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Randomized Controlled Trial
. 2018 Oct;21(10):e25195.
doi: 10.1002/jia2.25195.

Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis

Kathryn E Lancaster  1 , Irving F Hoffman  2 , Brett Hanscom  3 , Tran Viet Ha  4 , Kostyantyn Dumchev  5 , Hepa Susami  6 , Scott Rose  7 , Vivian F Go  4 , Sarah A Reifeis  8   9 , Katie R Mollan  9 , Michael G Hudgens  8   9 , Estelle M Piwowar-Manning  10 , Paul Richardson  10 , Sergii Dvoriak  5   11 , Zubairi Djoerban  6 , Tetiana Kiriazova  5 , Oleksandr Zeziulin  5 , Samsuridjal Djauzi  6 , Chu Viet Ahn  12 , Carl Latkin  13 , David Metzger  14 , David N Burns  15 , Jeremy Sugarman  16 , Steffanie A Strathdee  17 , Susan H Eshleman  10 , William Clarke  10 , Deborah Donnell  3 , Lynda Emel  3 , Lisa E Sunner  3 , Laura McKinstry  3 , Nirupama Sista  7 , Erica L Hamilton  7 , Jonathan P Lucas  7 , Bui D Duong  18 , Nguyen Van Vuong  19 , Riza Sarasvita  20 , William C Miller  1 ; HPTN 074 Study Team
Affiliations
Randomized Controlled Trial

Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis

Kathryn E Lancaster et al. J Int AIDS Soc. 2018 Oct.

Abstract

Introduction: People who inject drugs (PWID) experience high HIV incidence and face significant barriers to engagement in HIV care and substance use treatment. Strategies for HIV treatment as prevention and substance use treatment present unique challenges in PWID that may vary regionally. Understanding differences in the risk structure for HIV transmission and disease progression among PWID is essential in developing and effectively targeting intervention strategies of HIV treatment as prevention.

Methods: We present a baseline analysis of HIV Prevention Trials Network (HPTN) 074, a two-arm, randomized controlled trial among PWID in Indonesia (n = 258), Ukraine (n = 457) and Vietnam (n = 439). HPTN 074 was designed to determine the feasibility, barriers and uptake of an integrated intervention combining health systems navigation and psychosocial counselling for the early engagement of antiretroviral therapy (ART) and substance use treatment for PWID living with HIV. Discordant PWID networks were enrolled, consisting of an HIV-positive index and their HIV-negative network injection partner(s). Among the enrolled cohort of 1154 participants (502 index participants and 652 network partners), we examine regional differences in the baseline risk structure, including sociodemographics, HIV and substance use treatment history, and injection and sexual risk behaviours.

Results: The majority of participants were male (87%), with 82% of the enrolled females coming from Ukraine. The overall mean age was 34 (IQR: 30, 38). Most commonly injected substances included illegally manufactured methadone in Ukraine (84.2%), and heroin in Indonesia (81.8%) and Vietnam (99.5%). Injection network sizes varied by region: median number of people with whom participants self-reported injecting drugs was 3 (IQR: 2, 5) in Indonesia, 5 (IQR: 3, 10) in Ukraine and 3 (IQR: 2, 4) in Vietnam. Hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test - Alcohol Consumption Questions (AUDIT-C), was prominent in Ukraine (54.7%) and Vietnam (26.4%). Reported sexual risk behaviours in the past month, including having two or more sex partners and giving/receiving money or drugs in exchange for sex, were uncommon among all participants and regions.

Conclusions: While regional differences in risk structure exist, PWID particularly in Ukraine need immediate attention for risk reduction strategies. Substantial regional differences in risk structure will require flexible, tailored treatment as prevention interventions for distinct PWID populations.

Keywords: ART; HIV; PWID; injection drug use; substance use treatment; treatment as prevention.

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Figures

Figure 1
Figure 1. Cumulative enrolment by site in HPTN 074 (N = 1154)
See this image and copyright information in PMC

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