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Ganapathi L, Srikrishnan AK, McFall AM, Gunaratne MP, Kumar MS, Lucas GM, Mehta SH, Solomon SS. Expanding single-venue services to better engage young people who inject drugs: insights from India. Harm Reduct J 2024; 21:170. [PMID: 39272091 PMCID: PMC11401385 DOI: 10.1186/s12954-024-01084-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/30/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND Over the last decade, India has had an alarming rise in injection of opioids across several cities. Although scale-up of public sector services for people who inject drugs (PWID) in India has occurred over decades, accessibility has been diminished by fragmented services across physical locations. To circumvent this barrier, and in alignment with the World Health Organization's guidelines to provide comprehensive care to key populations, Integrated Care Centers (ICCs) were established across 8 Indian cities as a public-private service delivery model for providing free single-venue services to PWID. ICCs have been very successful in expanding service availability and convenience for PWID generally. However, few studies from low- and middle-income countries (LMIC) have evaluated how well young PWID (defined as those ≤ 29 years of age) engage with single-venue service models like ICCs or specific services provided in such models. Young PWID are an important subpopulation in India, as they bear a disproportionate burden of new HIV infections because of greater risk and evidence of lower receipt of HIV testing and harm reduction services compared to older PWID. In this comment, we offer insights specific to young PWID drawn from multiple quantitative and qualitative studies examining the reach and effectiveness of ICCs, which may provide generalizable insights into limitations of services for young PWID more broadly in India and globally. FINDINGS Our studies suggest that while ICCs have expanded service availability, particularly in cities with emerging injection drug use epidemics, population-level reach to foster initial engagement among young PWID can be optimized. Additionally, young PWID who do engage with ICCs experience gaps in substance use treatment receipt and retention, and experience barriers to receipt of ICC services that are distinct from those experienced by older PWID. Notably, HIV incidence among ICC clients is concentrated in young PWID. Finally, ICCs were not intended to reach adolescent PWID, and new services are needed for this subpopulation. CONCLUSIONS In addition to co-locating services, iterative optimization of models such as ICCs should incorporate youth-specific differentiated interventions and be accompanied by policy changes that are critical to improving the reach and effectiveness of harm reduction and HIV services among young PWID in India.
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Affiliation(s)
- Lakshmi Ganapathi
- Division of Pediatric Global Health, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Division of Pediatric Infectious Diseases, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA, 02114, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Aylur K Srikrishnan
- Y.R. Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai, Tamil Nadu, 600010, India
| | - Allison M McFall
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Mihili P Gunaratne
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Muniratnam Suresh Kumar
- Y.R. Gaitonde Centre for AIDS Research and Education, No. 34, East Street, Kilpauk Garden Colony, Chennai, Tamil Nadu, 600010, India
- Psymed Hospital, 49 Harrington Road, Chetpet, Chennai, Tamil Nadu, 600031, India
| | - Gregory M Lucas
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Shruti H Mehta
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, 733 N Broadway, Baltimore, MD, 21205, USA
| | - Sunil S Solomon
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
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Panda UK, Sahoo SS, Samantaray S. "Harm reduction approach for tuberculosis and substance use disorders: A review of approaches and implications in the Indian context". Indian J Tuberc 2024; 71:219-224. [PMID: 38589127 DOI: 10.1016/j.ijtb.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/05/2023] [Accepted: 09/22/2023] [Indexed: 04/10/2024]
Abstract
There are limitations to traditional treatment approaches in addressing the needs of individuals with dual comorbidity of TB and SUD. The concept of harm reduction as a distinct approach to addressing substance use, focusing on minimising the negative consequences associated with it rather than advocating for complete abstinence. Different harm reduction strategies, such as opioid substitution therapy, needle and syringe programmes, testing for viral infections etc. have been effectively employed for SUDs in past. Similarly, TB risk minimization approaches like improving housing and nutrition and focused testing strategies are considered as harm reduction strategies for TB management. The relationship between tuberculosis (TB) and substance use disorders (SUDs) involves a complex interplay of biopsychosocial factors. It is crucial to prioritise integrated and closely monitored care in order to address the treatment challenges and potential drug interactions that may arise. In light of the acknowledged challenges like limited awareness, infrastructure, drug resistance, and stigma, it is imperative to explore potential avenues for the implementation of harm reduction strategies targeting individuals with comorbid TB and SUD in India. Potential strategies for addressing the issue includes a range of measures, such as augmenting investments in healthcare, integrating policies, tackling social determinants, and establishing shared platforms for psychosocial rehabilitation.
