Getting to 90: linkage to HIV care among men who have sex with men and people who inject drugs in India

Abstract

UNAIDS set an ambitious target of “90-90-90” by 2020. The first 90 being 90% of those HIV-infected will be diagnosed; the second 90 being 90% of those diagnosed will be linked to medical care and on antiretroviral therapy (ART). While there has been dramatic improvement in HIV testing and ART use, substantial losses continue to occur at linkage-to-care following HIV diagnosis. Data on linkage among men who have sex with men (MSM) and people who inject drugs (PWID) are sparse, despite a greater burden of HIV in these populations. This cross-sectional study was conducted in 27 sites across India. Participants were recruited using respondent-driven sampling and had to be ≥18 years and self-identify as male and report sex with a man in the prior year (MSM) or injection drug use in the prior 2 years (PWID). Analyses were restricted to HIV-infected persons aware of their status. Linkage was defined as ever visiting a doctor for management of HIV after diagnosis. We explored factors that discriminated between those linked and not linked to care using multi-level logistic regression and area under the receiver operating curves (AUC), focusing on modifiable factors. Of 1726 HIV-infected persons aware of their status, 80% were linked to care. Modifiable factors around the time of diagnosis that best discriminated linkage included receiving assistance with HIV medical care (odds ratio [OR]: 10.0, 95% confidence interval [CI]): 5.6–18.2), disclosure of HIV-positive status (OR: 2.8; 95% CI: 2.4–6.1) and receiving information and counseling on management of HIV (OR: 2.3; 95% CI: 1.1–4.6). The AUC for these three factors together was 0.85, higher than other combinations of factors. We identified three simple modifiable factors around the time of diagnosis that could facilitate linkage to care among MSM and PWID in low- and middle-income countries to achieve UNAIDS targets.

Overlap between harm reduction and HIV service utilisation among PWID in India: Implications for HIV combination prevention

“…The potential impact of factors underlying this barrier such as unwilling providers (Chakrapani et al, 2013; Uhlmann et al, 2010) or lower ART-seeking behaviour among active PWID due to perceived or experienced stigma in healthcare settings (Steward et al, 2008), is an area for further inquiry. Better characterisation of such barriers will be an important starting point for creating effective ART programs for actively injecting PWID (Mathers et al, 2010; McFall et al, 2016; Wolfe, Carrieri, & Shepard, 2010)…”

Individual and Network Factors Associated With HIV Care Continuum Outcomes Among Nigerian MSM Accessing Health Care Services

“…Prior studies focused on individual characteristics associated with HIV testing, ART initiation and viral suppression 2–7 . Besides individual characteristics, sexual network factors may affect HIV testing and downstream engagement in health services 8 .…”

HIV Linkage to Care and Retention in Care Rate Among MSM in Guangzhou, China

“…Previous studies about the longitudinal change of retention in care have focused on PLHIV 10–12 , people who inject drugs or women. 8,9,13 With the exception of a few cross-sectional studies, 14,15 men who have sex with men (MSM) have not yet been systematically studied in low and middle income countries.…”