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J Int AIDS Soc. 2018 Oct;21(10):e25195. doi: 10.1002/jia2.25195.

Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis.

Author information

1
Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
2
Division of Infectious Diseases, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
3
SCHARP-FHCRC, Seattle, WA, USA.
4
Department of Health Behavior, Gilings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
5
Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
6
University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
7
FHI 360, Durham, NC, USA.
8
Department of Biostatistics, Gilings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
9
Center for AIDS Research (CFAR), School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
10
School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
11
Academy of Labor, Social Relations and Tourism, Kyiv, Ukraine.
12
UNC Project, Hanoi, Vietnam.
13
Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, MD, USA.
14
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
15
Division of AIDS, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health, Bethesda, MD, USA.
16
Department of Medicine, Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA.
17
Department of Medicine, School of Medicine, University of California San Diego, San Diego, CA, USA.
18
Vietnam Authority of HIV/AIDS Control - Ministry of Health, Hanoi, Vietnam.
19
Pho Yen Health District Center, Pho Yen, Vietnam.
20
National Narcotic Board, Jakarta, Indonesia.

Abstract

INTRODUCTION:

People who inject drugs (PWID) experience high HIV incidence and face significant barriers to engagement in HIV care and substance use treatment. Strategies for HIV treatment as prevention and substance use treatment present unique challenges in PWID that may vary regionally. Understanding differences in the risk structure for HIV transmission and disease progression among PWID is essential in developing and effectively targeting intervention strategies of HIV treatment as prevention.

METHODS:

We present a baseline analysis of HIV Prevention Trials Network (HPTN) 074, a two-arm, randomized controlled trial among PWID in Indonesia (n = 258), Ukraine (n = 457) and Vietnam (n = 439). HPTN 074 was designed to determine the feasibility, barriers and uptake of an integrated intervention combining health systems navigation and psychosocial counselling for the early engagement of antiretroviral therapy (ART) and substance use treatment for PWID living with HIV. Discordant PWID networks were enrolled, consisting of an HIV-positive index and their HIV-negative network injection partner(s). Among the enrolled cohort of 1154 participants (502 index participants and 652 network partners), we examine regional differences in the baseline risk structure, including sociodemographics, HIV and substance use treatment history, and injection and sexual risk behaviours.

RESULTS:

The majority of participants were male (87%), with 82% of the enrolled females coming from Ukraine. The overall mean age was 34 (IQR: 30, 38). Most commonly injected substances included illegally manufactured methadone in Ukraine (84.2%), and heroin in Indonesia (81.8%) and Vietnam (99.5%). Injection network sizes varied by region: median number of people with whom participants self-reported injecting drugs was 3 (IQR: 2, 5) in Indonesia, 5 (IQR: 3, 10) in Ukraine and 3 (IQR: 2, 4) in Vietnam. Hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test - Alcohol Consumption Questions (AUDIT-C), was prominent in Ukraine (54.7%) and Vietnam (26.4%). Reported sexual risk behaviours in the past month, including having two or more sex partners and giving/receiving money or drugs in exchange for sex, were uncommon among all participants and regions.

CONCLUSIONS:

While regional differences in risk structure exist, PWID particularly in Ukraine need immediate attention for risk reduction strategies. Substantial regional differences in risk structure will require flexible, tailored treatment as prevention interventions for distinct PWID populations.

KEYWORDS:

ART ; HIV ; PWID ; injection drug use; substance use treatment; treatment as prevention

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