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Affiliation(s)
- Udit Kumar Panda
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, 751024, India.
| | - Soumya Swaroop Sahoo
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Swayanka Samantaray
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, 751024, India
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Parmar A, Chakraborty R, Balhara YPS. Current status of harm reduction in India: Are we doing enough? Indian J Psychiatry 2024; 66:388-391. [PMID: 38778856 PMCID: PMC11107929 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_963_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Arpit Parmar
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Radhika Chakraborty
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Yatan P. S. Balhara
- National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India
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Menezes NP, Mehta SH, Wesolowski A, Clipman SJ, Srikrishnan AK, Kumar MS, Zook KJ, Lucas GM, Latkin C, Solomon SS. Network centrality and HIV prevention service use among people who inject drugs: Findings from a sociometric network cohort in New Delhi, India. Addiction 2024; 119:570-581. [PMID: 37967827 PMCID: PMC11003398 DOI: 10.1111/add.16379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 09/21/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND AND AIMS Network centrality, an indicator of an individual's importance and potential to drive behavioral change, is rarely used to select peer educators. Individual-level predictors of network centrality might be useful to identify people who inject drugs (PWID) for potential roles as peer navigators or change agents in network-based interventions in settings where sociometric data are unavailable. We assessed the relationship between network centrality and HIV prevention service engagement to determine whether centrally-positioned PWID share measurable commonalities. DESIGN Observational study and survey using baseline data from a sociometric network cohort of PWID, enumerated using network software and biometric data (2017-2020). Network ties corresponded to direct injection partnerships in the prior month. SETTING New Delhi, India. PARTICIPANTS A total of 2512 PWID who were ≥18 years, provided written informed consent, and reported illicit injection drug use within the 24 months before study enrollment. MEASUREMENTS Interviewer-administered questionnaires measured demographics and substance use behaviors. Central versus peripheral network position was categorized using betweenness centrality 75th%ile . Logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals (95%CI) between network position and HIV testing, medication for opioid use disorder (MOUD), or syringe service use. Lasso models selected predictors of central network position among 20 covariates detailing demographic, biologic, and substance use information. Predictive accuracy was evaluated using model performance metrics. FINDINGS Overall, median age was 26 years (interquartile range 22-34); 99% were male; 628 were classified as central. Compared with PWID at the periphery, central PWID were more likely to use MOUD (aOR: 1.59, 95%CI: 1.30-1.94) and syringe services (aOR: 2.91, 95%CI: 2.25, 3.76) in the prior six months. Findings for HIV testing were inconclusive (aOR: 1.30, 95%CI: 1.00-1.69). The lasso variable selector identified several predictors of network centrality: HIV and hepatitis C infection, number of PWID seen in the prior month, injecting heroin and buprenorphine (vs. heroin only) six months prior, sharing injection equipment six months prior, experiencing drug overdose in the past year, and moderate/severe depression (vs. none/mild). Average agreement between model-predicted vs. observed values was 0.75; area under the receiver operator curve was 0.69. CONCLUSIONS In a socioeconomic network of people who inject drugs (PWID) in New Delhi, India, there are common characteristics among individuals based on their network position (central vs. peripheral) but individual-level predictors have only moderate predictive accuracy. Although central network members appear to be more likely to use HIV prevention services than peripheral network members, their potential as change agents may be limited by other factors that impede their ability to adopt or promote HIV prevention service use.
