Incidence and molecular epidemiology of hepatitis C virus reinfection in prisons in Catalonia, Spain (Re-HCV study).

Hepatitis C virus (HCV) reinfection may hamper HCV elimination in prisons. We aimed to (i) determine the reinfection rate in people treated for HCV in Catalan prisons, (ii) measure reinfection in people entering prisons, and (iii) characterize the molecular epidemiology of HCV in prisons and people who inject drugs (PWID) in the community. Re-HCV was a prospective study in eight prisons (2019-2020) including two groups: (1) people cured with treatment in prison and followed-up every 6 months, and (2) people testing HCV-RNA positive at incarceration. Bio-behavioral data were collected. HCV isolates were sequenced and phylogenetically analyzed with those of PWID in the community. Reinfection follow-up after treatment was achieved in 97 individuals (103.05 person-years). Two reinfections were detected, resulting in an incidence ≤ 10/100 person-years. Among people entering prison, 2% (359/17,732) were viremic, of which 334 (93.0%) were included, and 44 (13.5%) presented with reinfection (84.7% being PWID). Frequently, HCV isolates in prisons and PWID in the community were phylogenetically related. Although HCV reinfection is low after treatment, it is common in people entering Catalan prisons. To maintain a low HCV prevalence in prisons, harm-reduction services and test-and-treat programs for PWID should be strengthened both inside and outside prisons.

Situación epidemiológica de las infecciones de transmisión sexual pospandemia en Cataluña, España / Epidemiological situation of post-pandemic sexually transmitted infections in Catalonia, Spain

Antecedentes La creciente tendencia de las infecciones de transmisión sexual (ITS) de los últimos años se vio alterada tras la irrupción de la pandemia por SARS-CoV-2. Objetivos Describir el impacto de la pandemia por el coronavirus de tipo 2 causante del síndrome respiratorio agudo severo (SARS-CoV-2) en las declaraciones de ITS recibidas durante el período prepandémico al pandémico y estimar el número de casos de ITS esperados para el período pandémico. Material y métodos Análisis descriptivo de las declaraciones de ITS recibidas durante el período prepandémico (2018-2019) y pandémico (2020-2021). Se estudió mediante un modelo de correlación la influencia del número de casos positivos de SARS-CoV-2 con el número de casos positivos de ITS durante los meses de pandemia. Mediante el modelo de series temporales Holt-Wilson se realizó una estimación del número de casos de ITS esperados para el período pandémico. Resultado La tasa de incidencia global para todas las ITS en 2020 descendió un 18,3% respecto a 2019. La Clamidia y la sífilis presentaron una reducción superior en su incidencia de 2019 a 2020 del 22,7% y 20,9%, respectivamente y del 9,5% y del 2,5% para gonococia y linfogranuloma venéreo. Las estimaciones mostraron que en 2020 se hubieran producido un 44,6% más de ITS que las declaradas. Las proporciones según el sexo, el país de nacimiento y la orientación sexual cambiaron significativamente en clamidia y gonococia. Conclusiones Las medidas adoptadas para la prevención de contagios por SARS-CoV-2 pudieron conseguir un descenso inicial de los casos de ITS en 2020; sin embargo, este cambio no se mantuvo durante 2021, que acabó con las incidencias más elevadas recogidas hasta la fecha (AU)

Background The growing trend of STIs in recent years was altered after the outbreak of the SARS-CoV-2 pandemic. Objectives Describe the impact of the SARS-CoV-2 pandemic on STI declarations received during the pre-pandemic to pandemic period and estimate the number of STI cases expected for the pandemic period. Material and methods Descriptive analysis of STI declarations received during the pre-pandemic (2018-2019) and pandemic (2020-2021) periods. The influence of the number of positive cases of SARS-CoV-2 with the number of positive cases of STIs during the months of the pandemic was studied using a correlation model. Using the Holt-Wilson time series model, an estimate was made of the number of STI cases expected for the pandemic period. Results The global incidence rate for all STIs in 2020 decreased by 18.3% compared to 2019. Chlamydia and syphilis presented a greater reduction in their incidence from 2019 to 2020 of 22.7% and 20.9%, respectively and 9.5% and 2.5% for gonorrhea and LGV. Estimates showed that in 2020 there would have been 44.6% more STIs than those declared. The proportions according to sex, country of birth and sexual orientation changed significantly in chlamydia and gonorrhea. Conclusions The measures adopted for the prevention of SARS-CoV-2 infections were able to achieve an initial decrease in STI cases in 2020, however, this change was not maintained during 2021, which ended with higher incidences recorded to date (AU)

[Epidemiological situation of post-pandemic sexually transmitted infections in Catalonia, Spain]. / Situación epidemiológica de las infecciones de transmisión sexual pospandemia en Cataluña, España.

