Engagement in HIV care and its correlates among people who inject drugs in St Petersburg, Russian Federation and Kohtla-Järve, Estonia

Abstract

Background and Aims HIV infection and mortality in Eastern Europe are driven by unsafe injection drug use. We sought to compare engagement in care from HIV testing through receipt of antiretroviral treatment among HIV-positive people who inject drugs (PWID) in St. Petersburg, Russian Federation (RF) and Kohtla-Järve, Estonia and identify factors significantly associated with failure to progress at each stage of the HIV treatment cascade. Design Cross-sectional biobehavioral surveys of PWID with an analysis stratified by location – two Russian speaking regions with similar HIV epidemic histories and current prevalence. Setting Field-based surveys conducted in St. Petersburg, RF and Kohtla-Järve, Estonia. Participants We recruited 452 HIV-positive PWID in St. Petersburg (November 2012 to June 2013) and 370 HIV-positive PWID in Kohtla-Järve (June–August 2012) using respondent driven sampling. Measurements Participants were tested for antibodies to HIV, and administered a questionnaire focusing on participants’ medical care histories. Engagement in care was categorized as a cascade of five transitional steps through six stages ranging from HIV testing to current receipt of antiretroviral medications. Findings Progress along the cascade was greater in Kohtla-Järve (32.7% were receiving antiretroviral medications) than in St. Petersburg (9.7%). In both locations, we found the steps with high failure rates were the transitions from being aware of one’s HIV diagnosis to being in regular care and initiation of highly active antiretroviral therapy (HAART). Factors significantly associated with transition failure in both locations and across steps included high alcohol consumption, variables associated with drug choice and injection frequency, and lack of basic medical insurance. Conclusion The two steps in treatment cascade for HIV-positive PWID in St. Petersburg, RF and Kohtla-Järve, Estonia requiring greatest improvement are retention in regular care and initiation of HAART. Both individual behavioral and structural factors are associated with failure to transition along the cascade.

Level of Alcohol Use Associated with HIV Care Continuum Targets in a National U.S. Sample of Persons Living with HIV Receiving Healthcare

“…In the U.S., 54% of PLWH report any alcohol use and 25% report any heavy episodic drinking, an unhealthy pattern of use known to adversely influence multiple health outcomes. 13 Alcohol use is associated with HIV care including: testing 14–16 and diagnosis; 17 care engagement, 18 quality, 19 and retention; 20–23 receipt and use of ART; 24,25 and potentially viral suppression. 26–28 Thus, alcohol use may represent a modifiable influence on HIV care continuum targets.…”

Design of a randomized controlled trial to Link Infectious and Narcology Care (LINC-II) in St. Petersburg, Russia

“…The LINC-II study will assess the effectiveness and implications of an intervention designed to pursue 90-90-90 HIV care cascade targets by facilitating coordination of care between the addiction (i.e., narcology) and HIV treatment systems in Russia. This is high-priority research given that in St. Petersburg, Russia, 50-60% of PWID are HIV-positive, yet among this key population, less than 10% are on ART [2,22,23]. Engaging this population in HIV care has immense consequences for the overall HIV epidemic in Russia, as it has the potential to limit onward HIV transmission through successful achievement of undetectable HVL.…”

“…therapy (ART) [2]. For Russia to make progress toward the UNAIDS 90-90-90 targets [i.e., 90% aware of HIV diagnosis, 90% of those diagnosed on antiretroviral therapy (ART), and 90% of those on ART with suppressed HIV viral load (HVL)], a bold new strategy is required.…”

An improved HIV care cascade to assess HIV control programs among people who inject drugs.

“…Accurate performance indicators of the HIV cascade of care need to be constantly improved and adapted to the target population [19]. Routine questionnaires are frequently biased by misreporting behavior leading to an often inappropriate evaluation of the HIV care performance [7,9]. Herein, we report that i) this misreporting is significant among PWID, leading to a biased estimate of the cascade of care, and ii) this bias can be corrected by adding plasma dosage of a quasi-universal ART (lamivudine) when elaborating the cascade.…”