The feasibility of an intensive case management program for injection drug users on antiretroviral therapy in St. Petersburg, Russia

Abstract

BackgroundThe majority of HIV-infected individuals requiring antiretroviral therapy (ART) in Russia are Injection Drug Users (IDU). Substitution therapy used as part of a comprehensive harm reduction program is unavailable in Russia. Past data shows that only 16% of IDU receiving substance abuse treatment completed the course without relapse, and only 40% of IDU on ART remained on treatment at 6 months. Our goal was to determine if it was feasible to improve these historic outcomes by adding intensive case management (ICM) to the substance abuse and ART treatment programs for IDU.MethodsIDU starting ART and able to involve a “supporter” who would assist in their treatment plan were enrolled. ICM included opiate detoxification, bi-monthly contact and counseling with the case, weekly group sessions, monthly contact with the “supporter” and home visits as needed. Full follow- up (FFU) was 8 months. Stata v10 (College Station, TX) was used for all analysis. Descriptive statistics were calculated for all baseline demographic variables, baseline and follow-up CD4 count, and viral load. Median baseline and follow-up CD4 counts and RNA levels were compared using the Kruskal-Wallis test. The proportion of participants with RNA < 1000 copies mL at baseline and follow-up was compared using Fisher’s Exact test. McNemar’s test for paired proportions was used to compare the change in proportion of participants with RNA < 1000 copies mL from baseline to follow-up.ResultsBetween November 2007 and December 2008, 60 IDU were enrolled. 34 (56.7%) were male. 54/60 (90.0%) remained in FFU. Overall, 31/60 (52%) were active IDU at enrollment and 27 (45%) were active at their last follow-up visit. 40/60 (66.7%) attended all of their ART clinic visits, 13/60 (21.7%) missed one or more visit but remained on ART, and 7/60 (11.7%) stopped ART before the end of FFU. Overall, 39/53 (74%) had a final 6–8 month HIV RNA viral load (VL) < 1000 copies/mL.ConclusionsDespite no substitution therapy to assist IDU in substance abuse and ART treatment programs, ICM was feasible, and the retention and adherence of IDU on ART in St. Petersburg could be greatly enhanced by adding ICM to the existing treatment programs.

Effect of a multi-dimensional case management model on anti-retroviral therapy-related outcomes among people living with human immunodeficiency virus in Beijing, China

“…Consequently, this has also led to improvements in clinical results. Specifically, in this study, the results of the multivariate logistic regression analysis indicated that patients who received the new case management model were at decreased odds of developing virological failure ( P < 0.001), which is consistent with other findings [ 32 – 34 ]. More so, those receiving case management experienced consistently higher survival rates compared to those in the control group.…”

Adherence to Antiretroviral Medications Among Persons Who Inject Drugs in Transitional, Low and Middle Income Countries: An International Systematic Review

“…There were 10 studies that did not control for confounders in their analysis of follow-up adherence among ART participants (20–22, 24–29). While there was clearly bias introduced among included primary studies, we did not note any systematic bias that would lead to removal from the analysis.…”

“It is easier for me to shoot up”: stigma, abandonment, and why HIV-positive drug users in Russia fail to link to HIV care

“…Case management and patient navigation can connect separated health care systems (Mugavero, Norton, & Saag, 2011; Pecoraro et al, 2015) and facilitate engagement with HIV care (Bradford, Coleman, & Cunningham, 2007; Gardner et al, 2005). Such an approach was shown promising in pilot research from Russia (Shaboltas et al, 2013). …”

“…Research indicates that facilitators of HIV care include case management, psychological and social support, opioid agonist therapy, integrated addiction and HIV treatment, acceptance of HIV status, and addressing HIV and drug stigma (Kamarulzaman & Altice, 2015; J. D. Kelly, Hartman, Graham, Kallen, & Giordano, 2014; Samet et al, 1995; Shaboltas et al, 2013). However, this prior work is largely quantitative and not specific to PWID, providing limited insight into how these factors affect care utilization among PWID.…”