HIV Epidemic Research Articles

Sociopolitical Diagnostic Tools to Understand National and Local Response Capabilities and Vulnerabilities to Epidemics and Guide Research into How to Improve the Global Response to Pathogens.

The AIDS and COVID-19 pandemics demonstrated that nations at similar economic development levels varied widely in their capacity to protect the health of their residents. For AIDS, Britain and Australia brought gay representatives into official counsels and adopted harm reduction far more rapidly than the United States or Spain, and East African countries responded more effectively than South Africa or the Democratic Republic of the Congo. National responses to COVID-19 varied widely, with New Zealand, China, and Vietnam more effective than Italy, Brazil, or the United States. Further, as phylogenetic research has demonstrated, these pandemics spread from one country to another, with those that responded poorly acting as sources for mutations and potentially sources of transmission to countries with more effective responses. Many observers expressed surprise at the poor responses of the United States to COVID-19, but in retrospect the cutbacks in public health funding at state and national levels made it clear that this was a predictable weakness even in addition to the political vacillations that crippled the US and Brazilian responses. In a time of global sociopolitical and climate instability, it is important to measure and conduct research into spatial and time variations in 1. public health and medical funding, 2. social influence networks, social cohesion and trust, and stigmatization, 3. income inequality, 4. social conflict, and 5. other factors that affect responsiveness to pandemics.

Queer failure in Freddy’s Revenge and Scream, Queen! A documentary’s recuperation of Elm Street’s queer memory

ABSTRACT In this queer reading of the 1985 horror sequel Freddy’s Revenge, I use Halberstam’s theory of queer failure to interrogate cultural mechanisms that validate and invalidate a film’s memory. The 2019 documentary Scream, Queen! guides my queer celebration of Freddy’s Revenge. The movies converge to create profound, low theoretical insights into queer desire at the apex of the AIDS pandemic. The essay challenges heteronormative impulses commonly used to frame a media artifact as significant and successful enough to merit investigation.

Developing HIV risk prediction tools in four African settings.

HIV risk prediction tools are a critical component of efforts to end the HIV pandemic. We aimed to create and validate tools for identifying individuals at highest risk of prevalent and incident HIV in an African setting. We used Logistic regression and Poisson regression to determine risk factors for HIV prevalence and incidence in a multi-country HIV vaccine trial preparedness cohort study among individuals at high risk of HIV, and used the identified factors to create and validate tools that predict HIV risk. We also assessed the performance of the VOICE risk score in predicting HIV incidence among women in the cohort. The prevalent HIV prediction tool created had good predictive ability [area under the curve (AUC) = 0.70, 95% CI 0.66-0.74]. It included the following participant variables: age, sex, recreational drug use, unprotected male-to-male anal sex, a sexual partner who had other partners, transactional sex and having a partner who was a long-distance truck driver/miner. It was not possible to create a valid HIV incidence prediction tool. Participants with high VOICE risk scores (≥7) had slightly higher HIV incidence but this tool performed poorly within our study (AUC = 0.58, 95% CI 0.51-0.64: Harrell's concordance index = 0.59). We created a prevalent HIV prediction tool that could be used to increase efficiency in diagnosis of HIV and linkage to care in sub-Saharan Africa. Existing incident HIV prediction tools may need modification to include context-specific predictors such as calendar period, participant occupation, study site, before adoption in settings different from those in which they were developed.

Rapid HIV Self-Testing


 Self-testing has become recognizable to most people in Canada as a way to reduce the spread of infections. HIV self-testing has recently become available in Canada and is an approach to HIV screening intended to complement existing HIV testing currently offered in medical and community settings. Self-test kits can be used in the home, alone or in the presence of another person, and they may help overcome barriers to HIV diagnosis, and help Canada achieve its commitments to end the HIV and AIDS epidemics by 2030.
 HIV self-testing is recommended by the WHO, used in countries worldwide. The INSTI HIV-1/2 Antibody Self Test is the first HIV self-test available in Canada. It is a single-use HIV test kit that detects HIV-1 and HIV-2 antibodies from a drop of blood collected by a fingerstick. In 50% of people, the test can detect HIV infection about 22 days after exposure, and in 99% of people can detect HIV infection 12 weeks (3 months) after infection.
 As the INSTI HIV-1/2 Antibody Self Test is intended as a screening test, a positive result must be confirmed with a laboratory-based test. If the result is negative, no further action is required unless the tester has had a potential HIV exposure in the previous 3 months. In this case, a person should self-test at a later date or seek a laboratory-based HIV test that is able to detect HIV in a shorter window of time since potential exposure.
 While the comparability of the INSTI HIV-1/2 Antibody Self Test with traditional lab testing has already been established, when used in real-world settings in Canada, there is a higher than-expected rate of invalid test results (that is, when the test does not produce a result and therefore another test must be taken). Improvements to the content, design, or delivery of the test instructions and other resource materials provided to testers have been offered as possible solutions.
 This report outlines information related to the INSTI HIV-1/2 Antibody Self Test use in Canada and issues for consideration when implementing an HIV self-testing program including cost, support for testers, and providing test access to groups who have historically had lower testing rates.