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Affiliation(s)
- Neia Prata Menezes
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States
| | - Amy Wesolowski
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States
| | - Steven J. Clipman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States
| | | | | | - Katie J.C. Zook
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Gregory M. Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Carl Latkin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States
- Department of Health, Behaviour and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States
| | - Sunil S. Solomon
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States
- Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India
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Shukla L, Shivaprakash P, Kumar MS. HIV, hepatitis B & C in people who inject drugs in India: A systematic review of regional heterogeneity & overview of opioid substitution treatment. Indian J Med Res 2023; 158:522-534. [PMID: 38265946 PMCID: PMC10878493 DOI: 10.4103/ijmr.ijmr_1930_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND OBJECTIVES This systematic review evaluates the human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) burden among people who inject drugs (PWIDs) in India. In addition, we selectively examined research on opioid substitution treatment (OST)-related services due to their role in antiviral treatment uptake and adherence. METHODS Data were sourced from peer-reviewed and government publications between 1991 and September 20, 2023, searched in MEDLINE, Scopus and EBSCOhost. English language studies reporting weighted prevalence or raw numbers and recruitment sites were included for review. Quality was assessed using the Joanna Briggs Institute tool. Data synthesis was done in graphs and tables. RESULTS We included 50 reports, yielding 150 HIV, 68 HCV and 24 HBV prevalence estimates across India, revealing significant regional heterogeneity. Notably, 16 States had a single community-based HIV estimate, and 19 States had limited or no HCV data. The highest HIV and HCV prevalence was in Manipur (74.7% and 97.5%, respectively) in 1996. Recent spikes included 50.2 per cent HIV prevalence in Punjab (2010) and 73 per cent HCV in Uttar Pradesh (2021). Nationally, OST coverage in 2020 was under five per cent, with some northeast, north and central States exceeding this, but most others were falling below two per cent. No studies on the cost-effectiveness of directly observed treatment models for OST were identified. INTERPRETATION CONCLUSIONS There is a lack of sufficiently granular and generalizable estimates for HIV prevalence and any estimates for HCV and HBV among PWIDs in large parts of the country. Community-based representative studies are required to quantify the prevalence and severity of these diseases and allocate resources.
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Affiliation(s)
- Lekhansh Shukla
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Prakrithi Shivaprakash
- Department of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - M. Suresh Kumar
- Schizophrenia Research Foundation (SCARF), Chennai, Tamil Nadu, India
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Dzinamarira T, Moyo E. The use of oral HIV pre-exposure prophylaxis among people who inject drugs: barriers, and recommendations. Front Public Health 2023; 11:1265063. [PMID: 37732092 PMCID: PMC10507712 DOI: 10.3389/fpubh.2023.1265063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Tafadzwa Dzinamarira
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- ICAP at Columbia University, Lusaka, Zambia
| | - Enos Moyo
- School of Nursing and Public Health, College of Health Sciences, University of Kwa-Zulu Natal, Durban, South Africa
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McFall AM, Solomon SS, Lau B, Latkin C, Srikrishnan AK, Anand S, Vasudevan CK, Kumar MS, Lucas GM, H Mehta S. Respondent-driven sampling is more efficient than facility-based strategies at identifying undiagnosed people who inject drugs living with HIV in India. Drug Alcohol Depend 2023; 249:110834. [PMID: 37352733 PMCID: PMC10330670 DOI: 10.1016/j.drugalcdep.2023.110834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/25/2023]
Abstract
INTRODUCTION Injection drug use drives HIV epidemics in many low-resource settings, yet many people who inject drugs (PWID) living with HIV are not diagnosed. We assessed the ability of respondent-driven sampling (RDS) - which uses peer network connections - to identify undiagnosed PWID living with HIV compared to a facility-based strategy in India. METHODS In six Indian cities from 2014 to 2017, integrated care centers (ICCs) provided HIV testing. From 2016 to 2017, RDS samples of PWID in these same cities were conducted. Using biometric matching, characteristics associated with identification by RDS only and both RDS and ICC, compared to ICC only were explored. Undiagnosed individuals tested positive and did not report a prior diagnosis. The number needed to recruit (NNR) (average number recruited to find one undiagnosed PWID living with HIV) and the identification rate (average number undiagnosed PWID identified per week) assessed the efficiency of RDS vs. ICCs. RESULTS There were 10,759 ICC clients and 6012 RDS participants; 40% of RDS participants were also ICC clients resulting in 14,397 unduplicated PWID. PWID identified by RDS vs. ICC only were more likely to be male (adjusted odds ratios [aOR] RDS only: 6.8, both: 2.7) and living with HIV but undiagnosed (aOR RDS only: 2.5, both: 1.5). Overall, the RDS NNR was 11 and the ICC NNR was 26. The RDS identification rate (18.6/week) was faster than the ICC identification rate (2.7/week) overall and in all cities. CONCLUSIONS RDS required screening fewer PWID and more rapidly identified undiagnosed PWID living with HIV as compared to ICCs.
