Misclassification of Men with Reported HIV Infection in Ukraine

Čakalo, Jurja-Ivana; Božičević, Ivana; Vitek, Charles; Mandel, Jeffrey S.; Salyuk, Tetyana; Rutherford, George W.

doi:10.1007/s10461-015-1112-0

Cited by 33 publications

(38 citation statements)

References 4 publications

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“…Our experience over the past 15 years working in Ukraine is that most street users will not go to AIDS Centers or military recruitment facilities (for example), to be tested, as there is little benefit to be gained and much to lose (e.g., stigma, discrimination, etc.). Moreover, a recent study by J-I Cakalo, et al found that misclassification of PWID occurred frequently [43]. The authors estimated that as many as 34.5% of men reported as heterosexual from 2005 to 2011 could have actually been PWID.…”

Section: Discussionmentioning

confidence: 99%

HIV incidence among people who inject drugs (PWIDs) in Ukraine: results from a clustered randomised trial

et al. 2016

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SummaryBackgroundIn this study, we sought to assess whether a social network intervention was superior to HIV testing and counseling in impacting HIV incidence among PWID. Although this was not a primary study aim, it is associated with reducing drug and sex risk behaviors, which were primary aims.MethodsPWID were recruited from street settings in Odessa, Donetsk, and Nikolayev, Ukraine for a clustered randomized clinical trial (RCT). “Index” or peer leaders, along with two of their network members, were randomly assigned to testing and counseling block (N=589) or testing and counseling plus a social network intervention block (N=611). Participants in the network intervention received 5-sessions to train their network members in risk reduction. Those assigned testing and counseling received no further intervention following counseling. Employing an intent to treat analyses, the primary outcome was HIV sero-conversion using Cox regression and incorporating a gamma frailty term to account for clustering. No stratification or minimization was utilized. The trail was registered with ClinicalTrial.gov, NCT01159704.FindingsBetween July 12, 2010 and November 23, 2012, 2,304 PWID were recruited, 1,200 of whom were HIV negative and included in the present study. At baseline, there were no significant differences between groups. Of the 1,200 HIV negative participants, 1,085 (90.4%) were retained at 12 months. Incidence density revealed 18.45 (95% CI 14.87 – 22.03, 102 events in 553.0 py) per 100 person years (py) for those in the intervention group and 31.78 (95% CI 26.83–36.74, 158 events in 497.1 py) per 100 py among control arm participants. This corresponded to a reduced hazard in the intervention group, HR= 0.53 (95% CI 0.38, 0.76, p =0.0003). There were no study-related adverse events.InterpretationThese data provide strong support for integrating peer education into comprehensive HIV prevention programs for PWID and suggest the value in developing and testing peer-led interventions for improving access and adherence to PrEP and ART.FundingThis study was funded by the National Institute on Drug Abuse (RO1 DA026739).

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Section: Discussionmentioning

confidence: 99%

HIV incidence among people who inject drugs (PWIDs) in Ukraine: results from a clustered randomised trial

et al. 2016

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“…Though previous surveillance suggested a generalizing epidemic in Ukraine (4), new information triangulating multiple data sources confirms that HIV remains concentrated in key populations (5). Among PWID, who account for the majority of cumulative HIV cases, HIV prevalence exceeds 40% (6, 7).…”

Section: Introductionmentioning

confidence: 94%

Attitudes Toward Addiction, Methadone Treatment, and Recovery Among HIV-Infected Ukrainian Prisoners Who Inject Drugs: Incarceration Effects and Exploration of Mediators

et al. 2016

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In this study, we use data from a survey conducted in Ukraine among 196 HIV-infected people who inject drugs (PWID), to explore attitudes toward drug addiction and methadone maintenance therapy (MMT), and intentions to change drug use during incarceration and after release from prison. Two groups were recruited: Group 1 (n=99) was currently incarcerated and Group 2 (n=97) had been recently released from prison. This paper’s key finding is that MMT treatment and addiction recovery were predominantly viewed as mutually exclusive processes. Group comparisons showed that participants in Group 1 exhibited higher optimism about changing their drug use, were less likely to endorse methadone, and reported higher intention to recover from their addiction. Group 2 participants, however, reported higher rates of HIV stigma. Structural equation modeling revealed that in both groups, optimism about recovery and awareness of addiction mediated the effect of drug addiction severity on intentions to recover.

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“…59 Required name-based HIV registries often undermine voluntary testing efforts and treatment engagement. 98,108 Officially reported HIV data therefore underestimate true prevalence, 118 with restriction of access to HIV treatment due to mandatory registration combined with stigma, discrimination, and criminalisation of key populations. 6,110,119 Similarly, patients receiving opioid agonist therapy must be officially registered before receiving it in all EECA countries, which can lead to restrictions on employment opportunities, limitations in housing, and revocation of drivers’ licences, further compounding economic disparities.…”

Section: Risk Environment Framework For Criminal Justice Settings In mentioning

confidence: 99%

The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

et al. 2016

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Despite global reductions in HIV incidence and mortality, the 15 UNAIDS-designated countries of Eastern Europe and Central Asia (EECA) that gained independence from the Soviet Union in 1991 constitute the only region where both continue to rise. HIV transmission in EECA is fuelled primarily by injection of opioids, with harsh criminalisation of drug use that has resulted in extraordinarily high levels of incarceration. Consequently, people who inject drugs, including those with HIV, hepatitis C virus, and tuberculosis, are concentrated within prisons. Evidence-based primary and secondary prevention of HIV using opioid agonist therapies such as methadone and buprenorphine is available in prisons in only a handful of EECA countries (methadone or buprenorphine in five countries and needle and syringe programmes in three countries), with none of them meeting recommended coverage levels. Similarly, antiretroviral therapy coverage, especially among people who inject drugs, is markedly under-scaled. Russia completely bans opioid agonist therapies and does not support needle and syringe programmes—with neither available in prisons—despite the country’s high incarceration rate and having the largest burden of people with HIV who inject drugs in the region. Mathematical modelling for Ukraine suggests that high levels of incarceration in EECA countries facilitate HIV transmission among people who inject drugs, with 28–55% of all new HIV infections over the next 15 years predicted to be attributable to heightened HIV transmission risk among currently or previously incarcerated people who inject drugs. Scaling up of opioid agonist therapies within prisons and maintaining treatment after release would yield the greatest HIV transmission reduction in people who inject drugs. Additional analyses also suggest that at least 6% of all incident tuberculosis cases, and 75% of incident tuberculosis cases in people who inject drugs are due to incarceration. Interventions that reduce incarceration itself and effectively intervene with prisoners to screen, diagnose, and treat addiction and HIV, hepatitis C virus, and tuberculosis are urgently needed to stem the multiple overlapping epidemics concentrated in prisons.

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Misclassification of Men with Reported HIV Infection in Ukraine

Cited by 33 publications

References 4 publications

HIV incidence among people who inject drugs (PWIDs) in Ukraine: results from a clustered randomised trial

HIV incidence among people who inject drugs (PWIDs) in Ukraine: results from a clustered randomised trial

Attitudes Toward Addiction, Methadone Treatment, and Recovery Among HIV-Infected Ukrainian Prisoners Who Inject Drugs: Incarceration Effects and Exploration of Mediators

The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

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