Integration of sexually transmitted infection and HIV pre-exposure prophylaxis services in sub-Saharan Africa: a scoping review.

Persons living in sub-Saharan Africa (SSA) face disproportionate risk from overlapping epidemics of HIV and bacterial sexually transmitted infections (STIs). Pre-exposure prophylaxis (PrEP) for prevention is gradually being scaled up globally including in several settings in SSA, which represents a key opportunity to integrate STI services with HIV pre-exposure prophylaxis (PrEP). However, there is limited literature on how to successfully integrate these services, particularly in the SSA context. Prior studies and reviews on STI and PrEP services have largely focused on high income countries. We conducted a scoping review of prior studies of integration of STI and PrEP services in SSA. We searched PubMed, EMBASE, Cochrane, and CINAHL, in addition to grey literature to identify studies that were published between January 2012 and December 2022, and which provided STI and PrEP services in SSA, with or without outcomes reported. Citations and abstracts were reviewed by two reviewers for inclusion. Full texts were then retrieved and reviewed in full by two reviewers. Our search strategy yielded 1951 records, of which 250 were retrieved in full. Our final review included 61 reports of 45 studies. Most studies were conducted in Southern (49.2%) and Eastern (24.6%) Africa. Service settings included public health clinics (26.2%), study clinics (23.0%), sexual and reproductive care settings (23.0%), maternal and child health settings (8.2%), community based services (11.5%), and mobile clinics (3.3%). A minority (11.4%) of the studies described only syndromic STI management while most (88.6%) included some form of etiological laboratory STI diagnosis. STI testing frequency ranged from baseline testing only to monthly screening. Types of STI tested for was also variable. Few studies reported outcomes related to implementation of STI services. There were high rates of curable STIs detected by laboratory testing (baseline genitourinary STI rates ranged from 5.6-30.8% for CT, 0.0-11.2% for GC, and 0.4-8.0% for TV). Existing studies have implemented a varied range of STI services along with PrEP. This range reflects the lack of specific guidance regarding STI services within PrEP programs. However, there was limited evidence regarding implementation strategies for integration of STI and PrEP services in real world settings.

Dynamics of hospital admissions and all-cause mortality of HIV infected patients in Kazakhstan: data from unified nationwide electronic healthcare system 2014-2019.

Although global HIV pandemic has stabilized, it continues to rise in Eastern Europe and Central Asia due to exponential growth of newly acquired cases. Based on UNAIDS, there are currently 35,000 people living with HIV (PLWH) in Kazakhstan. This alarming HIV epidemiologic situation mandates urgent investigation of causes, routes of transmission and other characteristics in order to halt the epidemic. We aimed to analyze the data of all hospitalized patients for the period of 2014-2019 who tested positive for HIV from the Unified National Electronic Health System (UNEHS) of Kazakhstan. This cohort study extracted data for all HIV positive patients during 2014-2019 from UNEHS of Kazakhstan to apply descriptive, Kaplan-Meier estimation, and Cox proportional hazards regression model. Crosscheck of the target population data was conducted with tuberculosis, viral hepatitis, alcohol abuse and intravenous drug user (IDU) cohorts in order to create a comprehensive database. All survival functions and factors associated with mortality were tested for significance. The cohort population (n = 2,213) mean age was 33.3 ± 13.3 years with 1,375 males (62.1%) and 838 females (37.9%). Incidence rate decreased from 2.05 in 2014 to 1.88 in 2019, however, prevalence and mortality continues to escalate every year, the mortality raised significantly from 0.39 in 2014 to 0.97 in 2019. People aged >50 years, males, retired people, patients from tuberculosis hospital profile had much lower survival probabilities than the corresponding groups. Adjusted Cox regression model death hazard showed strong association of HIV patients with tuberculosis coinfection (HR 1.4, 95% CI 1.1; 1.7, p < 0.001). The results of this study demonstrate high rates of HIV mortality, strong association of HIV with TB coinfection, regional, age specific, gender, hospital profile and social status differences that significantly affect HIV prevalence. Since the prevalence of HIV is continuing to increase, more information is necessary for evaluation and implementation of prevention procedures.

