Objectives: In the early 2000s, Estonia and Latvia experienced a rapidly growing HIV epidemic among people who inject drugs (PWID), and had, with Russia, the highest diagnosis rates in Europe. Understanding epidemic dynamics in both countries and how responses to HIV impacted them is essential to ending injection-driven epidemics. Design: Statistical modeling, programmatic data collection, and triangulation. Methods: Data on newly diagnosed HIV cases were used in a back-calculation model to estimate, for each country, trends in HIV incidence, time to diagnosis, and undiagnosed infections. Modeled estimates were then triangulated with programmatic data on harm reduction services, HIV testing, and ART. Results: From 2007 to 2016, HIV incidence decreased in Estonia by 61% overall, for all exposure groups, and particularly for male PWID (97%), except men who have sex with men, where it increased by 418%. In Latvia, it increased by 72% overall. Median time to diagnosis decreased for male PWID in Estonia, from 3.5 to 2.6 years, but not in Latvia. In 2016, most new and undiagnosed infections, ∼50% in Latvia and ∼75% in Estonia, affected individuals reporting heterosexual transmission, showing a gradual shift toward heterosexual route as the main reported exposure mode. Coverage of services had been higher in Estonia; for example, by 2016, for PWID, there were >200 needles and syringes distributed per PWID annually, and HIV testing and ART coverage reached ∼50% and 76%, respectively, in Estonia, against respectively less than 100%, 10% and 27% in Latvia. Conclusions: Estonia has turned the tide of its epidemic – large scale-up of prevention and care programs probably contributed to it – whereas in Latvia it remains very active.

The World Health Organization (WHO) has published guidance to help national governments minimise terrorist threats to food by integrating the mechanisms which manage outbreaks of both unintentional and deliberate foodborne diseases and contamination (1,2). The need for guidance was raised during the 55th World Health Assembly in May 2002, and Terrorist threats to food: guidance for establishing and strengthening prevention and response systems (www.who.int/fsf) is a response to recent increasing concern worldwide about the possible use of chemical, biological or radionuclear (CBRN) agents against civilian populations.

Background According to previous epidemiological studies there is 2.4% prevalence of anti-HCV in Latvian population. Hepatitis C can lead to liver cirrhosis and HCC. There is available an effective HCV treatment with 100% reimbursement. WHO has settled a goal – to eliminate HCV as a public health threat by 2030. The biggest obstacle to achieve this goal is to find an infected persons. The aim of this study was to screen and analyze the data of patients from Psychiatry hospitals (PH) in Latvia. Patients were screened for hepatitis C infection (anti-HCV) and analyze the possible risk factors. Methods 795 patients of all PH in Latvia were tested, including 57.1% males and 42.9% females. The mean age was 49 years (range 18 - 93). Data were obtained by performing survey and rapid blood antibody tests. The questionnaire included demographic information and 10 questions on infection risk factors. Study was done from May till October 2021 by HIV Prevention Point workers in PHs of 7 PH in Latvia – Riga, Daugavpils, Liepaja, Strenci, Gintermuiza, Akniste and Vecpiebalga. Data were analyzed using MS Excel and IBM SPSS. Results 24.8% of patients noted they have been sexually active in the last year, but only 9.9% admitted usage of condoms. 3.8% noted they are or have been used IV drugs. 11.2% of patients have a history of incarceration. In total 6.8% of performed tests were positive for anti-HCV. Incarcerated persons were positive in 16% of cases, non-incarcerated – in 6%. IV drug users (IVDU) were positive in 49%, non-users – in 4.9%, all differences are statistically significant. Conclusion Patients in PH are at higher risk of HCV infection in comparison to population in Latvia. Besides already well known risk groups – IVDU and incarcerated people, we found 2.8 times higher anti-HCV prevalence in psychiatric hospital’s patients, with markedly higher prevalence in those previously incarcerated or IVDU. This study provides valuable data to better identify groups of individuals with higher risk of HCV infection. Latvia. PNC patients should further be tested, especially individuals who have been incarcerated, use or have used IV drugs. Disclosures All Authors: No reported disclosures.

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