Role of substance use in HIV care cascade outcomes among people who inject drugs in Russia

Abstract

BackgroundEngaging people who drink alcohol or inject drugs in HIV care can be challenging, particularly in Eastern Europe. Healthcare facilities in Russia are organized by specialty; therefore linking patients from addiction care to HIV hospitals has been difficult. The HIV care cascade outlines stages of HIV care (e.g., linkage to care, prescribed antiretroviral therapy [ART], and achieving HIV viral suppression). We hypothesized that unhealthy alcohol use, injection drug use, and opioid craving are associated with unfavorable HIV care cascade outcomes.MethodsWe analyzed data from a cohort (n = 249) of HIV-positive Russians who have been in addiction hospital treatment in the past year and had a lifetime history of injection drug use (IDU). We evaluated the association between unhealthy alcohol use (AUDIT score > 7 [both hazardous drinking and dependence]), past-month injection drug use (IDU), and opioid craving (visual analogue scale from 1 to 100) with HIV care cascade outcomes. The primary outcome was linkage to HIV care within 12 months. Other outcomes were prescription of ART (secondary) and achievement of undetectable HIV viral load (HVL < 500 copies/mL) within 12 months (exploratory); the latter was analyzed on a subset in which HVL was measured (n = 48). We assessed outcomes via medical record review (linkage, ART) and serum tests (HVL). To examine the primary outcome, we used multiple logistic regression models controlling for potential confounders.ResultsAmong 249 study participants, unhealthy alcohol use (n = 148 [59%]) and past-month IDU (n = 130 [52%]) were common. The mean opioid craving score was 49 (SD: 38). We were unable to detect significant associations between the independent variables (i.e., unhealthy alcohol use, IDU and opioid craving) and any HIV care cascade outcomes in unadjusted and adjusted analyses.ConclusionIn this cohort of HIV-positive Russians with a history of IDU, individual substance use factors were not significantly associated with achieving HIV care cascade milestones (i.e., linkage to HIV care; prescription for ART; or suppressed viral load). Given no detection of an association of cascade outcomes with recent unhealthy use of alcohol or injection drugs in this cohort, examining systemic factors to understand determinants of HIV care engagement for people with drug use would be important.

Linking intravenous drug users to treatment through non-governmental organizations in Ukraine: how well is it working?

“…First, although considerable numbers of PWID were enrolled into CITI and on ART, only 23% accessed ART. However, the latter is almost twice what has been reported in the Russian Federation [23,24]. ART enrollment in our study reflects the endpoint of cohort analysis approach which has not been the case with other published studies reported on ART uptake in Ukraine and other parts of the world [25,26].…”

Substance use and the HIV care continuum: important advances

“…Qualitative interviews with public health and HIV service providers in Connecticut identified the need to increase mental health and substance use services and peer navigation/case management services and the need to decrease service agency stigma as key barriers and potential facilitators for improving HIV testing, engagement, and treatment [ 10 ]. Idrisov et al [ 11 ] reported no association between individual injection use histories and HIV outcomes, suggesting that systems issues may also prove a dominating contributor to HIV outcomes in Russia, obscuring individual factors.…”

Perspectives on the HIV continuum of care among adult opioid users in New York City: a qualitative study

“…Most participants were favorable to integrated treatment for HIV and OUD in primary care. Key insights shared by participants emphasized enhancing patient-centered approaches (e.g., shared decision making, emotional support, coordination and integration of care, information to facilitate health promotion) that reinforced key elements of the HIV care cascade (i.e., testing, diagnosis, receipt and retention on ART and medical care, viral suppression) [17, 21, 22]. Such approaches were critical in reengaging individuals with HIV care across different clinical settings (e.g., emergency rooms, inpatient detoxification, residential treatment).…”