title: Correlates of anti-hepatitis C positivity and use of harm reduction services among people who inject drugs in two cities in Croatia.
abstract: We assessed correlates of anti-hepatitis C (anti-HCV) positivity and utilization of needle and syringe exchange programs (NSEP) and opioid agonist treatment (OAT) among people who inject drugs (PWID) in two Croatian cities.
  
  
  
  We conducted a cross-sectional study using respondent-driven (RDS) sampling among PWID in Rijeka (N=255) and Split (N=399). We used RDS-weighted population estimates and multivariable logistic regression to explore correlates of anti-HCV positivity and NSEP and OAT utilization.
  
  
  
  Seventy-eight percent (78.0%) of PWID in Rijeka and 61.5% in Split had been tested previously for HCV, while 21.5% and 7.0%, respectively, were tested for HCV in the past 12 months. Among PWID who report being infected with HCV, 24.9% in Rijeka and 11.3% in Split received anti-HCV treatment. In Rijeka, PWID who utilized NSEP and, in Split, those who were ever imprisoned, had higher odds of anti-HCV positivity. In Rijeka, PWID on OAT were more likely to use non-sterile injecting equipment and to inject for longer than 10 years. PWID enrolled in NSEP were more likely to inject opioid agonist medication (OAM) and less likely to use non-sterile injecting equipment. More than half of PWID reported misuse of OAM in the past month, while out of PWID enrolled in OAT, 65.4% in Rijeka and 88.7% in Split injected OAM in the month prior to the survey.
  
  
  
  Key findings of the paper point to the need to scale up HCV testing and treatment, improve access to NSEP and the quality of OAT provisions in order to prevent its misuse among PWID.
authors.affiliation: WHO Collaborating Centre for HIV Strategic Information, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova ulica 4, 10000 Zagreb, Croatia. Electronic address: shandanagic@yahoo.com.
authors.forename: Senad
authors.initials: S
authors.lastname: Handanagic
authors.affiliation: Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Ivana Lucica 3, 10000 Zagreb, Croatia. Electronic address: ssevic1@ffzg.hr.
authors.forename: Sandra
authors.initials: S
authors.lastname: Sevic
authors.affiliation: WHO Collaborating Centre for HIV Strategic Information, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova ulica 4, 10000 Zagreb, Croatia. Electronic address: j_barbaric@yahoo.com.
authors.forename: Jelena
authors.initials: J
authors.lastname: Barbaric
authors.affiliation: Non-governmental Organization for Sexual and Gender Minorities Iskorak, Petrinjska ulica 27, 10000 Zagreb, Croatia. Electronic address: zoran@iskorak.hr.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Dominkovic
authors.affiliation: University Hospital for Infectious Diseases "Dr. Fran Mihaljevic", School of Medicine, University of Zagreb, Mirogojska cesta 8, 10000 Zagreb, Croatia. Electronic address: orode@bfm.hr.
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 cesta 8, 10000 Zagreb, Croatia. Electronic address: jbegovac@bfm.hr.
authors.forename: Josip
authors.initials: J
authors.lastname: Begovac
authors.affiliation: WHO Collaborating Centre for HIV Strategic Information, Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, Rockefellerova ulica 4, 10000 Zagreb, Croatia. Electronic address: Ivana.Bozicevic@lshtm.ac.uk.
authors.forename: Ivana
authors.initials: I
authors.lastname: Bozicevic
mesh_terms: D000328:Adult; D002947:Cities / Q000453:epidemiology*; D017523:Croatia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D040261:Harm Reduction; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs / Q000379:methods; D015819:Substance Abuse, Intravenous / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D011795:Surveys and Questionnaires; D013594:Syringes
keywords: Croatia; Harm reduction; Hepatitis C; Injecting drug use; Respondent-driven sampling; Risk behaviors