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

M. Kumi Smith, Sunil Solomon, Derek A.T. Cummings, Aylur K. Srikrishnan, M. Suresh Kumar, C. K. Vasudevan, Allison McFall, Gregory M Lucas, David D Celentano, Shruti Hemendra Mehta

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)111-118
Number of pages8
JournalInternational Journal of Drug Policy
Volume57
DOIs
StatePublished - Jul 1 2018

Keywords

  • Harm reduction
  • HIV
  • India
  • Injection drug use

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

Fingerprint Dive into the research topics of 'Overlap between harm reduction and HIV service utilisation among PWID in India: Implications for HIV combination prevention'. Together they form a unique fingerprint.

  • Cite this