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

IntroductionInjection 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. MethodsIn 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. ResultsThere 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. ConclusionsRDS required screening fewer PWID and more rapidly identified undiagnosed PWID living with HIV as compared to ICCs.

The Unspoken Plight of HIV Gripping Asian/Pacific Islander Communities in America

The HIV pandemic has made a significant impact on various communities and demographics in the US. Although special attention has been given to African, Latin, Hispanic, and non-Hispanic white American communities, Asian American and Pacific Islander (A/PI) communities are often overlooked in HIV prevention efforts. Regardless of how statistically reassuring HIV diagnoses by ethnicity may seem, HIV poses a threat to the A/PI community. The “model minority” stereotype, lack of cultural and linguistic accommodations in HIV education, and cultural barriers may account for the lack of HIV testing and prevention in A/PI communities. The “model minority” stereotype projected onto A/PI individuals and their health gives a false sense of security in their current health status. Lack of education leads to misconceptions around HIV spread and transmission within A/PI communities. Cultural barriers continue to impact disclosure of HIV status among A/PI individuals and has a role in limiting HIV prevention efforts in these communities. Personal accounts and studies on HIV-positive Asian Americans show the lasting impact the “model minority” label, gap in HIV education, and cultural barriers have on combating HIV in A/PI communities. HIV needs to be addressed in A/PI communities and public health measures, HIV education, and A/PI HIV support groups may encourage greater HIV awareness, testing, and prevention in A/PI communities.

Bridging Divides: art and religion in the early AIDS pandemic.

Throughout the 1980s and 1990s, visual artists created a canon of work examining the illness experience of people living with AIDS. Largely forgotten today is a subset of this canon that simultaneously engaged AIDS narratives and religion, thereby dialoguing across political, cultural, and ideological divides. The artists who crafted these works created spaces of sanctioned discourse, drawing together sexual and religious histories in a manner reminiscent of the confessional as analyzed in Michel Foucault's work. This article rediscovers an archive rich in interdisciplinary illness narratives, arguing that the unearthed art pieces articulate four themes that interrogate the relationship between people with AIDS and religious traditions. In addition to furthering our understanding of a forgotten expression of AIDS illness narratives, this analysis provides insight into art's capacity to dialogue between communities in the setting of internal divisions. These lessons may aid us as we endeavor to understand the diversity, function, and applications of illness narratives in the setting of the politicized diseases of the 21st century, including COVID-19.

The Histories of HIVs: The Emergence of the Multiple Viruses That Caused the AIDS Epidemics ed. by William H. Schneider (review)

The Histories of HIVs: The Emergence of the Multiple Viruses That Caused the AIDS Epidemics ed. by William H. Schneider (review)

The intertwined epidemics of HIV and COVID-19 - emerging data and responses.

aDivision of HIV, Infectious Diseases, and Global Medicine; Department of Medicine; University of California, San Francisco (UCSF), USA bIII Division of Infectious Diseases, Department of Biomedical and Clinical Sciences (DIBIC), Luigi Sacco University Hospital, University of Milan, Italy Correspondence to Agostino Riva, and Monica Gandhi, MD, Universita degli Studi di Milano, Milano, Italy. E-mail: [email protected]; [email protected]

Violation of the vaginal microbiome and the risk of HIV infection in women

Women are the main population responsible for new HIV infections and the persistence of the HIV pandemic. The article provides a review of the current literature on the factors and mechanisms by which the vaginal microbiome can contribute to HIV infection. A key determinant of susceptibility to HIV infection is the composition of the vaginal microbiome, which can influence the local immune cell population and inflammation status. A low diversity microbial composition dominated by Lactobacillus crispatus does not increase the risk of HIV infection, and a high microbial diversity environment associated with bacterial vaginosis increases the risk of HIV infection. The female reproductive tract has a unique susceptibility to viral infection because tissue-specific immunity must elicit rapid antimicrobial responses to pathogens while maintaining sperm tolerance. It is important to note that the risk of HIV infection during sexual intercourse is multifactorial and is determined not only by the state of the microbiota of a woman’s genital tract, but also by the state of the partner’s microbiota, the viral load of HIV in the blood of the sexual partner, the presence/absence of anti-retroviral therapy in the partner, hormonal background and the phase of the menstrual cycle, which also affect the state of the microbiota.

