Overlap between harm reduction and HIV service utilisation among PWID in India: Implications for HIV combination prevention. Smith, M. K., Solomon, S. S., Cummings, D. A. T., Srikrishnan, A. K., Kumar, M. S., Vasudevan, C. K., McFall, A. M., Lucas, G. M., Celentano, D. D., & Mehta, S. H. International Journal of Drug Policy, 57:111–118, July, 2018.
Overlap between harm reduction and HIV service utilisation among PWID in India: Implications for HIV combination prevention [link]Paper  doi  abstract   bibtex   
Background In some regions, HIV incidence is rising among people who inject drugs (PWID). Combination prevention approaches are well suited to PWID who face multiple sources of HIV risk. This analysis investigates patterns of utilisation to basic HIV services (HIV counselling and testing [HCT], antiretroviral therapy [ART]) as well as harm reduction programs (needle and syringe exchange programs [NSEP] and opioid agonist therapy [OAT]) among PWID and how utilisation of harm reduction services is associated with HIV-related care seeking behaviours. Methods Respondent-driven sampling was used to recruit 14,481 PWID across 15 cities in India. Sampling-weighted multilevel logistic regression models assessed associations between utilisation of harm reduction service and HCT and ART use among those indicated (90.3% and 5.0% of full sample, respectively). We considered both recent (prior year) and ever use of services. Results Overall, 42.3% reported prior HIV testing and 57.9% of eligible persons reported ART initiation, but overlap with NSEP and OAT use was limited. In adjusted models, recent and ever use of both NSEP and OAT were significantly associated with recent and ever HCT utilisation, respectively; however, harm reduction utilisation was not associated with ART initiation among eligible participants. Conclusions Harm reduction services may play a key role in linking PWID with HIV testing; however, they were not associated with ART initiation among eligible individuals. Moreover, a large majority who utilised NSEP and OAT were not engaged in optimal HIV care or prevention, highlighting missed opportunities and a need for stronger linkages between NSEP/OAT and HIV care and treatment, particularly among those actively injecting. These findings provide key insights to better understand how services can be linked or combined to optimise service utilisation among PWID.
@article{smith_overlap_2018,
	title = {Overlap between harm reduction and {HIV} service utilisation among {PWID} in {India}: {Implications} for {HIV} combination prevention},
	volume = {57},
	issn = {0955-3959},
	shorttitle = {Overlap between harm reduction and {HIV} service utilisation among {PWID} in {India}},
	url = {http://www.sciencedirect.com/science/article/pii/S0955395918300422},
	doi = {10.1016/j.drugpo.2018.02.007},
	abstract = {Background
In some regions, HIV incidence is rising among people who inject drugs (PWID). Combination prevention approaches are well suited to PWID who face multiple sources of HIV risk. This analysis investigates patterns of utilisation to basic HIV services (HIV counselling and testing [HCT], antiretroviral therapy [ART]) as well as harm reduction programs (needle and syringe exchange programs [NSEP] and opioid agonist therapy [OAT]) among PWID and how utilisation of harm reduction services is associated with HIV-related care seeking behaviours.
Methods
Respondent-driven sampling was used to recruit 14,481 PWID across 15 cities in India. Sampling-weighted multilevel logistic regression models assessed associations between utilisation of harm reduction service and HCT and ART use among those indicated (90.3\% and 5.0\% of full sample, respectively). We considered both recent (prior year) and ever use of services.
Results
Overall, 42.3\% reported prior HIV testing and 57.9\% of eligible persons reported ART initiation, but overlap with NSEP and OAT use was limited. In adjusted models, recent and ever use of both NSEP and OAT were significantly associated with recent and ever HCT utilisation, respectively; however, harm reduction utilisation was not associated with ART initiation among eligible participants.
Conclusions
Harm reduction services may play a key role in linking PWID with HIV testing; however, they were not associated with ART initiation among eligible individuals. Moreover, a large majority who utilised NSEP and OAT were not engaged in optimal HIV care or prevention, highlighting missed opportunities and a need for stronger linkages between NSEP/OAT and HIV care and treatment, particularly among those actively injecting. These findings provide key insights to better understand how services can be linked or combined to optimise service utilisation among PWID.},
	urldate = {2018-06-22},
	journal = {International Journal of Drug Policy},
	author = {Smith, M. Kumi and Solomon, Sunil S. and Cummings, Derek A. T. and Srikrishnan, Aylur K. and Kumar, M. Suresh and Vasudevan, C. K. and McFall, Allison M. and Lucas, Gregory M. and Celentano, David D. and Mehta, Shruti H.},
	month = jul,
	year = {2018},
	keywords = {HIV, Harm reduction, India, Injection drug use},
	pages = {111--118}
}
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