Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 1:249:110834.
doi: 10.1016/j.drugalcdep.2023.110834. Epub 2023 Jun 16.

Respondent-driven sampling is more efficient than facility-based strategies at identifying undiagnosed people who inject drugs living with HIV in India

Allison M McFall  1 , Sunil S Solomon  2 , Bryan Lau  3 , Carl Latkin  4 , Aylur K Srikrishnan  5 , Santhanam Anand  5 , Canjeevaram K Vasudevan  5 , Muniratnam Suresh Kumar  5 , Gregory M Lucas  2 , Shruti H Mehta  3
Affiliations

Respondent-driven sampling is more efficient than facility-based strategies at identifying undiagnosed people who inject drugs living with HIV in India

Allison M McFall et al. Drug Alcohol Depend. .

Abstract

Introduction: Injection drug use drives HIV epidemics in many low-resource settings, yet many people who inject drugs (PWID) living with HIV are not diagnosed. We assessed the ability of respondent-driven sampling (RDS) - which uses peer network connections - to identify undiagnosed PWID living with HIV compared to a facility-based strategy in India.

Methods: In six Indian cities from 2014 to 2017, integrated care centers (ICCs) provided HIV testing. From 2016 to 2017, RDS samples of PWID in these same cities were conducted. Using biometric matching, characteristics associated with identification by RDS only and both RDS and ICC, compared to ICC only were explored. Undiagnosed individuals tested positive and did not report a prior diagnosis. The number needed to recruit (NNR) (average number recruited to find one undiagnosed PWID living with HIV) and the identification rate (average number undiagnosed PWID identified per week) assessed the efficiency of RDS vs. ICCs.

Results: There were 10,759 ICC clients and 6012 RDS participants; 40% of RDS participants were also ICC clients resulting in 14,397 unduplicated PWID. PWID identified by RDS vs. ICC only were more likely to be male (adjusted odds ratios [aOR] RDS only: 6.8, both: 2.7) and living with HIV but undiagnosed (aOR RDS only: 2.5, both: 1.5). Overall, the RDS NNR was 11 and the ICC NNR was 26. The RDS identification rate (18.6/week) was faster than the ICC identification rate (2.7/week) overall and in all cities.

Conclusions: RDS required screening fewer PWID and more rapidly identified undiagnosed PWID living with HIV as compared to ICCs.

Keywords: HIV testing; India; People who inject drugs; Respondent-driven sampling.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest No conflicts declared.

Figures

Figure 1:
Figure 1:
Number needed to recruit (NNR) for undiagnosed HIV-infected PWID, stratified by city and strategy. This figure shows the NNR - number screened in order to find one undiagnosed HIV-infected person who inject drugs – overall and by city for the different approaches examined - ICCs vs. RDS. Also shown for reference is the HIV prevalence and incidence overall and by city. The Y-axis is ln transformed. Abbreviations used: PWID: people who inject drugs ICC: integrated care center RDS: respondent-driven sampling prev.: prevalence from RDS, RDS-II weighted inc.: annual cross-sectional incidence estimate from RDS
Figure 2:
Figure 2:
Identification rate per week for undiagnosed HIV-infected PWID, stratified by city and strategy. This figure shows the identification rate - average number of undiagnosed HIV-infected people who inject drugs identified in a week - overall and by city for the different approaches examined - ICCs vs. RDS. Also shown for reference is the HIV prevalence and incidence overall and by city. The Y-axis is ln transformed. Abbreviations used: PWID: people who inject drugs ICC: integrated care center RDS: respondent-driven sampling prev.: prevalence from RDS, RDS-II weighted inc.: annual cross-sectional incidence estimate from RDS
See this image and copyright information in PMC

References

    1. Ambekar A, Agrawal A, Rao R, Mishra AK, Khandelwal SK and Chadda RK (2019). “Magnitude of substance use in India.” New Delhi: Ministry of Social Justice and Empowerment, Government of India.
    1. Baral SD, Ketende S, Schwartz S, Orazulike I, Ugoh K, Peel SA, Ake J, Blattner W and Charurat M (2015). “Evaluating respondent-driven sampling as an implementation tool for universal coverage of antiretroviral studies among men who have sex with men living with HIV.” Journal of Acquired Immune Deficiency Syndromes 68: S107–S113. - PMC - PubMed
    1. Chakrapani V, Velayudham J, Shunmugam M, Newman PA and Dubrow R (2014). “Barriers to antiretroviral treatment access for injecting drug users living with HIV in Chennai, South India.” AIDS Care 26(7): 835–841. - PMC - PubMed
    1. Degenhardt L, Peacock A, Colledge S, Leung J, Grebely J, Vickerman P, Stone J, Cunningham EB, Trickey A and Dumchev K (2017). “Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review.” The Lancet Global Health 5(12): e1192–e1207. - PMC - PubMed
    1. Dennis AM, Murillo W, de Maria Hernandez F, Guardado ME, Nieto AI, de Rivera IL, Eron JJ and Paz-Bailey G (2013). “Social network based recruitment successfully reveals HIV-1 transmission networks among high risk individuals in El Salvador.” Journal of Acquired Immune Deficiency Syndromes 63(1): 135–141. - PMC - PubMed

Publication types