Life Expectancy and Life Years Lost After HIV or AIDS Diagnosis: A Retrospective Cohort Study

The AIDS pandemic on average took a life every minute in 2021 despite effective HIV treatment and tools to prevent, detect, and treat opportunistic infections. The objective of this study was to estimate the average life expectancy and life years lost (LYL) in people diagnosed with HIV or AIDS in Puerto Rico from 2000-2020. The epidemiological design was a retrospective cohort study of 24,143 people diagnosed with HIV or AIDS and received services under the Eligible Metropolitan Area (EMA) of San Juan, Puerto Rico. The population with a diagnosis of HIV or AIDS was described using socioeconomic characteristics with frequencies and proportions by category. We estimated the LYL by matching the expected residual lifetime for someone diagnosed with the disease with the life expectancy of the general population at that specific age as the null model. Average years of life lost (LYL) is a measure that reflects expected earlier death as a result of a condition. The number of LYL is dependent on the year of onset of the condition. In general, the earlier the onset of HIV or AIDS results in a larger impact of LYL. For individuals diagnosed at the age of 30 with AIDS the LYL is approximately 35.5 years, whereas for an individual where the onset is at age 70 years, being diagnosed with HIV or AIDS results in approximately 2.7 years lost. In our study, we found a greater number of LYL in patients diagnosed with AIDS in this population compared to those diagnosed with HIV. This study confirms the dramatic impact of HIV and AIDS on the lifespan of individuals and how the age of onset of the conditions impacts LYL.

Improving Biomarker-based HIV Incidence Estimation in the Treatment Era.

Estimating HIV-1 incidence using biomarker assays in cross-sectional surveys is important for understanding the HIV pandemic. However, the utility of these estimates has been limited by uncertainty about what input parameters to use for false recency rate (FRR) and mean duration of recent infection (MDRI) after applying a recent infection testing algorithm (RITA). This article shows how testing and diagnosis reduce both FRR and mean duration of recent infection compared to a treatment-naive population. A new method is proposed for calculating appropriate context-specific estimates of FRR and mean duration of recent infection. The result of this is a new formula for incidence that depends only on reference FRR and mean duration of recent infection parameters derived in an undiagnosed, treatment-naive, nonelite controller, non-AIDS-progressed population. Applying the methodology to eleven cross-sectional surveys in Africa results in good agreement with previous incidence estimates, except in 2 countries with very high reported testing rates. Incidence estimation equations can be adapted to account for the dynamics of treatment and recent infection testing algorithms. This provides a rigorous mathematical foundation for the application of HIV recency assays in cross-sectional surveys.

Correlation of polymorphism in Toll-Like Receptor (TLR1 and TLR2) genes with susceptibility of pulmonary tuberculosis in Doda region of India

BackgroundPulmonary tuberculosis has emerged as one of the leading causes of deaths across the globe. The prevalence of Mycobacterium tuberculosis has also shown an increasing trend over the time which may be attributed to the increase in multidrug resistant strains and HIV epidemics. There are several factors like change in the gene structure and cellular activities of the host and the bacterium which may have changed the host response towards tuberculosis. Additionally, the recent reports have suggested that Toll-Like Receptors (TLRs) play an important role in the activation of immune responses against various pathogens. Therefore, this study has been designed to investigate the possible correlation of TLR gene polymorphism and prevalence of pulmonary tuberculosis. MethodThis study investigates 300 samples collected from patients with pulmonary tuberculosis (150) and healthy controls (150) from the Doda region of Jammu, India. For analysis purpose, DNA from the collected samples were isolated and subjected to sequence specific PCR amplification of TLR-1 and TLR-2 genes. The amplicons of TLR-1 and TLR-2 were further digested with restriction enzymes PvuII and Xbal, respectively, and visualized on agarose gel, subsequently. ResultThe results suggest that frequency of TLR2 gene polymorphism (73.9%) is high in the patients below the age of 50 years, whereas, frequency of TLR-1 gene polymorphism is high (71%) in the patients above 50 years of age (p = 0.005). Further, the restriction digestion analysis of TLR1 genes has shown that nearly 78% of the confirmed normal cases exhibit homozygous normal conditions followed by 12% cases with heterozygous conditions and 10% cases of homozygous mutants. Similarly for TLR2 genes, nearly 78.6% of the confirmed normal cases have shown homozygous normal conditions followed heterozygous conditions (12.6%) and homozygous mutants (8.6%). ConclusionThis study establishes a preliminary correlation between TLR polymorphism and tuberculosis.

