title: HIV and hepatitis C prevalence, and related risk behaviours among people who inject drugs in three cities in Croatia: Findings from respondent-driven sampling surveys.
abstract: There are limited data on HIV and hepatitis C virus (HCV) epidemiology among people who inject drugs (PWID) in Croatia. This study aims to provide data on HIV and HCV prevalence and sexual and injecting risk behaviours among PWID in Zagreb, Split, and Rijeka.
  
  
  
  Using respondent-driven sampling (RDS) we recruited from November 2014 to February 2015 a total of 176 PWID in Zagreb, 255 in Rijeka and 399 in Split. Participants provided biological specimens for HIV and HCV testing and completed a behavioural questionnaire.
  
  
  
  The proportion of female PWID ranged from 19.5% in Zagreb to 26.0% in Split. In the month before the survey, 2.5% of PWID in Split, 5.6% in Rijeka and 8.0% in Zagreb reported sharing non-sterile needles and syringes. Many PWID injected opioid substitution therapy (OST) in the month before the survey (57.0% in Zagreb and 57.5% in Split and Rijeka, respectively). Among PWID who had a casual sexual partner in the past 12 months (ranging from 39.2% in Split to 44.4% in Rijeka) condom use was low. Although HIV prevalence was low (0.2% in Rijeka and Zagreb, 0.3% in Split), HCV antibody prevalence was considerable (29.1% in Zagreb, 31.5% in Rijeka, 38.3% in Split). HIV and HCV testing coverage in the past 12 months was insufficient (6.8% and 7.0% in Split; 13.2% and 13.5% in Zagreb; 20.2% and 21.5% in Rijeka, respectively).
  
  
  
  We found a low-level HIV epidemic and a sizable HCV epidemic among PWID in Zagreb, Split and Rijeka. Presence of high-risk injecting and sexual behaviours together with inadequate HIV and HCV testing coverage call for development of a comprehensive approach to harm reduction and introduction of needle and syringe exchange programmes in prisons, as well as strengthening sexual health interventions.
authors.affiliation: WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia. Electronic address: shandanagic@yahoo.com.
authors.forename: Senad
authors.initials: S
authors.lastname: Handanagic
authors.affiliation: WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Bozicevic
authors.affiliation: Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia.
authors.forename: Marta
authors.initials: M
authors.lastname: Civljak
authors.affiliation: WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Dominkovic
authors.affiliation: Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Ivana Lucica 3, 10000, Zagreb, Croatia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sevic
authors.affiliation: WHO Collaborating Centre for HIV Surveillance, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova 4, 10000, Zagreb, Croatia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Barbaric
authors.affiliation: Croatian Institute of Public Health, Rockefellerova 7, 10000, Zagreb, Croatia.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Nemeth Blazic
authors.affiliation: University Hospital for Infectious Diseases "Dr Fran Mihaljevic", School of Medicine, University of Zagreb, Mirogojska 8, 10000, Zagreb, Croatia.
authors.forename: Oktavija
authors.initials: O
authors.lastname: Dakovic Rode
authors.affiliation: University Hospital for Infectious Diseases "Dr Fran Mihaljevic", School of Medicine, University of Zagreb, Mirogojska 8, 10000, Zagreb, Croatia.
authors.forename: Josip
authors.initials: J
authors.lastname: Begovac
mesh_terms: D000328:Adult; D002947:Cities / Q000706:statistics & numerical data; D017523:Croatia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D040261:Harm Reduction; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D008297:Male; D058850:Opiate Substitution Treatment / Q000379:methods; D015995:Prevalence; D012306:Risk; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Croatia; HIV; Hepatitis C; Injecting drug use; Risk behaviours