BACKGROUND: The growing trend of STIs in recent years was altered after the outbreak of the SARS-CoV-2 pandemic. OBJECTIVES: Describe the impact of the SARS-CoV-2 pandemic on STI declarations received during the pre-pandemic to pandemic period and estimate the number of STI cases expected for the pandemic period. MATERIAL AND METHODS: Descriptive analysis of STI declarations received during the pre-pandemic (2018-2019) and pandemic (2020-2021) periods. The influence of the number of positive cases of SARS-CoV-2 with the number of positive cases of STIs during the months of the pandemic was studied using a correlation model. Using the Holt-Wilson time series model, an estimate was made of the number of STI cases expected for the pandemic period. RESULTS: The global incidence rate for all STIs in 2020 decreased by 18.3% compared to 2019. Chlamydia and syphilis presented a greater reduction in their incidence from 2019 to 2020 of 22.7% and 20.9%, respectively and 9.5% and 2.5% for gonorrhea and LGV. Estimates showed that in 2020 there would have been 44.6% more STIs than those declared. The proportions according to sex, country of birth and sexual orientation changed significantly in chlamydia and gonorrhea. CONCLUSIONS: The measures adopted for the prevention of SARS-CoV-2 infections were able to achieve an initial decrease in STI cases in 2020, however, this change was not maintained during 2021, which ended with higher incidences recorded to date.

Vulnerabilidad frente al VIH, clamidia y gonococia según el lugar donde se ejerce el trabajo sexual / HIV, Chlamydia and gonorrhoea vulnerability depending to sex work site

IntroducciónLas mujeres que ejercen el trabajo sexual (MTS) son una de las poblaciones clave en la monitorización y la evaluación del VIH y otras infecciones de transmisión sexual (ITS). Factores socioeconómicos, estructurales y asociados al ámbito de trabajo influyen en la exposición a estas infecciones. Los objetivos del estudio fueron describir y comparar características sociales, conductas de riesgo y prevalencia del VIH, clamidia y gonococia según el lugar de realización del trabajo sexual (calle o carretera, clubs, pisos).MétodosEstudio transversal en 400MTS en Cataluña. Se recogieron características sociodemográficas, del trabajo sexual y conductuales mediante entrevista personal y muestras de fluido oral y orina para determinar la prevalencia de ITS.ResultadosLas MTS que ejercen en la calle o en la carretera presentaron condiciones más precarias y mayor vulnerabilidad relacionada con factores socioeconómicos: población más envejecida, con nivel de estudios inferior y menor retribución económica por su servicio. Se observaron otros factores asociados al estilo de vida o conductuales: mayor consumo de drogas por vía parenteral, mayor tiempo de trabajo sexual o vulnerabilidades asociadas a una serie de determinantes a nivel estructural o sociales: menor acceso a servicios de salud, mayor proporción de relaciones forzadas y estancia en prisión. La prevalencia global de VIH, clamidia y gonococia fue del 3,0, del 1,8% y del 0,5%, respectivamente, y superiores en las mujeres que ejercían en la calle-carretera: 5,6%, 1,9% y 1,2%, respectivamente.ConclusiónLa información generada en este estudio será clave para el diseño de intervenciones preventivas específicas dirigidas a este colectivo.

IntroductionWomen sex workers (WSW) are one of key population on the HIV and other sexually transmitted infections (STIs) monitoring and evaluation. Socioeconomic, structural factors and other factors associated with the workplace influence exposure to these infections. The objectives of this study were to describe and compare the social characteristics, risk behaviours and HIV, Chlamydia and gonorrhoeae prevalence according to sex work site (street or highway, clubs and flats).MethodsCross-sectional study on 400WSW in Catalonia. Socio-demographic, sex work and behavioral characteristics were collected through personal interview. Oral fluid and urine samples were collected to determine STI prevalence.ResultsWSW that exercised in the street or highway presented more precarious conditions and a greater vulnerability related to socioeconomic factors: older population, with a lower education level and with less economic remuneration for their service. Other factors associated with lifestyle or behaviour was also observed: greater injecting drug use, longer sex work or vulnerabilities associated with structural or social determinants: less access to health services, higher proportion of forced relations and stay in prison. The overall HIV, Chlamydia and gonorrhoeae prevalence was 3.0%, 1.8% and 0.5%, respectively, and higher in women who exercised on the street or highway: 5.6%, 1.9% and 1.2%, respectively.ConclusionThe information generated in this study will be useful for the design specific preventive interventions aimed at this group.

HIV, Chlamydia and gonorrhoea vulnerability depending to sex work site.

INTRODUCTION: Women sex workers (WSW) are one of key population on the HIV and other sexually transmitted infections (STIs) monitoring and evaluation. Socioeconomic, structural factors and other factors associated with the workplace influence exposure to these infections. The objectives of this study were to describe and compare the social characteristics, risk behaviours and HIV, chlamydia and gonorrhoeae prevalence according to sex work site (street or highway, clubs and flats). METHODS: Cross-sectional study on 400 WSW in Catalonia. Socio-demographic, sex work and behavioral characteristics were collected through personal interview. Oral fluid and urine samples were collected to determine STI prevalence. RESULTS: WSW that exercised in the street or highway presented more precarious conditions and a greater vulnerability related to socioeconomic factors: older population, with a lower education level and with less economic remuneration for their service. Other factors associated with lifestyle or behaviour was also observed: greater injecting drug use, longer sex work or vulnerabilities associated with structural or social determinants: less access to health services, higher proportion of forced relations and stay in prison. The overall HIV, chlamydia and gonorrhoeae prevalence was 3.0%, 1.8% and 0.5%, respectively and higher in women who exercised on the street or highway, 5.6%, 1.9% and 1.2%, respectively. CONCLUSION: The information generated in this study will be useful for the design specific preventive interventions aimed at this group.

