Antiretroviral therapy for prevention of HIV transmission: Potential role for people who inject drugs in Central Asia

McNairy, Margaret L.; Deryabina, Anna; Hui‐Kang, David; El‐Sadr, Wafaa

doi:10.1016/j.drugalcdep.2013.06.034

Cited by 10 publications

(11 citation statements)

References 50 publications

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“…The “seek, test, treat, and retain” strategy for HIV prevention, which calls for identification and prompt treatment of HIV-infected individuals, has gained favour based on evidence showing effective viral suppression through ART treatment results in impressive reductions in HIV transmission among HIV serodiscordant couples (M. S. Cohen et al, 2011); more recent data point to a similar effect among PWIDs (McNairy, Deryabina, Hoos, & El-Sadr, 2013; Milloy, Marshall, Montaner, & Wood, 2012). …”

Section: Discussionmentioning

confidence: 99%

Within-prison drug injection among HIV-infected Ukrainian prisoners: Prevalence and correlates of an extremely high-risk behaviour

Izenberg

Bachireddy

Wickersham

et al. 2014

International Journal of Drug Policy

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Background In Ukraine, HIV-infection, injection drug use, and incarceration are syndemic; however, few services are available to incarcerated people who inject drugs (PWIDs). While data are limited internationally, within-prison drug injection (WP-DI) appears widespread and may pose significant challenges in countries like Ukraine, where PWIDs contribute heavily to HIV incidence. To date, WP-DI has not been specifically examined among HIV-infected prisoners, the only persons that can transmit HIV. Methods A convenience sample of 97 HIV-infected adults recently released from prison within 1–12 months was recruited in two major Ukrainian cities. Post-release surveys inquired about WP-DI and injection equipment sharing, as well as current and prior drug use and injection, mental health, and access to within-prison treatment for HIV and other comorbidities. Logistic regression identified independent correlates of WP-DI. Results Complete data for WP-DI were available for 95 (97.9%) respondents. Overall, 54 (56.8%) reported WP-DI, among whom 40 (74.1%) shared injecting equipment with a mean of 4.4 (range 0–30) other injectors per needle/syringe. Independent correlates of WP-DI were recruitment in Kyiv (AOR 7.46, p=0.003), male gender (AOR 22.07, p=0.006), and active pre-incarceration opioid use (AOR 8.66, p=0.005). Conclusions Among these recently released HIV-infected prisoners, WP-DI and injection equipment sharing were frequent and involved many injecting partners per needle/syringe. The overwhelming majority of respondents reporting WP-DI used opioids both before and after incarceration, suggesting that implementation of evidence-based harm reduction practices, such as opioid substitution therapy and/or needle/syringe exchange programs within prison, is crucial to addressing continuing HIV transmission among PWIDs within prison settings. The positive correlation between Kyiv site and WP-DI suggests that additional structural interventions may be useful.

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Section: Discussionmentioning

confidence: 99%

Within-prison drug injection among HIV-infected Ukrainian prisoners: Prevalence and correlates of an extremely high-risk behaviour

Izenberg

Bachireddy

Wickersham

et al. 2014

International Journal of Drug Policy

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“…70 Achieving the UNAIDS 90-90-90 targets of identifying 90% of people living with HIV, 90% of these initiating and remaining on antiretroviral therapy, and 90% achieving viral suppression, requires more effective HIV screening, treatment, and optimal medication adherence 71 in EECA countries, including in prisons. Despite National AIDS Centres in some countries reporting high coverage levels with antiretroviral therapy in prisoners who are diagnosed, 61,72 most people living with HIV within EECA prisons remain undiagnosed.…”

Section: The Confluence Of Mass Incarceration Substance Use Disordermentioning

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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“…Many PWID have been lost to follow-up and some have not been assessed for ART eligibility (McNairy, Deryabina, Hoos, & El-Sadr, 2013). In 2010, the overall coverage of ART in Eastern Europe and Central Asia is estimated to be 35%, which is well below the global level of 60% (Donoghoe & Stengaard, 2010).…”

Section: Combination Hiv Prevention For Pwidmentioning

confidence: 99%

Illicit drugs in Central Asia: What we know, what we don’t know, and what we need to know

Latypov¹,

Grund

El‐Bassel

et al. 2014

International Journal of Drug Policy

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Antiretroviral therapy for prevention of HIV transmission: Potential role for people who inject drugs in Central Asia

Cited by 10 publications

References 50 publications

Within-prison drug injection among HIV-infected Ukrainian prisoners: Prevalence and correlates of an extremely high-risk behaviour

Within-prison drug injection among HIV-infected Ukrainian prisoners: Prevalence and correlates of an extremely high-risk behaviour

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

Illicit drugs in Central Asia: What we know, what we don’t know, and what we need to know

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