID who reported non-injection drug use mentioned use of new psychoactive drugs.
  • Injected drug scene has significantly changed during last years. Heroin is the most frequently used substance among drug users in Georgia followed by buprenorphine. Heroin use dropped in 2012 and then increased to the same level in 2015 (58.1%).  Buprenorphine use also dropped in 2012 and increased up to 26% in 2014-2015. Alternatively, lower proportion of PWID reported use of homemade opioid-type drugs like Desomorphine and Amphetamine type stimulants (so called “Vint”, “Jeff”) compared to 2012.
HIV knowledge and HIV testing practice
  • Knowledge of HIV/AIDS among PWID remains relatively good. The majority is aware of primary transmission risks associated with injection and sexual behavior.
  • There is significant increase in proportion of PWID who were tested during last 12 months and know their status. Increase is observed across all cities. In general one in four injecting drug user has been recently tested on HIV.
Sexual behavior
  • More drug injectors have safe sexual contacts with occasional partners than in previous years in some study locations, although protective behavior remains at alarmingly low levels and needs special attention.
Access to and coverage of treatment and harm reduction interventions
  • The majority of PWIDs have never attended drug treatment facilities. Only 6% underwent or was still under any kind of treatment.
  • Coverage of preventive programs (minimal coverage) has increased from 24% to 32.4% since 2012.
  • While awareness about syringe exchange programs has improved in Telavi, Batumi, and Zugdidi, in general, knowledge about the program remains low and needs to be improved. Substitution therapy programs are much better known among PWIDs.
HIV and HICV prevalence
  • The combined dataset analysis of all seven cities shows that HIV prevalence in 2015 was 2.2% (95% CI 1.53-2.99) and has not changed since 2012, when HIV prevalence was  3.0% (95% CI 2.20-4.04) because of overlapping confidence intervals. An estimate for PWID living with HIV varies from the lowest 0.9% (95%CI, 0%-4.3%) in Rustavi to the highest 4.8% in Zugdidi (95%CI, 0.2%-11%). Batumi and Zugdidi remain the cities with highest HIV prevalence rates.
  • The study revealed alarmingly high HCV prevalence (66.2% – in all seven cities).

Full study report is available here.

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