STI epidemic re-emergence, socio-epidemiological clusters characterisation and HIV coinfection in Catalonia, Spain, during 2017-2019: a retrospective population-based cohort study.

OBJECTIVES: To describe the epidemiology of sexually transmitted infections (STIs), identify and characterise socio-epidemiological clusters and determine factors associated with HIV coinfection. DESIGN: Retrospective population-based cohort. SETTING: Catalonia, Spain. PARTICIPANTS: 42 283 confirmed syphilis, gonorrhoea, chlamydia and lymphogranuloma venereum cases, among 34 600 individuals, reported to the Catalan HIV/STI Registry in 2017-2019. PRIMARY AND SECONDARY OUTCOMES: Descriptive analysis of confirmed STI cases and incidence rates. Factors associated with HIV coinfection were determined using logistic regression. We identified and characterized socio-epidemiological STI clusters by Basic Health Area (BHA) using K-means clustering. RESULTS: The incidence rate of STIs increased by 91.3% from 128.2 to 248.9 cases per 100 000 population between 2017 and 2019 (p<0.001), primarily driven by increase among women (132%) and individuals below 30 years old (125%). During 2017-2019, 50.1% of STIs were chlamydia and 31.6% gonorrhoea. Reinfections accounted for 10.8% of all cases and 6% of cases affected HIV-positive individuals. Factors associated with the greatest likelihood of HIV coinfection were male sex (adjusted OR (aOR) 23.69; 95% CI 16.67 to 35.13), age 30-39 years (versus <20 years, aOR 18.58; 95% CI 8.56 to 52.13), having 5-7 STI episodes (vs 1 episode, aOR 5.96; 95% CI 4.26 to 8.24) and living in urban areas (aOR 1.32; 95% CI 1.04 to 1.69). Living in the most deprived BHAs (aOR 0.60; 95% CI 0.50 to 0.72) was associated with the least likelihood of HIV coinfection. K-means clustering identified three distinct clusters, showing that young women in rural and more deprived areas were more affected by chlamydia, while men who have sex with men in urban and less deprived areas showed higher rates of STI incidence, multiple STI episodes and HIV coinfection. CONCLUSIONS: We recommend socio-epidemiological identification and characterisation of STI clusters and factors associated with HIV coinfection to identify at-risk populations at a small health area level to design effective interventions.

The impact of the COVID-19 pandemic on Sexually Transmitted Infections surveillance data: incidence drop or artefact?

BACKGROUND: Before the COVID-19 pandemic, Sexually transmitted infections (STIs) were increasing in Europe, and Spain and Catalonia were not an exception. Catalonia has been one of the regions with the highest number of COVID-19 confirmed cases in Spain. The objective of this study was to estimate the magnitude of the decline, due to the COVID-19 pandemic, in the number of STI confirmed cases in Catalonia during the lockdown and de-escalation phases. METHODS: Interrupted time series analysis was performed to estimate the magnitude of decline in the number of STI reported confirmed cases - chlamydia, gonorrhoea, syphilis, and lymphogranuloma venereum- in Catalonia since lockdown with historical data, from March 13th to August 1st 2020, comparing the observed with the expected values. RESULTS: We found that since the start of COVID-19 pandemic the number of STI reported cases was 51% less than expected, reaching an average of 56% during lockdown (50% and 45% during de-escalation and new normality) with a maximum decrease of 72% for chlamydia and minimum of 22% for syphilis. Our results indicate that fewer STIs were reported in females, people living in more deprived areas, people with no previous STI episodes during the last three years, and in the HIV negative. CONCLUSIONS: The STI notification sharp decline was maintained almost five months after lockdown started, well into the new normality. This fact can hardly be explained without significant underdiagnosis and underreporting. There is an urgent need to strengthen STI/HIV diagnostic programs and services, as well as surveillance, as the pandemic could be concealing the real size of the already described re-emergence of STIs in most of the European countries.

Primeros datos de prevalencia de Chlamydia trachomatis, otras ITS y coinfecciones en gestantes menores de 25 años en Cataluña / First data of Chlamydia trachomatis and other STI prevalence and co-infections in pregnant women under 25 years in Catalonia, Spain

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HIV, Chlamydia and gonorrhoea vulnerability depending to sex work site. / Vulnerabilidad frente al VIH, clamidia y gonococia según el lugar donde se ejerce el trabajo sexual.

