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

Abstract

Background: In some regions, HIV incidence is rising among people who inject drugs (PWID). Combination prevention approaches are well suited to PWID who face multiple sources of HIV risk. This analysis investigates patterns of utilisation to basic HIV services (HIV counselling and testing [HCT], antiretroviral therapy [ART]) as well as harm reduction programs (needle and syringe exchange programs [NSEP] and opioid agonist therapy [OAT]) among PWID and how utilisation of harm reduction services is associated with HIV-related care seeking behaviours.

Methods: Respondent-driven sampling was used to recruit 14,481 PWID across 15 cities in India. Sampling-weighted multilevel logistic regression models assessed associations between utilisation of harm reduction service and HCT and ART use among those indicated (90.3% and 5.0% of full sample, respectively). We considered both recent (prior year) and ever use of services.

Results: Overall, 42.3% reported prior HIV testing and 57.9% of eligible persons reported ART initiation, but overlap with NSEP and OAT use was limited. In adjusted models, recent and ever use of both NSEP and OAT were significantly associated with recent and ever HCT utilisation, respectively; however, harm reduction utilisation was not associated with ART initiation among eligible participants.

Conclusions: Harm reduction services may play a key role in linking PWID with HIV testing; however, they were not associated with ART initiation among eligible individuals. Moreover, a large majority who utilised NSEP and OAT were not engaged in optimal HIV care or prevention, highlighting missed opportunities and a need for stronger linkages between NSEP/OAT and HIV care and treatment, particularly among those actively injecting. These findings provide key insights to better understand how services can be linked or combined to optimise service utilisation among PWID.

Keywords: HIV; Harm reduction; India; Injection drug use.

Figure 1

TITLE: Overlap of OAT and NSEP utilisation among the 13,073 HIV negative and HIV positive but unaware individuals with having accessed HCT within the past year (panel A), and ever having accessed HCT (panel B). Of the 13,073, 177 (1.4%) individuals reported that they did not know when they had last accessed NSEP or OAT so were excluded from the analyses of recent use patterns (panel A). CAPTION: HCT: HIV counseling and testing NSEP: needle and syringe exchange program OAT: opioid agonist therapy

Figure 2.

TITLE: Overlap of OAT and NSEP utilisation among the 712 ART eligible individuals with having ever initiated ART. CAPTION: ART: antiretroviral therapy NSEP: needle and syringe exchange program OAT: opioid agonist therapy

Figure 3.

TITLE: Adjusted odds ratios and 95% confidence intervals for effect of recent (within the past year) and ever use of NSEP and OAT, on the utilisation of HIV counselling and testing (red) and ART initiation (black). CAPTION: * Individuals who accessed HCT, NSEP, or OAT in the past year are by definition also considered to have ever accessed this service; that is, the two categories were not mutually exclusive. ** Models assessing associations with recent HCT utilisation were adjusted for other harm reduction use (NSEP or OAT, depending on the exposure of interest), alcohol use, drug choice, education level, and monthly income. Models assessing associations with ART utilisation were adjusted for other harm reduction use (NSEP or OAT, depending on the exposure of interest), age, alcohol use, drug choice, and education level. OR: odds ratio; CI: confidence interval; HCT: HIV counselling and testing; ART: antiretroviral therapy; NSEP: needle and syringe exchange; program; OAT: opioid agonist therapy