Abstract
BackgroundThe majority of HIV-infected individuals requiring antiretroviral therapy (ART) in Russia are Injection Drug Users (IDU). Substitution therapy used as part of a comprehensive harm reduction program is unavailable in Russia. Past data shows that only 16% of IDU receiving substance abuse treatment completed the course without relapse, and only 40% of IDU on ART remained on treatment at 6 months. Our goal was to determine if it was feasible to improve these historic outcomes by adding intensive case management (ICM) to the substance abuse and ART treatment programs for IDU.MethodsIDU starting ART and able to involve a “supporter” who would assist in their treatment plan were enrolled. ICM included opiate detoxification, bi-monthly contact and counseling with the case, weekly group sessions, monthly contact with the “supporter” and home visits as needed. Full follow- up (FFU) was 8 months. Stata v10 (College Station, TX) was used for all analysis. Descriptive statistics were calculated for all baseline demographic variables, baseline and follow-up CD4 count, and viral load. Median baseline and follow-up CD4 counts and RNA levels were compared using the Kruskal-Wallis test. The proportion of participants with RNA < 1000 copies mL at baseline and follow-up was compared using Fisher’s Exact test. McNemar’s test for paired proportions was used to compare the change in proportion of participants with RNA < 1000 copies mL from baseline to follow-up.ResultsBetween November 2007 and December 2008, 60 IDU were enrolled. 34 (56.7%) were male. 54/60 (90.0%) remained in FFU. Overall, 31/60 (52%) were active IDU at enrollment and 27 (45%) were active at their last follow-up visit. 40/60 (66.7%) attended all of their ART clinic visits, 13/60 (21.7%) missed one or more visit but remained on ART, and 7/60 (11.7%) stopped ART before the end of FFU. Overall, 39/53 (74%) had a final 6–8 month HIV RNA viral load (VL) < 1000 copies/mL.ConclusionsDespite no substitution therapy to assist IDU in substance abuse and ART treatment programs, ICM was feasible, and the retention and adherence of IDU on ART in St. Petersburg could be greatly enhanced by adding ICM to the existing treatment programs.
Highlights
The majority of HIV-infected individuals requiring antiretroviral therapy (ART) in Russia are Injection Drug Users (IDU)
Inclusion criteria HIV-infected, active IDU, who were eligible to start ART or recently began ART; were able to identify a parent, relative, partner or friend who could actively assist them in their treatment plans; and for the active users, were willing to enroll in a 10 day in-patient detoxification program, were recruited at the City AIDS Center, St
Study visits Once an IDU was confirmed eligible, an enrollment visit was conducted which included an informed consent procedure, a risk assessment questionnaire including drug use and psychological status assessment, an HIV risk behavior evaluation, a physical examination of the skin looking for fresh needle marks, a urine drug screen and an alcohol breathalyzer
Summary
The majority of HIV-infected individuals requiring antiretroviral therapy (ART) in Russia are Injection Drug Users (IDU). Our goal was to determine if it was feasible to improve these historic outcomes by adding intensive case management (ICM) to the substance abuse and ART treatment programs for IDU. Russia currently has one of the highest rates of injecting drug users (IDU) in the world at 1.8% among adults over 15 years of age [2] and it is estimated that one of the highest IDU populations in the world (> 80,000 active IDU) live in St. Petersburg, the second largest city in Russia [3]. Petersburg have been consistently high, with a 30% prevalence and an incidence of 4.5 per 100 person-years in 2003 [6,7], 14 per 100 person-years incidence in 2008 [8], and 35% prevalence and 7.2 per 100 person-years incidence in 2010 [9]
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