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Using time-location sampling for HIV surveillance in street youth. Dmitry Kissin, MD, MPH Unintended pregnancy, STI, HIV Intervention Research (USHIR) Team, Youth Cluster Division of Reproductive Health Centers for Disease Control and Prevention. HIV Epidemic and Youth.

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using time location sampling for hiv surveillance in street youth

Using time-location sampling for HIV surveillance in street youth

Dmitry Kissin, MD, MPH

Unintended pregnancy, STI, HIV Intervention

Research (USHIR) Team, Youth Cluster

Division of Reproductive Health

Centers for Disease Control and Prevention

hiv epidemic and youth
HIV Epidemic and Youth
  • About one half of all new HIV infections occur among youth aged 15 to 24
  • Young people are vulnerable to HIV due to engagement in high-risk behaviors (having unprotected sex, having multiple partners or sharing needles while injecting drugs)
street youth
Street Youth
  • Youth living part- or full-time on streets
  • Band together into groups
  • High-risk lifestyle
    • Violence
    • Exploitation
    • Discrimination
    • Adverse health outcomes including HIV/AIDS
  • Estimated 100 million street youth globally

Photos by Doctors of the World-USA, Mindanao Magazine, Canadian International Developmental Agency

global hiv epidemic
Global HIV Epidemic

Russia

Ukraine

Source: UNAIDS, 2008

objectives
Objectives
  • Assess HIV seroprevalence among street youth in 4 Eastern European cities
  • Identify risk factors for HIV infection
hiv epidemic in russia
HIV Epidemic in Russia

St. Petersburg

Source: UNAIDS, 2007

slide7

Chernigiv

Volyn

Rivne

Sumy

Zhytomyr

Kyiv

Lviv

Kharkiv

Khmel-nytskiy

Ternopil

Poltava

Luhansk

Cherkasy

Iv.-Frank.

Vinnytsia

Zakarpatska

Kirovograd

Chernivtsi

Dnipropetrovsk

Donetsk

Zaporizhia

Mykolaiv

Odessa

Kherson

ARCrimea

HIV Epidemic in Ukraine

Kiev

Number of

registered cases

< 1,000

1,000 – 3,999

4,000 – 8,999

> 9,000

Odessa

Donetsk

Source: Ukrainian AIDS Center, 2007 (registered cases of HIV-infected under medical care)

12

methods sampling frame
Methods: Sampling Frame
  • Comprehensive mapping of public sites (from NGOs and street youth themselves)
  • Classification of sites
    • DEFINITE – reported by 2+ organizations
    • PRESUMPTIVE – reported by 1 organization
    • POTENTIAL – typical street youth location, not reported
  • Outreach evaluation of PRESUMPTIVE and POTENTIAL sites(min. 3 visits to “empty” site)
  • Site inclusion criteria:DEFINITE site or site with 5+ youth observed over a 1-hour period
methods selection of sites and participants
Methods: Selection of Sites and Participants
  • Sampling Stage I: Random selection of sites
  • Sampling Stage II: Universal selection of youth
  • Sample size calculation
    • 80% power
    • 95% significance
    • 2.5 risk ratio
    • 20% HIV+ IDU (exposed) and 8% HIV+ non-IDU (unexposed)
    • Need approximately 300 youth per city
time location sampling of street youth
Time-location Sampling of Street Youth

Benefits Limitations

  • Preserves anonymity of participant
  • City-wide access to all groups more likely
  • Fast, efficient and inexpensive
  • Analytic approach well established
  • May be feasible to access only public sites
definition of street youth
Definition of Street Youth

15-19 y/o

20-24 y/o

  • Found at street venues without parents AND
  • At least one of the following:
      • Living part-time or full-time on the street
      • Living out of family care
      • Self-identified as street youth
      • Attended school irregularly or not at all
  • At least one of the following:
      • Living part-time or full-time on the street
      • Self-identified as street youth
  • Plus: ability to express informed consent
field assessment takes 6 8 weeks
2 mobile teams (vans)

ALL youth at each site evaluated for eligibility (return to site if not finished)

Procedures (40-60 min/youth, 10.5 youth/day)

Informed consent (verbal, comprehension of consent)