INTRODUCTION: Women sex workers (WSW) are one of key population on the HIV and other sexually transmitted infections (STIs) monitoring and evaluation. Socioeconomic, structural factors and other factors associated with the workplace influence exposure to these infections. The objectives of this study were to describe and compare the social characteristics, risk behaviours and HIV, Chlamydia and gonorrhoeae prevalence according to sex work site (street or highway, clubs and flats). METHODS: Cross-sectional study on 400WSW in Catalonia. Socio-demographic, sex work and behavioral characteristics were collected through personal interview. Oral fluid and urine samples were collected to determine STI prevalence. RESULTS: WSW that exercised in the street or highway presented more precarious conditions and a greater vulnerability related to socioeconomic factors: older population, with a lower education level and with less economic remuneration for their service. Other factors associated with lifestyle or behaviour was also observed: greater injecting drug use, longer sex work or vulnerabilities associated with structural or social determinants: less access to health services, higher proportion of forced relations and stay in prison. The overall HIV, Chlamydia and gonorrhoeae prevalence was 3.0%, 1.8% and 0.5%, respectively, and higher in women who exercised on the street or highway: 5.6%, 1.9% and 1.2%, respectively. CONCLUSION: The information generated in this study will be useful for the design specific preventive interventions aimed at this group.

Pooling of urine samples for molecular detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium as a screening strategy among young adults in Catalonia / Pooling de muestras de orina para la detección molecular de Chlamydia trachomatis, Neisseria gonorrhoeae y Mycoplasma genitalium como estrategia de cribado entre la población joven en Cataluña

INTRODUCTION: Bacterial sexually transmitted infections (STIs) have an important impact on reproductive health, highlighting the increase in Chlamydia trachomatis infection rates among young people. To reduce the costs of STI detection, the pooling strategy is beneficial for high-throughput tests in low-prevalence populations using non-invasive samples. OBJECTIVES: (1) To describe the performance of a 7-STI PCR assay using the pooling of three urine samples to detect C. trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium; (2) to estimate the cost saving of the pooling strategy; (3) to describe the prevalence, risk factors and coinfections of C. trachomatis, N. gonorrhoeae and M. genitalium in young people ≤ 25 years in Catalonia. METHODS: cross-sectional prevalence study conducted in 2016 among young people ≤ 25 years of age seen in sexual and reproductive health centres throughout Catalonia from pools of three urine samples. A standardized questionnaire was used to collect clinical-epidemiological and behavioural variables. RESULTS: 1032 young people were tested. The prevalence of C. trachomatis, N. gonorrhoeae and M. genitalium was 8.5%, 0.6% and 3.5%, respectively. The pooling strategy provided a 33% savings in reagent costs. CONCLUSIONS: The pooling strategy implemented for epidemiological studies in our context provides a savings that has an impact on the viability of STI detection programmes. In the same way, this study shows that C. trachomatis prevalence continues to increase in this population and, for the first time in Catalonia, the prevalence of M. genitalium in young people is shown

INTRODUCCIÓN: Las infecciones bacterianas de transmisión sexual (ITS) tienen un impacto importante en la salud reproductiva, destacando el aumento en las tasas de infección por Chlamydia trachomatis entre los jóvenes. Para reducir los costes de detección de las ITS, la estrategia de agrupación de muestras (pooling) es beneficiosa para pruebas de alto rendimiento en poblaciones de baja prevalencia utilizando muestras no invasivas. OBJETIVOS: 1) Describir el rendimiento de un ensayo de PCR 7-STI utilizando el pooling de 3 muestras de orina para detectar Chlamydia trachomatis, Neisseria gonorrhoeae y Mycoplasma genitalium; 2) Estimar el ahorro de la estrategia de pooling; 3) Describir la prevalencia, los factores de riesgo y las coinfecciones de Chlamydia trachomatis, Neisseria gonorrhoeae y Mycoplasma genitalium en jóvenes ≤ 25 años en Cataluña. MÉTODOS: Estudio transversal de prevalencia realizado durante 2016 entre jóvenes ≤ 25 años atendidos en centros de salud sexual y reproductiva en todo el territorio catalán a partir de pools de 3 muestras de orina. Se utilizó un cuestionario estandarizado para recopilar variables clínico-epidemiológicas y de comportamiento. RESULTADOS: Se testaron 1032 jóvenes. La prevalencia de Chlamydia trachomatis, Neisseria gonorrhoeae y Mycoplasma genitalium fue del 8,5, 0,6 y 3,5%, respectivamente. La estrategia de pooling proporcionó un ahorro del 33% en los costos de reactivo. CONCLUSIONES: La estrategia de pooling llevado a cabo para estudios epidemiológicos en nuestro contexto proporciona un ahorro que tiene un impacto en la viabilidad de los programas de detección de las ITS. De la misma manera, en este estudio se observa que la prevalencia de Chlamydia trachomatis continúa aumentando en esta población y, por primera vez en Cataluña, se determina la prevalencia de Mycoplasma genitalium en la población joven

Pooling of urine samples for molecular detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium as a screening strategy among young adults in Catalonia.

