A Scalable, Integrated Intervention to Engage People Who Inject Drugs in HIV Care

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Mortality was lower in the intervention group for infected injection drug users and injection drug partners than in the standard of care group.
Mortality was lower in the intervention group for infected injection drug users and injection drug partners than in the standard of care group.

A scalable, integrated intervention for human immunodeficiency virus (HIV) care that combines systems navigation and flexible psychosocial counselling may improve uptake of antiretroviral therapy (ART) and medication-assisted treatment (MAT) and reduce mortality in people who inject drugs, according to the results of a randomized controlled study published in The Lancet.1

Studies show that people who inject drugs have a high incidence of HIV and related morbidity and mortality, with less access to ART and MAT.2-5 An integrated intervention was designed to be scalable and incorporates systems navigation, flexible psychosocial counseling, and access to ART regardless of CD4 cell count in order to reduce HIV transmission from HIV-infected people who inject drugs to their non-infected injection partners.1

Researchers in the Ukraine, Vietnam, and Indonesia evaluated the feasibility of conducting a future, larger HIV-transmission prevention trial and assessed the efficacy of this intervention on ART use, viral suppression, and MAT use. They enrolled 502 HIV-infected injection drug users and 806 non-infected injection drug partners; the HIV-infected injection drug users were randomly assigned to receive either standard of care (n=376) or the intervention (n=126), which included systems navigation, psychosocial counseling, and ART at any CD4 count. At week 52, self-reported ART use, MAT use, and viral suppression were higher in the HIV-infected injection drug users in the intervention group than in patients receiving standard of care. However, 7 incident HIV infections occurred in injection drug partners of HIV-infected injection drug users that were in the standard of care group.

“Our findings showed that this integrated intervention, which combined systems navigation and tailored, brief, psychosocial counselling for PWID [people who inject drugs] who are infected with HIV was feasible, with good intervention uptake, and led to increased ART use, MAT use, and viral suppression,” concluded the investigators.

References

  1. Miller WC, Hoffman IF, Hanscom BS, et al. A scalable, integrated intervention to engage people who inject drugs in HIV care and medication-assisted treatment (HPTN 074): a randomised, controlled phase 3 feasibility and efficacy study. Lancet. 2018;392:747-759.
  2. Degenhardt L, Charlson F, Stanaway J, et al. Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013. Lancet Infect Dis. 2016;16:1385-1398.
  3. Mathers BM, Degenhardt L, Phillips B, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;372:1733-1745.
  4. Strathdee SA, Shoptaw S, Dyer TP, Quan VM, Aramrattana A. Towards combination HIV prevention for injection drug users: addressing addictophobia, apathy and inattention. Curr Opin HIV AIDS. 2012;7(4):320-325.
  5. Larney S, Peacock A, Leung J, et al. Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review. Lancet Glob Health. 2017;5(12):e1208-e1220.

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