Systemic Activism: Uneasy Coalitions During the Canadian AIDS Pandemic of the 1980s and 1990s

The AIDS pandemic disproportionately affects Canadian gay men, women, racialized communities, people who inject drugs, and people who have been or are incarcerated, leading these groups to engage in coalitional activism to advance HIV/AIDS prevention and treatment. This paper examines how the effects of AIDS necessitated a response across these marginalized groups. Oral history interviews conducted in Toronto by the Canadian AIDS Activist History Project were examined to discuss the coalitions that were formed amongst marginalized groups in Toronto during the height of the Canadian AIDS crisis of the 1980s and 1990s. Oral history interviews are incredibly valuable to marginalized communities; yet, once they are collected, they are often left unanalyzed. This paper analyzes existing oral history interviews to provide an overview of some of the tensions and successes between activists who belonged to different social groups. The paper ends with a discussion of intersectionality and the role of systemic activism in Canadian AIDS activist history.

Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis

Measuring the incidence of HIV and hepatitis C virus (HCV) infection among people who inject drugs (PWID) is key to track progress towards elimination. We aimed to summarise global data on HIV and primary HCV incidence among PWID and associations with age and sex or gender. In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies among PWID by searching MEDLINE, Embase, and PsycINFO, capturing studies published between Jan 1, 2000, and Dec 12, 2022, with no language or study design restrictions. We contacted authors of identified studies for unpublished or updated data. We included studies that estimated incidence by longitudinally re-testing people at risk of infection or by using assays for recent infection. We pooled incidence and relative risk (RR; young [generally defined as ≤25 years] vs older PWID; women vs men) estimates using random-effects meta-analysis and assessed risk of bias with a modified Newcastle-Ottawa scale. This study is registered with PROSPERO, CRD42020220884. Our updated search identified 9493 publications, of which 211 were eligible for full-text review. An additional 377 full-text records from our existing database and five records identified through cross-referencing were assessed. Including 28 unpublished records, 125 records met the inclusion criteria. We identified 64 estimates of HIV incidence (30 from high-income countries [HICs] and 34 from low-income or middle-income countries [LMICs]) and 66 estimates of HCV incidence (52 from HICs and 14 from LMICs). 41 (64%) of 64 HIV and 42 (64%) of 66 HCV estimates were from single cities rather than being multi-city or nationwide. Estimates were measured over 1987-2021 for HIV and 1992-2021 for HCV. Pooled HIV incidence was 1·7 per 100 person-years (95% CI 1·3-2·3; I2=98·4%) and pooled HCV incidence was 12·1 per 100 person-years (10·0-14·6; I2=97·2%). Young PWID had a greater risk of HIV (RR 1·5, 95% CI 1·2-1·8; I2=66·9%) and HCV (1·5, 1·3-1·8; I2=70·6%) acquisition than older PWID. Women had a greater risk of HIV (RR 1·4, 95% CI 1·1-1·6; I2=55·3%) and HCV (1·2, 1·1-1·3; I2=43·3%) acquisition than men. For both HIV and HCV, the median risk-of-bias score was 6 (IQR 6-7), indicating moderate risk. Although sparse, available HIV and HCV incidence estimates offer insights into global levels of HIV and HCV transmission among PWID. Intensified efforts are needed to keep track of the HIV and HCV epidemics among PWID and to expand access to age-appropriate and gender-appropriate prevention services that serve young PWID and women who inject drugs. Canadian Institutes of Health Research, Fonds de recherche du Québec-Santé, Canadian Network on Hepatitis C, UK National Institute for Health and Care Research, and WHO.