INTRODUCTION: Bacterial sexually transmitted infections (STIs) have an important impact on reproductive health, highlighting the increase in Chlamydia trachomatis infection rates among young people. To reduce the costs of STI detection, the pooling strategy is beneficial for high-throughput tests in low-prevalence populations using non-invasive samples. OBJECTIVES: (1) To describe the performance of a 7-STI PCR assay using the pooling of three urine samples to detect C. trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium; (2) to estimate the cost saving of the pooling strategy; (3) to describe the prevalence, risk factors and coinfections of C. trachomatis, N. gonorrhoeae and M. genitalium in young people ≤25 years in Catalonia. METHODS: cross-sectional prevalence study conducted in 2016 among young people ≤25 years of age seen in sexual and reproductive health centres throughout Catalonia from pools of three urine samples. A standardized questionnaire was used to collect clinical-epidemiological and behavioural variables. RESULTS: 1032 young people were tested. The prevalence of C. trachomatis, N. gonorrhoeae and M. genitalium was 8.5%, 0.6% and 3.5%, respectively. The pooling strategy provided a 33% savings in reagent costs. CONCLUSIONS: The pooling strategy implemented for epidemiological studies in our context provides a savings that has an impact on the viability of STI detection programmes. In the same way, this study shows that C. trachomatis prevalence continues to increase in this population and, for the first time in Catalonia, the prevalence of M. genitalium in young people is shown.

[Monitoring and evaluation of hiv in catalonia, getting closer to the 90-90-90 objectives]. / Monitorización y evaluación del VIH en Cataluña, cada vez más cerca de los objetivos 90-90-90.

OBJECTIVE: Epidemiological surveillance of HIV infection allows monitoring its incidence as well as possible epidemiological changes, allowing specific interventions to be planned and their impact monitored. The objective of this article is to describe the results of the monitoring and evaluation of the response to the HIV epidemic in Catalonia, based on data included in the Integrated System of Epidemiological Surveillance of AIDS/HIV and Sexually Transmitted Infections of Catalonia (SIVES). METHODS: A descriptive analysis of the data from the different sources of information of the SIVES was performed. The time period was defined based on the availability of data from each of the sources of information included in the analysis. The information was structured according to the conceptual representation of the cascade of HIV care, as described in the World Health Organization consolidated strategic information guidelines for HIV. RESULTS: Of the total of 4,849 new diagnoses notified (2012-2018), 86% were men, of these; the most frequently reported transmission group was men having sex with men with 65%. The trend in the number of new diagnoses decreased in all transmission groups. It is estimated that in 2018 there were 32,429 people living with HIV in Catalonia, of which 89% were diagnosed, of these, 83% were under follow-up in a specialized unit and 78% of them were under treatment. 73% of people in treatment had suppressed the viral load. CONCLUSIONS: SIVES as an integrated system of different sources of strategic information allows monitoring the HIV epidemic in Catalonia and evaluating the response to it, identifying key populations and determinants to acquire HIV, as well as the barriers to which people living with HIV they face to achieve viral suppression.

OBJETIVO: La vigilancia epidemiológica de la infección por el VIH permite monitorizar su incidencia así como eventuales cambios epidemiológicos, permitiendo planificar intervenciones específicas y monitorizar su impacto. El objetivo de este artículo fue describir los resultados de la monitorización y evaluación de la respuesta a la epidemia del VIH en Cataluña, a partir de los datos incluidos en el Sistema Integrado de Vigilancia Epidemiológica del Sida/VIH e Infecciones de transmisión sexual de Cataluña (SIVES). METODOS: Se realizó un análisis descriptivo de los datos de las diferentes fuentes de información del SIVES. El periodo de tiempo se definió a partir de la disponibilidad de los datos de cada una de las fuentes de información incluidas en el análisis. La información se estructuró de acuerdo a la representación conceptual de la cascada de diagnóstico y tratamiento de VIH, tal y como se describe en las directrices de información estratégica consolidada de la Organización Mundial de la Salud para el VIH. RESULTADOS: Del total de 4.849 nuevos diagnósticos notificados (2012-2018), el 86% eran hombres. De estos, el grupo de transmisión informado más frecuente fueron los hombres que tiene sexo con hombres con un 65%. La tendencia del número de nuevos diagnósticos descendió en todos los grupos de transmisión. Se estima que en 2018 había 32.429 personas viviendo con el VIH en Cataluña, de las cuales el 89% estaban diagnosticadas. De estas, el 83% estaban en seguimiento en una unidad especializada, y el 78% de ellas estaban en tratamiento. El 73% de las personas en tratamiento tenían la carga viral suprimida. CONCLUSIONES: El SIVES, como sistema integrado de diferentes fuentes de información estratégica, permite monitorizar la epidemia del VIH en Cataluña y evaluar la respuesta a la misma, identificando poblaciones claves y determinantes para adquirir el VIH, así como las barreras a las que se enfrentan las personas que viven con VIH para lograr a supresión viral.

