Knowledge on HIV and attitudes towards people living with HIV among prisoner population in Serbia

over is very low, which calls for combined efforts in improving the proportion of tests in this group. Training, campaigning and health information dissemination through the media, as well as creating specific community settings for testing which may overcome barriers to access, are examples of strategies that may help improve this indicator. Key messages: The rise in new HIV diagnoses among people aged 50 and over does not accompany a rise in testing – efforts should be made to address this mismatch. The contribution and commitment of all stakeholders is essential to reach feasible targets and get Public Health gains.


Background:
Russia, a country with a growing HIV epidemic, made progress in the prevention of mother-to-child transmission through provision of antiretroviral (ARV) prophylaxis to pregnant women. But, women's longer-term ARV use is staggeringly low. We aimed to explore factors influencing postpartum retention in HIV care and treatment in Russia.

Methods:
We conducted community-based, qualitative research in a large metropolitan city (St. Petersburg) and a town in Sverdlovskaya Oblast'. We conducted in-depth interviews with 50 young, HIVpositive mothers and 20 service providers. We purposively sampled for diversity based on ARV use and history of drug use and/or sex work. Using thematic analysis, we identified factors influencing young mothers' retention in care.

Results:
Women with strong family and/or partner support valued its importance for retention in care. Single mothers, mothers afraid to disclose their serostatus, and mothers married to AIDS denialists are especially vulnerable to stopping treatment. Women voiced the need for counselors who can explain the details of their diagnoses and medications. Feelings of isolation, stigma, and fear associated with HIV and with motherhood were common. Many women expressed grave financial need -lacking money for food or housing. Lack of childcare and specifically for when women need to go for doctors' visits was a salient issue in both sites. Women cited distance to the AIDS Centers, twice a day dosage, and severe side effects as being especially difficult postpartum. Similar concerns were expressed across the two sites; however, lack of access to resource, poverty, and HIV-related stigma were even more salient in the smaller town.

Conclusions:
Policies and programs should be implemented to provide financial, informational, psychological, and social support to HIV-positive women. Structural issues such as economic opportunities, childcare, clinic location, and availability of quality ARVs need to be addressed.

Key messages:
Absence of family support, HIV-related stigma, poverty, misinformation, and lack of childcare are some of the barriers to HIV-positive mothers' long-term adherence to HIV treatment and care in Russia. Professional support, including psychological and informational counseling from health care providers, would help HIV-positive mothers' longer-term retention in HIV care and treatment in Russia.

Background:
Hepatitis A outbreak among MSM in Europe is still ongoing. In Slovenia detection of hepatitis A virus (HAV) circulation among MSM was mainly based on self-identification of cases which may underestimate burden. We performed an epidemiological investigation coupled with sequence-based typing to characterise circulating HAV strains linked to MSM outbreaks in order to tailor preventive measures and improve surveillance.

Methods:
A case was defined as a reported laboratory-confirmed hepatitis A (confirmation of anti-HAV specific antibodies and/or detection of HAV RNA in serum or stool by PCR) from May 2017-March 2018. We interviewed cases and performed sequence-based typing of HAV isolates using HAVNET protocol.

Conclusions:
Epidemiological investigation coupled with sequence-based typing allowed identification of circulating outbreak strains. Routine HAV sequence-based typing of all isolates should be routinely implemented. Circulation of HAV among MSM calls for improved health education activities and promotion of freely available two-dose vaccination. Control measures to prevent secondary household transmission of HAV should always be included in health education material.

Key messages:
Enhanced surveillance with routine real-time sequencebased typing is needed to provide better insight on disease burden among risk groups. Tailored health education activities, including prevention of household transmission and promotion of free two-dose vaccination, are needed to reduce the risk of disease.
Use of HAV Hepatis related internet searches as a proxy of disease incidence trends Background: HAV incidence is decreasing worldwide but outbreaks are still being reported. Traditional surveillance methods are effective in detecting outbreaks, but the process can take months, hindering a prompt response. We propose an infodemiology based approach to detect outbreaks, through monitoring of internet search trends on HAV.

Methods:
We extracted monthly Italian searches on ''HAV Hepatitis'' from Google Trends and HAV cases from the national HAV surveillance program, from 2004 to 2017. We also extracted searches on HBV and HCV Hepatitis as control. Trends were adjusted for searches on general health topics to decrease confounding and log-transformed. We used a quadratic smoothing spline to reduce noise, with smoothing parameters chosen by generalized cross-validation. Cross-correlation function (CCF) was used to estimate the lag between trends and Pearson correlation to compare them.

Results:
There is a strong temporal correlation between HAV incidence trends and HAV related searches: CCF found a lag up to one month between outbreaks and an increase in searches, with a correlation score from 0.

Conclusions:
HAV hepatitis related searches correlate well with HAV incidence trends, probably due to people searching for information after being diagnosed with the disease. This motivates investigating a real-time detection system for HAV outbreaks using search data and increased effort in verifying the accuracy of information present on the internet regarding HAV hepatitis.

Key messages:
Internet search trends monitoring works well as a fast integration of traditional epidemiological surveillance of HAV Hepatitis. This study confirms that individuals rely on internet search results for investigating health issues. It is therefore important to monitor the reliability of health information on the internet.
Predictors of possible rabies exposure in travelers: a case-control study

Background:
Rabies is transmitted by rabid animals. Timely administration of post-exposure prophylaxis (PEP) can prevent the development of rabies. For non-vaccinated persons PEP consists of 5 vaccinations and anti-rabies immunoglobulin (RIG) on indication. Since RIG is scarce and expensive, the need for PEP should be restricted through prevention of animal contact and/or pre-exposure vaccination. We aimed to identify determinants for possible rabies exposure to better guide pre-travel (vaccination) advice.

Methods:
A case-control study was performed. Cases were defined as persons who traveled to a rabies endemic country, contacted their public health service (PHS) between July 1, 2016 and July 1, 2017 after a possible rabies exposure, and had a PEP indication. Cases were randomly selected from all PHS in the Netherlands. Controls were persons that visited one of three participating PHS travel clinics before travel in the same time period and did not report an exposure. A possible rabies exposure was defined as a type II or III injury according to the WHO classification.

Results:
In total, 229 cases and 1427 controls were included. Their median age was 28 years (IQR 23-38) and 34 years (IQR 26-54), respectively. For both cases and controls the most visited countries were Indonesia (15%) and Thailand (10%). The most important reasons for travel were holidays (86%) and visiting friends and relatives (14%). Of the injuries 77% were type III, 15% type II and 7% unknown. Most injuries were caused by dogs (39%) and monkeys (38%). Univariable analyses showed significant (p < 0.05) positive predictors of possible rabies exposure were male sex, region visited, visiting a monkey park, being a pet owner. Significant negative predictors were age, travelling for business, camping, horse riding, visiting a wildlife park and fear of animals. Multivariable analyses will follow.

Conclusions:
Pre-travel (vaccination) advice should take the identified risk groups into account. Key messages: The need for rabies post-exposition prophylaxis should be restricted through prevention of animal contact and/or vaccination.