Transmission modeling to infer tuberculosis incidence prevalence and mortality in settings with generalized HIV epidemics

Tuberculosis (TB) killed more people globally than any other single pathogen over the past decade. Where surveillance is weak, estimating TB burden estimates uses modeling. In many African countries, increases in HIV prevalence and antiretroviral therapy have driven dynamic TB epidemics, complicating estimation of burden, trends, and potential intervention impact. We therefore develop a novel age-structured TB transmission model incorporating evolving demographic, HIV and antiretroviral therapy effects, and calibrate to TB prevalence and notification data from 12 African countries. We use Bayesian methods to include uncertainty for all TB model parameters, and estimate age-specific annual risks of TB infection, finding up to 16.0%/year in adults, and the proportion of TB incidence from recent (re)infection, finding a mean across countries of 34%. Rapid reduction of the unacceptably high burden of TB in high HIV prevalence settings will require interventions addressing progression as well as transmission.

Modelling the impact of combining HIV prevention interventions on HIV dynamics in fishing communities in Uganda

BackgroundIn countries with mature generalized HIV epidemics such as Uganda, there are still groups of individuals that are disproportionately affected. Among the key populations in Uganda are fishing communities, which make up about 10% of the population. Compared to the general population, HIV prevalence and incidence among individuals living in these communities is high. This high HIV burden has been attributed to several factors including limited access to prevention and treatment services as well as ongoing high-risk sexual behaviour.MethodsWe investigated the impact of combined HIV prevention interventions on HIV transmission dynamics in high-risk fishing communities in Uganda using a deterministic compartmental model. The model was calibrated to seroprevalence data from a census performed in 2014. To account for remaining uncertainty in the calibrated model parameters, 50 000 simulated scenarios were modelled to investigate the impact of combined prevention interventions.ResultsThe projected HIV incidence decreased from 1.87 per 100 PY without intervention scale-up to 0.25 per 100 PY after 15 years (2014–2029) of intervention scale-up. A potential combination achieving this 87% reduction in incidence over 15 years in Ugandan FCs included condom use in about 60% of sexual acts, 23% of susceptible men circumcised, 87% of people living with HIV aware of their status, 75% of those on ART, and about 3% of susceptible individuals on oral PrEP. Uncertainty analysis revealed relative reductions in incidence ranging from 30.9 to 86.8%. Sensitivity analyses suggested that condom use and early ART were the most important interventions.ConclusionReducing HIV incidence, as well as prevalence and AIDS-related mortality, in these high-risk fishing communities in Uganda is attainable over 15 years with a combination prevention package. Our projected intervention coverage levels are well within the national targets set by the Uganda government and enable coming close to reaching the UNAIDS 95-95-95 targets to end AIDS as a public health threat by 2030.

Buprenorphine treatment receipt characteristics and retention among people who inject drugs at Integrated Care Centers in India

BackgroundIndia is facing overlapping opioid injection and HIV epidemics among people who inject drugs (PWID) in several cities. Integrated Care Centers (ICCs) provide single-venue HIV and substance use services to PWID. We evaluated PWID engagement in daily observed buprenorphine treatment at 7 ICCs to inform interventions. MethodsWe analyzed 1-year follow-up data for PWID initiating buprenorphine between 1 January – 31 December 2018, evaluating receipt frequency, treatment interruptions (no buprenorphine receipt for 60 consecutive days with subsequent re-engagement), and drop-out (no buprenorphine receipt for 60 consecutive days without re-engagement). Using descriptive statistics, we explored differences between ICCs in the opioid-endemic Northeast region and ICCs in the emerging opioid epidemic North/Central region. We used a multivariable logistic regression model to determine predictors of treatment drop-out by 6 months. Results1312 PWID initiated buprenorphine (76% North/Central ICCs vs. 24% Northeast ICCs). 31% of PWID in North/Central, and 25% in Northeast ICCs experienced ≥ 1 treatment interruption in 1 year. Over 6 months, 48% of PWID in North/Central vs. 60% in Northeast ICCs received buprenorphine ≤ 2 times/week (p < 0.0001). A third of PWID in North/Central vs. half in Northeast ICCs experienced treatment drop-out by 6 months (p < 0.001). In the multivariable model, living in Northeast cities was associated with increased odds of drop-out while counseling receipt was associated with decreased odds. ConclusionsRetention among PWID initiating buprenorphine at ICCs was comparable to global reports. However, regional heterogeneity in retention, and low daily buprenorphine receipt suggest patient-centered interventions adapted to regional contexts are urgently needed.