Monitorización y evaluación del VIH en Cataluña, cada vez más cerca de los objetivos 90-90-90 / Monitoring and evaluation of hiv in catalonia, getting closer to the 90-90-90 objectives

OBJETIVO: La vigilancia epidemiológica de la infección por el VIH permite monitorizar su incidencia así como eventuales cambios epidemiológicos, permitiendo planificar intervenciones específicas y monitorizar su impacto. El objetivo de este artículo fue describir los resultados de la monitorización y evaluación de la respuesta a la epidemia del VIH en Cataluña, a partir de los datos incluidos en el Sistema Integrado de Vigilancia Epidemiológica del Sida/VIH e Infecciones de transmisión sexual de Cataluña (SIVES). MÉTODOS: Se realizó un análisis descriptivo de los datos de las diferentes fuentes de información del SIVES. El periodo de tiempo se definió a partir de la disponibilidad de los datos de cada una de las fuentes de información incluidas en el análisis. La información se estructuró de acuerdo a la representación conceptual de la cascada de diagnóstico y tratamiento de VIH, tal y como se describe en las directrices de información estratégica consolidada de la Organización Mundial de la Salud para el VIH. RESULTADOS: Del total de 4.849 nuevos diagnósticos notificados (2012-2018), el 86% eran hombres. De estos, el grupo de transmisión informado más frecuente fueron los hombres que tiene sexo con hombres con un 65%. La tendencia del número de nuevos diagnósticos descendió en todos los grupos de transmisión. Se estima que en 2018 había 32.429 personas viviendo con el VIH en Cataluña, de las cuales el 89% estaban diagnosticadas. De estas, el 83% estaban en seguimiento en una unidad especializada, y el 78% de ellas estaban en tratamiento. El 73% de las personas en tratamiento tenían la carga viral suprimida. CONCLUSIONES: El SIVES, como sistema integrado de diferentes fuentes de información estratégica, permite monitorizar la epidemia del VIH en Cataluña y evaluar la respuesta a la misma, identificando poblaciones claves y determinantes para adquirir el VIH, así como las barreras a las que se enfrentan las personas que viven con VIH para lograr a supresión viral

BACKGROUND: Epidemiological surveillance of HIV infection allows monitoring its incidence as well as possible epidemiological changes, allowing specific interventions to be planned and their impact monitored. The objective of this article is to describe the results of the monitoring and evaluation of the response to the HIV epidemic in Catalonia, based on data included in the Integrated System of Epidemiological Surveillance of AIDS/HIV and Sexually Transmitted Infections of Catalonia (SIVES). METHODS: A descriptive analysis of the data from the different sources of information of the SIVES was performed. The time period was defined based on the availability of data from each of the sources of information included in the analysis. The information was structured according to the conceptual representation of the cascade of HIV care, as described in the World Health Organization consolidated strategic information guidelines for HIV. RESULTS: Of the total of 4,849 new diagnoses notified (2012-2018), 86% were men, of these; the most frequently reported transmission group was men having sex with men with 65%. The trend in the number of new diagnoses decreased in all transmission groups. It is estimated that in 2018 there were 32,429 people living with HIV in Catalonia, of which 89% were diagnosed, of these, 83% were under follow-up in a specialized unit and 78% of them were under treatment. 73% of people in treatment had suppressed the viral load. CONCLUSIONS: SIVES as an integrated system of different sources of strategic information allows monitoring the HIV epidemic in Catalonia and evaluating the response to it, identifying key populations and determinants to acquire HIV, as well as the barriers to which people living with HIV they face to achieve viral suppression

Prevalencia y tasa de reinfección de la infección genital por C. trachomatis en menores de 25 años en Cataluña / Prevalence and re-infection rate of C. trachomatis genital infections in young people under 25 years in Catalonia

Introducción: La infección genital por Chlamydia trachomatis es la infección de transmisión sexual bacteriana más común. Un problema importante para su control son las reinfecciones, ya que incrementan la probabilidad de desarrollar secuelas. Objetivos: Estimar la prevalencia de C. trachomatis y la tasa de reinfección a los 6 meses de tratamiento determinando las posibles causas. Métodos: Estudio transversal con muestra de orina analizada por PCR en una muestra de conveniencia de 506 jóvenes de 16-25 años sexualmente activos con encuesta epidemiológica y re-test a los 3 meses. Resultados: La prevalencia de C. trachomatis fue del 8,5%. La edad (OR = 2,34; IC 95% 1,21-4,55) y la concurrencia (OR = 3,64; IC 95% 3,58-26,39) fueron factores determinantes para su adquisición. La tasa de reinfección fue del 10,34%. Discusión: La elevada prevalencia de C. trachomatis, así como la tasa de reinfección, plantean la necesidad de valorar la eficacia de un programa de cribado oportunista y garantizar altos niveles de notificación de parejas sexuales. Garantizar estos enfoques facilitaría el control de C. trachomatis entre los jóvenes (AU)

