Changes in HIV care continuum indicators among community-based samples of HIV-infected people who inject drugs and men who have sex with men across 21 cities in India

ABSTRACT

Monitoring key populations’ progress towards UNAIDS 90-90-90 targets is essential to achieving HIV/AIDS epidemic control. Using serial cross-sectional data, we evaluated changes in HIV care continuum among people who inject drugs(PWID) and men who have sex with men(MSM) in India. Cross-sectional baseline (2012/2013) and follow-up (2016/2017) samples were recruited using respondent-driven sampling across 21 cities. All participants were tested for HIV and RNA measured in HIV-positive participants. Linear regression was used to model temporal site-level changes in continuum indicators in MSM versus PWID. At baseline, we recruited 2,544 HIV-infected PWID and 1,086 HIV-infected MSM. At follow-up, we recruited 2,517 HIV-infected PWID and 1,763 HIV-infected MSM. At baseline, there were no significant differences in continuum indicators between MSM and PWID. At follow-up, compared to PWID, the proportion of MSM reaching each care continuum indicator—awareness of status, receipt of care, ART use, viral suppression—increased by 15-33 percentage points: 78% of MSM versus 49% of PWID were aware of their status (p < 0.01); 56% of MSM versus 32% of PWID were virologically suppressed (p = 0.05). MSM showed marked improvements across the care continuum, whereas PWID lagged and may require additional intervention. Differential improvement in HIV engagement may necessitate population-specific interventions and routine surveillance to facilitate HIV elimination.

KEYWORDS:

• Injection drug use
• India
• HIV prevalence
• HIV incidence
• harm reduction
• needle and syringe exchange

Acknowledgements

NPM and GL were responsible for drafting the manuscript. SSS, SHM, and GL were responsible for the design of the study, data collection, and interpretation of data. NPM and AM were responsible for data analysis. AS, CV, and MK led data collection. DC was involved in the design of the study and contributed to manuscript development. All authors read and approved the final manuscript. We thank the National AIDS Control Organization (India) and all our partner non-governmental organizations across India who were instrumental in facilitating the recruitment of the study sample. We are especially thankful to our participants, without whom this research would not be possible.

Data availability statement

The data that support the findings of this study are available from the study principal investigators, SHM and GL, upon reasonable request.

Disclosure statement

SHM reports personal fees from Gilead Sciences, outside the submitted work. SSS reports receiving grants, personal fees, and non-financial support from Gilead Sciences, and grants and non-financial support from Abbott Laboratories, outside the submitted work. All other authors declare no competing interests. (s).

Additional information

Funding

This work was supported by the National Institutes of Health (NIH) (R01DA032059, R01MH089266, K24DA035684, T32AI102623, F31DA044046) and by the Center for AIDS Research, Johns Hopkins University (P30AI094189). Additional support was provided by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, NIH , and by the Elton John AIDS Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations.