The HIV care continuum among men who have sex with men in Moscow, Russia: a cross-sectional study of infection awareness and engagement in care

Abstract

Objectives Early diagnosis and treatment of HIV infection is critical to improving clinical outcomes for HIV-infected individuals. We sought to characterise the HIV care continuum and identify correlates of being unaware of one’s HIV infection among MSM in Moscow, Russia. Methods Participants (N=1,376) were recruited via respondent-driven sampling and completed a socio-behavioural survey and HIV testing from 2010–2013. Sample and population estimates were calculated for key steps along the HIV care continuum for HIV-infected MSM and logistic regression methods were utilized to examine correlates of being unaware of HIV infection. Results 15.6% (184/1177; population estimate:11.6%; 95%CI:8.5–14.7%) of participants were HIV infected. Of these, only 23.4% (43/184; population estimate:13.2; 95%CI:11.0–15.4) were previously aware of their infection, 8.7% (16/184 population estimate:4.7; 95%CI:1.0–8.5) were on ART, and 4.4% (8/164; population estimate:3.0; 95%CI:0.3 – 5.6) reported an undetectable viral load. Bisexual identity (reference: homosexual; AOR:3.69; 95%CI:1.19–11.43), having ≥5 sexual partners in the last 6 months (reference: ≤1; AOR:4.23; 95%CI:1.17–15.28), and employment HIV testing requirements (reference: no; AOR:15.43; 95%CI:1.62–147.01) were associated with being unaware of one’s HIV infection. HIV testing in a specialized facility (reference: private; AOR: 0.06; 95%CI: 0.01–0.53) and testing ≥2 times in the last 12 months (reference: none; AOR:0.17; 95%CI:0.04–0.73) were inversely associated with being unaware of HIV infection. Conclusion There is a steep gradient along the HIV care continuum for Moscow-based MSM beginning with low awareness of HIV infection. Efforts that improve access to acceptable HIV testing strategies, such as alternative testing facilities, and linkage to care are needed for key populations.

HIV treatment cascade in MSM, people who inject drugs, and sex workers

“…Care cascade reports were available from the United States[49,50*,53,54,76,77]; Canada[51*]; the United Kingdom[55]; Nigeria[58]; Burkina Faso and Togo[56]; Russia[57]; and India[52]. MSM living with HIV in Burkina Faso and Togo, Russia, and India had alarmingly low levels of status awareness (18, 20 and 44%, respectively).…”

Incorporating services for common mental disorders and substance use disorders for people living with HIV along the HIV treatment cascade

“…As shown in Figure 1, a standard cascade analytic tool provides a population estimate of the number of PLHIV; data comprising the number of individuals diagnosed with HIV infection, the number of PLHIV who are linked to/receiving antiretroviral treatment and the number of ART recipients obtaining a suppressed viral load. Various versions of the cascade can be generated using additional components of the HIV care continuum, as well as, specific populations and subpopulations as part of the analyses of epidemic control [55,56].…”

Emerging opportunities and challenges for HIV prevention, treatment and care for MSM in the former Soviet Union and other post-communist states in Eastern Europe

“…A recent large, respondent-driven sample of over 1,300 MSM in Moscow showed biologically-identified HIV prevalence of up to 15.6% (with a population level estimate of 11.6%). [7] Remarkably, over three-quarters of HIV-positive participants were unaware of their serostatus prior to the study.…”