Introduction: Chlamydia trachomatis infection is the most common bacterial sexually transmitted disease. Re-infections are a major problem in its control as they increase the probability of developing sequellae. Objectives: To estimate the prevalence of C. trachomatis and re-infection rate after 6 months of treatment by determining the possible causes. Methods: Cross-sectional study in which a urine sample was analysed by PCR in a convenience sample of 506 sexually active youths aged 16-25 years. An epidemiological survey and re-test was performed at 3 months. Results: The prevalence of C. trachomatis was 8.5%. The age (OR = 2.34; 95% CI: 1.21-4.55) and concurrency (OR = 3.64; 95% CI: 3.58-26.39) were determining factors for acquiring C. trachomatis. The re-infection rate was 10.34%. Discussion: The high prevalence of C. trachomatis, as well as the rate of re-infection, suggest the need to assess the effectiveness of the opportunistic screening program and ensure high levels of reporting of sexual partners. Ensuring these approaches facilitate the control of C. trachomatis among young people (AU)

Prevalence and re-infection rate of C. trachomatis genital infections in young people under 25 years in Catalonia. / Prevalencia y tasa de reinfección de la infección genital por C. trachomatis en menores de 25 años en Cataluña.

INTRODUCTION: Chlamydia trachomatis infection is the most common bacterial sexually transmitted disease. Re-infections are a major problem in its control as they increase the probability of developing sequellae. OBJECTIVES: To estimate the prevalence of C.trachomatis and re-infection rate after 6 months of treatment by determining the possible causes. METHODS: Cross-sectional study in which a urine sample was analysed by PCR in a convenience sample of 506 sexually active youths aged 16-25years. An epidemiological survey and re-test was performed at 3months. RESULTS: The prevalence of C.trachomatis was 8.5%. The age (OR=2.34; 95%CI: 1.21-4.55) and concurrency (OR=3.64; 95% CI: 3.58-26.39) were determining factors for acquiring C.trachomatis. The re-infection rate was 10.34%. DISCUSSION: The high prevalence of C.trachomatis, as well as the rate of reinfection, suggest the need to assess the effectiveness of the opportunistic screening program and ensure high levels of reporting of sexual partners. Ensuring these approaches facilitate the control of C.trachomatis among young people.

Tendencia y determinantes de la infección genital por Chlamydia trachomatis en menores de 25 años. Cataluña 2007-2014 / Trends and determinants factors of Chlamydia trachomatis genital infection in young people under 25 years. Catalonia 2007-2014

INTRODUCCIÓN: Chlamydia trachomatis (clamidia) causa la infección de transmisión sexual (ITS) bacteriana más frecuente. Sin embargo, la prevalencia entre los jóvenes es desconocida en nuestro país. En 2007 la monitorización de la prevalencia y conductas relacionadas con su adquisición se inició en Cataluña en jóvenes ≤25 años. OBJETIVOS: Conocer y monitorizar la prevalencia de clamidia y determinantes entre la población joven ≤25años sexualmente activa atendida en los centros de Atención a la Salud Sexual y Reproductiva (CT/NG-ASSIR) e interna en centros penitenciarios (CT/NG-Prisiones). MATERIAL Y MÉTODOS: Se analizan los datos de 6 estudios transversales realizados en 2 poblaciones centinela de jóvenes para el periodo 2007-2014. Se recogen indicadores conductuales y muestras de orina que serán analizadas mediante PCR. Se describe la prevalencia y la tendencia de clamidia, y mediante el análisis multivariante de regresión logística se evalúan las variables asociadas a la infección. RESULTADOS: La media de la prevalencia para CT/NG-ASSIR fue del 7,4%, con tendencia creciente (p = 0,174) e incremento del 46,5%. Para CT/NG-Prisiones la media fue del 8,0%, con tendencia creciente (p = 0,282) e incremento del 31,6%. La edad y el origen extranjero se presentan como factores de riesgo en ambas poblaciones. La concurrencia de parejas se añade a CT/NG-ASSIR, y el tiempo de estancia en prisión, en CT/NG-Prisiones. DISCUSIÓN: Los resultados obtenidos ponen de relieve la necesidad de un enfoque más eficiente en las actividades de control para clamidia en Cataluña, y de intensificar las políticas de promoción de comportamientos sexuales más seguros y la búsqueda activa de casos con un cribado oportunista en menores de 25 años

