Association between drug use and ART use among people living with HIV who inject drugs in Vietnam, Ukraine and Indonesia: results from HPTN 074

ABSTRACT

Background and objective

Drug use type and frequency may affect Anti-Retroviral Therapy (ART) uptake for HIV-infected people who inject drugs (PWID). This paper assesses the association between self-reported baseline drug use and ART among HIV-infected PWID in Indonesia, Ukraine and Vietnam.

Methods

Data on self-reported baseline drug use and ART among HIV-infected PWID at the 26- and 52-week follow-ups were extracted from the HIV Prevention Trials Network (HPTN) 074, a randomized, controlled vanguard study to facilitate HIV treatment for PWID in Indonesia, Ukraine, and Vietnam. Multivariable logistic regression models were fit by study site and the whole HPTN 074 sample, using a 0.5 type I error rate.

Results

The response rate were 83.3% and 77.0% at 26^th and 52^th weeks. At 26-week, baseline use of over one non-opiate/non-stimulant drug was associated with lower odds of ART use among Indonesian participants (OR = 0.21, 95%CI: 0.05–0.82); and baseline injecting drugs for over 20 days in the previous month was associated with lower odds of ART use among all HPTN 074 sample (OR = 0.59, 95% CI: 0.36–0.97).

Conclusion

The association of a specific drug use pattern with later ART uptake implies the importance of medication-assisted treatment to enhance ART uptake and adherence among participants.

KEYWORDS:

• People living with HIV
• people who inject drugs
• drugs
• substance use
• antiretroviral therapy
• HPTN074

Acknowledgments

The authors would like to express our gratitude to the HPTN 074 protocol team and the research teams from Indonesia, Ukraine and Vietnam and all the outreach community workers from each of the three sites. Also, we are grateful for the support in Vietnam from the Vietnam Administration of HIV/AIDS Control, Thai Nguyen Department of Health and the Pho Yen Health District Center; and from Ukraine the NGO “Club Eney” and the Gromashevsky Institute of Epidemiology and Infectious Diseases. Lastly, we thank the participants for their invaluable contributions to this research.

Author contribution

TVH drafted, finalized and submitted the manuscript. AG conducted the statistical analyses. VFG commented on and revised the manuscript. CVA, KEL, KRM, PR, OZ, ZD, TS provided feedback on the manuscript. All authors reviewed the draft manuscript and approved the final version.

Disclosure statement

The authors declare that they have no competing interests. Additional data and materials are available upon requests sent to the corresponding author.

Ethics and consent

The study protocol, available at clinicaltrials.gov (NCT02935296), was approved by at least one local IRB in each site, namely University of Indonesia, Ukrainian Institute of Public Health Policy, Vietnam Administration of HIV/AIDS Control, University of North Carolina at Chapel Hill and Faculty of Medicine. All study participants provided written informed consent in their local languages, or English if preferred, upon joining the study.

Paper context

Drug use pattern detrimentally affects the well-beings of PWID, resulting in delay in ART use. Our study’s results demonstrate that using more non-opiate/non-stimulant drug and more days injecting drugs were associated with lower odds of ART use at 26-week follow-up. This implies the importance of medication-assisted treatment in association with HIV treatment to enhance ART uptake and adherence among PWID.

Additional information

Funding

This study take data from the parent trial which were funded by the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH); award numbers UM1AI068619 [HPTN Leadership and Operations Center], UM1AI068617 [HPTN Statistical and Data Management Center], UM1AI068613 [HPTN Laboratory Center] and the University of North Carolina at Chapel Hill Center for AIDS Research (P30 AI50410). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.