HIV screening and retention in care in people who use drugs in Madrid, Spain: a prospective study

Pablo Ryan,Jesús Troya,Nuria Muñoz-Rivas,Salvador Resino,Jorge Valencia,Juan Torres-Macho,Isabel Canorea,Guillermo Cuevas,María José Muñoz-Gómez,Sonia Vázquez-Morón

doi:10.1186/s40249-021-00894-5

Abstract

BackgroundThe burden of human immunodeficiency virus (HIV) infection in people who use drugs (PWUD) is significant. We aimed to screen HIV infection among PWUD and describe their retention in HIV care. Besides, we also screen for hepatitis C virus (HCV) infection among HIV-seropositive PWUD and describe their linkage to care.MethodsWe conducted a prospective study in 529 PWUD who visited the “Cañada Real Galiana” (Madrid, Spain). The study period was from June 1, 2017, to May 31, 2018. HIV diagnosis was performed with a rapid antibody screening test at the point-of-care (POC) and HCV diagnosis with immunoassay and PCR tests on dried blood spot (DBS) in a central laboratory. Positive PWUD were referred to the hospital. We used the Chi-square or Fisher’s exact tests, as appropriate, to compare rates between groups.ResultsThirty-five (6.6%) participants were positive HIV antibodies, but 34 reported previous HIV diagnoses, and 27 (76%) had prior antiretroviral therapy. Among patients with a positive HIV antibody test, we also found a higher prevalence of homeless (P < 0.001) and injection drug use (PWID) (P < 0.001), and more decades of drug use (P = 0.002). All participants received HIV test results at the POC. Of the 35 HIV positives, 28 (80%) were retained in HIV medical care at the end of the HIV screening study (2018), and only 22 (62.9%) at the end of 2020. Moreover, 12/35 (34.3%) were positive for the HCV RNA test. Of the latter, 10/12 (83.3%) were contacted to deliver the HCV results test (delivery time of 19 days), 5/12 (41.7%) had an appointment and were attended at the hospital and started HCV therapy, and only 4/12 (33.3%) cleared HCV.ConclusionsWe found almost no new HIV-infected PWUD, but their cascade of HIV care was low and remains a challenge in this population at risk. The high frequency of active hepatitis C in HIV-infected PWUD reflects the need for HCV screening and reinforcing the link to care.

Highlights

The burden of human immunodeficiency virus (HIV) infection in people who use drugs (PWUD) is significant
The high frequency of active hepatitis C in HIV-infected PWUD reflects the need for hepatitis C virus (HCV) screening and reinforcing the link to care
88% of participants had usual care in a primary health center, 11% were never tested for HIV infection, 35% had not been tested for HIV infection in the last year, and 28% had taken opioid substitution therapy

Summary

Introduction

The burden of human immunodeficiency virus (HIV) infection in people who use drugs (PWUD) is significant. The most determining factors in increasing the risk of HIV and HCV acquisition are intravenous drug use, increased frequency of injection, syringe sharing, homelessness, incarceration, and exposure to physical and sexual violence, among others [8,9,10,11,12] Both HIV and HCV infections are usually diagnosed at hospitals using standardized tests, but this causes very high tracking losses among PWUD. Strategies to scale up HIV and HCV testing, such as rapid tests at the point of care (POC) and the use of mobile medical units, increase the probability of diagnosis among PWUD [13, 14] Another alternative is the use of dried blood samples (DBS) and to carry out the diagnosis in reference centers. This strategy has limitations, such as the diagnosis is delayed and hinder the link with medical care [15, 16]

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