INTRODUCTION: Chlamydia trachomatis (chlamydia) infection is the most common bacterial sexually transmitted diseases (STD). However, the prevalence among young people is unknown in our country. In 2007, the monitoring of the prevalence and behaviours related to acquiring it began in Catalonia in young people ≤25 years. OBJECTIVES: To determine and monitor the prevalence and determining factors of chlamydia among a young sexually active population ≤25 years, treated in sexual and reproductive health care centras (CT/NG-ASSIR) and in prisons (CT/NG-Prisons). MATERIALS AND METHODS: An analysis was performed on 6 cross-sectional data studies in two sentinel populations of young people from the period 2007-2014. Behavioural indicators were recorded and urine specimens were collected for analysis by PCR. The prevalence and trends are described, and the variables associated with infection were evaluated using multivariate logistic regression analysis. RESULTS: The mean prevalence for CT/NG-ASSIR was 7.4%, with an upward trend (P=.174), and an increase of 46.5%. CT/NG-Prisons had a mean 8.0%, with an upward trend (P=.282), and an increase of 31.6%. Age and foreign origin are presented as risk factors in both populations. The concurrent sexual partners added to CT/NG-ASSIR and the time spent in prison to CT/NG-Prisons. DISCUSSION: The results underscore the need for a more efficient approach to control activities related to chlamydia infection in Catalonia. Policies need to be strengthened to promote safer sexual behaviours and active case finding by opportunistic screening in less than 25 year-old

[Trends and determinants factors of Chlamydia trachomatis genital infection in young people under 25 years. Catalonia 2007-2014]. / Tendencia y determinantes de la infección genital por Chlamydia trachomatis en menores de 25 años. Cataluña 2007-2014.

INTRODUCTION: Chlamydia trachomatis (chlamydia) infection is the most common bacterial sexually transmitted diseases (STD). However, the prevalence among young people is unknown in our country. In 2007, the monitoring of the prevalence and behaviours related to acquiring it began in Catalonia in young people ≤25years. OBJECTIVES: To determine and monitor the prevalence and determining factors of chlamydia among a young sexually active population ≤25years, treated in sexual and reproductive health care centras (CT/NG-ASSIR) and in prisons (CT/NG-Prisons). MATERIALS AND METHODS: An analysis was performed on 6 cross-sectional data studies in two sentinel populations of young people from the period 2007-2014. Behavioural indicators were recorded and urine specimens were collected for analysis by PCR. The prevalence and trends are described, and the variables associated with infection were evaluated using multivariate logistic regression analysis. RESULTS: The mean prevalence for CT/NG-ASSIR was 7.4%, with an upward trend (P=.174), and an increase of 46.5%. CT/NG-Prisons had a mean 8.0%, with an upward trend (P=.282), and an increase of 31.6%. Age and foreign origin are presented as risk factors in both populations. The concurrent sexual partners added to CT/NG-ASSIR and the time spent in prison to CT/NG-Prisons. DISCUSSION: The results underscore the need for a more efficient approach to control activities related to chlamydia infection in Catalonia. Policies need to be strengthened to promote safer sexual behaviours and active case finding by opportunistic screening in less than 25year-old.

Conductas de riesgo y prevalencia de Chlamydia trachomatis en presos según el tiempo de estancia en prisión / Risk behaviours and Chlamydia trachomatis prevalence in prisoners by length of stay in prison

Fundamento y objetivo: La población joven penitenciaria presenta elevadas conductas de riesgo y una precariedad socioeconómica que incrementa su vulnerabilidad frente a la adquisición de Chlamydia trachomatis (CT). Monitorizar su prevalencia ayudará a reducir las tasas de infección. Pacientes y métodos: Estudio transversal a partir de una muestra de conveniencia de presos de 18-25 años. Se obtuvieron muestras de orina para determinar CT. Se utilizó un cuestionario estandarizado anónimo para recoger las variables de estudio. Resultados: La prevalencia global de CT fue del 11%, significativamente superior en aquellos con menos de un año de estancia en prisión, presentando también frecuencias más elevadas en las conductas de riesgo, disminuyendo estas en aquellos que llevaban más de un año presos. Conclusiones: Los valores de prevalencia obtenidos dan una idea de la concentración de la población vulnerable a esta afección en las cárceles y subrayan la necesidad de continuar con los programas de prevención y control de infecciones de transmisión sexual (ITS). El hecho de estar mayor tiempo preso disminuyó los comportamientos de riesgo. Por tanto, creemos importante el cribado de ITS en el momento del ingreso, ya que hay una mayor probabilidad de estar infectado, e incidir en ese momento en la educación sexual, puesto que es cuando presentan conductas de riesgo más elevadas, que son las que probablemente realizaban cuando estaban en libertad

Background and objective: Young prisoners have high-risk behaviors and socio-economic insecurity that increases vulnerability for Chlamydia trachomatis (CT) acquisition. Monitoring its prevalence will help to reduce infection rates. Patients and methods: Cross-sectional study from a convenience sample of prisoners aged 18-25 years. Urine samples were obtained to determine CT. A standardized and anonymous questionnaire was used to collect the study variables. Results: The overall CT prevalence was 11%, significantly higher in those with less than one year in prison, who also presented higher frequencies in risk behaviors, while these were reduced in those who had been imprisoned for more than a year. Conclusions: The prevalence values obtained give an idea of the concentration of the population vulnerable to this disease in prisons and underscore the need to continue programs for the prevention and control of sexual transmitted infections (STIs). Being imprisoned longer decreased risk behaviors; therefore, it is important to screen for STIs upon admission because they are more likely to be infected and it would be thus possible to influence at that time in sex education because, at that time, risk behaviors occur more commonly, which are most likely done when they were free