Linking intravenous drug users to treatment through non-governmental organizations in Ukraine: how well is it working?

Julia Kuznetsova,Tetiana Mykhalchuk,Olga Denisiuk,Rony Zachariah,Pavlo Smyrnov,Nataliia Kravchenko,Yuliia Sereda ,Joshua Chadwick Jayaraj

doi:10.3855/jidc.11291

Abstract

Alliance for Public Health, the International Charitable Foundation, coordinates HIV prevention in Non-Governmental Organizations (NGO) working with people who inject drugs (PWID) in Ukraine. We aimed to describe the performance of the differential model of linking PWID to HIV care and treatment (Community Initiated Treatment Intervention - CITI). A retrospective cohort study using routine program data was conducted among 8,927 PWID who were tested positive for the first time during January 2016 - June 2017. Study outcomes were enrollment into CITI and initiating antiretroviral treatment (ART). Factors associated with outcomes were estimated by logistic regressions with random effects. Among the study participants, 54% enrolled into CITI and 23% initiated ART. CITI enrolment was associated with being married (adjusted odds ratio (AOR) = 1.17; 95%: 1.02-1.34); less than weekly compared to daily (AOR = 1.31; 95%: 1.13-1.52); less than 5 years of drug use compared to > 14 years (AOR = 1.73; 95%: 1.40-2.13), and having no criminal records (AOR = 1.30; 95%: 1.12-1.50). Factors of non-ART initiation were male gender (AOR = 1.33; 95%: 1.16-1.53); being single (AOR = 1.48; 95%: 1.21-1.82); drug use duration > 14 years compared to < 5 years (AOR = 1.38; 95%: 1.03-1.85), unemployment (AOR = 1.45; 95%: 1.15-1.83) and history of incarceration (AOR = 1.21; 95%: 1.003-1.45). Mobilizing the NGO community and PWID to engage in outreach HIV testing activity and harm reduction for key populations has succeeded in opening the gateway to prevention, care and ART for thousands of PWID in Ukraine.

Highlights

Alliance for Public Health, the International Charitable Foundation, coordinates HIV prevention in Non-GovernmentalOrganizations (NGO) working with people who inject drugs (PWID) in Ukraine
Mobilizing the Non-Governmental Organizations (NGO) community and PWID to engage in outreach HIV testing activity and harm reduction for key populations has succeeded in opening the gateway to prevention, care and antiretroviral therapy (ART) for thousands of PWID in Ukraine
Infections occur in key populations, the first and second targets can only be achieved if there is an improved focus on people who are at increased risk of acquiring and transmitting HIV due to their high-risk behaviors including People Who Inject Drugs (PWID) [3]

Summary

Introduction

Organizations (NGO) working with people who inject drugs (PWID) in Ukraine. A vital component of this strategy is the 90-90-90 targets [2]:90% of all people living with HIV know their status; 90% of those diagnosed with HIV will receive sustained antiretroviral therapy (ART) and 90% of those on ART have viral suppression [2]. As about 50% of new HIV infections occur in key populations, the first and second targets can only be achieved if there is an improved focus on people who are at increased risk of acquiring and transmitting HIV due to their high-risk behaviors including People Who Inject Drugs (PWID) [3]. 158 countries have reported injecting drug use, of which 78% have reported HIV among.

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