HIV pretest counseling

Rapid HIV testing

Questionnaire

HIV post-test counseling

Field Assessment(takes 6-8 weeks)
determine hiv 1 2 test
Detects HIV-1 and HIV-2

Sensitivity: 100%

Specificity: 99.9%

Determine® HIV 1/2 Test

Abbott Laboratories

linkage of hiv youth into care
Linkage of HIV+ youth into care
  • Follow-up options (by same social worker)
    • Escort to City AIDS Center the same day
    • Overnight shelter and escort to City AIDS Center the next day
    • Escorted to City AIDS Center at earliest possible day/time
  • City AIDS Center services
    • Confirmatory HIV testing
    • CD4 to assess need for ARV therapy
    • ARV therapy if needed and if compliance can be established
  • Referral according to specific needs (drug rehabilitation, prenatal care, other medical care)
hiv seroprevalence street youth

Chernigiv

Volyn

Rivne

Sumy

Zhytomyr

Kyiv

Lviv

Kharkiv

Khmel-nytskiy

Ternopil

Poltava

Luhansk

Cherkasy

Iv.-Frank.

Vinnytsia

Zakarpatska

Kirovograd

Chernivtsi

Dnipropetrovsk

Donetsk

Zaporizhia

Mykolaiv

Odessa

Kherson

ARCrimea

HIV seroprevalence, street youth

St. Petersburg:

37.4%

Kiev:

18.6%

Odessa:26.7%

Donetsk:9.8%

conclusions
Conclusions
  • Time-location sampling is an efficient, inexpensive and accurate method of HIV surveillance in street youth
  • High HIV seroprevalence among street youth in Russia and Ukraine
  • Street youth in each of the 4 cities had social, sexual and drug-related risk factors
limitations
Limitations
  • Few confirmatory tests
    • UNAIDS/WHO guidelines: 1 rapid test sufficient for surveillance purposes if HIV prevalence >10%
  • Cross-sectional data
  • Self-report data
slide29
Acknowledgements

Doctors of the World – USA

Tom Dougherty Erin Finnerty

Allison Lynch Tara Ornstein

Jennifer Leigh Vandana Tripathi

Nadiya Pylypchuk Roman Yorick

Konstantin Zakharov Anna Shapoval

Halyna Skipalska

Centers for Disease Control and Prevention

Susan Hillis, PI Lauren Zapata

Cheryl Robbins Denise Jamieson

Polly Marchbanks Pauli Amornkul

Holly Faber Keith Sabin

International HIV/AIDS Alliance

Tetiana Saliuk Andriy Klepikov

Inna Shvab Elena Purik

St. Petersburg, Russia, Team

Natalia Kirik Maria Zagaynova

Elena Cherkassova Larisa Kuzmina

Elena Arkhipova Marina Margovich

Elena Boguzh Elena Fedoseeva

Arkady Genkin Vyacheslav Yanston

Maria Nikitina Victor Vasiliev

Kiev, Ukraine, Team

Leonid Krysov* M. Sayko

Vitaly Tkalitch Vitaly Tkachuk

Elena Khodzhenski Elena Pysmennaya

Vitaly Kabanets Natalia Timashova

V. Yakovenko Eugene Kirik

Alex Schedrygin Anton Panin

Odessa, Ukraine, Team

Natalya Kitsenko* Victoria Danilyuk

Inna Lazaryuk Vitaly Demeshin

Alla Evmenenko Tatiana Pylypenko

Mikhail Zakharov Alexander Karpinsky

Ruslana Yastreb Nadezgda Kalcheva

Donetsk, Ukraine, Team

Elena Kulakovskaya* L. Bereteli

I. Kalinichenko Igor Birkin

Olga Makeeva Leonid Zgilak

Oksana Shuh M. Zagrebna

Olga Baranova Tatiana Dolgova

Anton Kolesnik

St. Petersburg Collaborators and Consultants

Center for Innovations Children’s Crisis Ctr.

Humanitarian Action Russian Red Cross

StellitElena Vinogradova Lydia Kryga

Zoya Lisitsina Galina Volkova

Ukraine Collaborators and Consultants

Olga Sydorova Ludmyla Volynets

Mykola kuleba Oleksandr Yurchenko

Valery Novosvitny Mykola Grazhdanov

Vasyl Panteliuk Leslie Perry

Anna Teltschik