Getting to 90: linkage to HIV care among men who have sex with men and people who inject drugs in India

ABSTRACT

UNAIDS set an ambitious target of “90-90-90” by 2020. The first 90 being 90% of those HIV-infected will be diagnosed; the second 90 being 90% of those diagnosed will be linked to medical care and on antiretroviral therapy (ART). While there has been dramatic improvement in HIV testing and ART use, substantial losses continue to occur at linkage-to-care following HIV diagnosis. Data on linkage among men who have sex with men (MSM) and people who inject drugs (PWID) are sparse, despite a greater burden of HIV in these populations. This cross-sectional study was conducted in 27 sites across India. Participants were recruited using respondent-driven sampling and had to be ≥18 years and self-identify as male and report sex with a man in the prior year (MSM) or injection drug use in the prior 2 years (PWID). Analyses were restricted to HIV-infected persons aware of their status. Linkage was defined as ever visiting a doctor for management of HIV after diagnosis. We explored factors that discriminated between those linked and not linked to care using multi-level logistic regression and area under the receiver operating curves (AUC), focusing on modifiable factors. Of 1726 HIV-infected persons aware of their status, 80% were linked to care. Modifiable factors around the time of diagnosis that best discriminated linkage included receiving assistance with HIV medical care (odds ratio [OR]: 10.0, 95% confidence interval [CI]): 5.6–18.2), disclosure of HIV-positive status (OR: 2.8; 95% CI: 2.4–6.1) and receiving information and counseling on management of HIV (OR: 2.3; 95% CI: 1.1–4.6). The AUC for these three factors together was 0.85, higher than other combinations of factors. We identified three simple modifiable factors around the time of diagnosis that could facilitate linkage to care among MSM and PWID in low- and middle-income countries to achieve UNAIDS targets.

KEYWORDS:

• India
• HIV care continuum
• linkage to care
• men who have sex with men
• MSM
• people who inject drugs

Acknowledgments

We thank the National AIDS Control Organisation, India, all of our partner nongovernmental organizations throughout India, and the countless participants, without whom this research would not have been possible.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Allison M. McFall http://orcid.org/0000-0002-1157-2931

Shruti H. Mehta http://orcid.org/0000-0002-2523-0959

Gregory M. Lucas http://orcid.org/0000-0002-3013-4339

David D. Celentano http://orcid.org/0000-0002-6061-8799

Additional information

Funding

This work was supported by the National Institutes of Health (grant numbers MH 89266, DA 032059, and T32 AI102623). Additional support was provided by the Johns Hopkins University Center for AIDS Research (grant numbers P30 AI094189 and K24 DA035684).