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Affiliation(s)
- Allison M McFall
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States.
| | - Sunil S Solomon
- Johns Hopkins University School of Medicine, Infectious Diseases Department, Baltimore, MD, United States
| | - Bryan Lau
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Baltimore, MD, United States
| | | | - Santhanam Anand
- YR Gaitonde Centre for AIDS Research and Education, Chennai, India
| | | | | | - Gregory M Lucas
- Johns Hopkins University School of Medicine, Infectious Diseases Department, Baltimore, MD, United States
| | - Shruti H Mehta
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
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Pachuau LN, Tannous C, Chawngthu RL, Agho KE. HIV and its associated factors among people who inject drugs in Mizoram, Northeast India. PLoS One 2023; 18:e0286009. [PMID: 37216389 DOI: 10.1371/journal.pone.0286009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/05/2023] [Indexed: 05/24/2023] Open
Abstract
AIM To estimate the prevalence and associated factors with the human immune-deficiency virus (HIV) among people who inject drugs (PWID) in Mizoram, Northeast India. METHODS The data source for the analysis was the 2019-2020 Mizoram State AIDS Control Society (MSACS) survey from 2695 PWID registered for the Targeted Intervention (TI) services. Logistic regression analysis was conducted to examine the factors associated with HIV among PWID after adjusting for sociodemographic characteristics, injection, and sexual behaviours. RESULTS 21.19% of the participants tested positive for HIV and the prevalence of HIV among male and female participants were 19.5% and 38.6%, respectively. Multiple logistic regression analysis revealed that female (AOR 1.74; 95% CI 1.26-2.41), 35 years or older (AOR 1.45; 95% CI 1.06-1.99), married (AOR 1.41; 95% CI1.08-1.83), divorced/separated/widowed (AOR 2.12; 95% CI 1.59-2.82) and sharing of needle/syringe (AOR 1.62; 95% CI 1.30-2.00) were all positively associated with HIV infection. We also found that concomitant alcohol use was reduced by 35% (AOR 0.65; 95% CI 0.51-0.82) among HIV positive PWID, and HIV infection was also reduced by 46% (AOR 0.54; 95% CI 0.44-0.67) among those PWID who use a condom with a regular partner. CONCLUSION The findings of this study suggested that there is a high prevalence of HIV among PWID with 1 in 5 PWID reported to have HIV. HIV among PWID was significantly higher among those over 35 years of age, females and divorced/separated/widowed participants. Needle/syringe sharing behaviour is an important determinant of HIV infection. The high prevalence of HIV among PWID population is multifactorial. To reduce HIV among PWID in Mizoram, interventions should target those sharing needles/syringes, females, especially those over 35 years of age and unmarried participants.
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Affiliation(s)
| | - Caterina Tannous
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | | | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Westville Campus, Durban, South Africa
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Parmar A, Bhatia G, Sharma P, Pal A. Understanding the epidemiology of substance use in India: A review of nationwide surveys. Indian J Psychiatry 2023; 65:498-505. [PMID: 37397843 PMCID: PMC10309258 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_791_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/21/2023] [Accepted: 04/11/2023] [Indexed: 07/04/2023] Open
Abstract
Substance use is a public health concern on a global and national levels. There is a scarcity of nationally representative systematic research on the epidemiology of substance use in India. This narrative review aims to discuss the various large epidemiological surveys providing data on substance use in India. Attempts have been made to extract data pertaining to special population groups as well.
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Affiliation(s)
- Arpit Parmar
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Gayatri Bhatia
- Department of Psychiatry, All India Institute of Medical Sciences, Rajkot, Gujarat, India
| | - Pawan Sharma
- Department of Psychiatry, Patan Academy of Health Sciences, Nepal
| | - Arghya Pal
- Department of Psychiatry, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
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Saing CH. OAT and NSP and their potential to reduce HIV incidence among people who inject drugs in low- and middle-income countries. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 34:100744. [PMID: 37283980 PMCID: PMC10240351 DOI: 10.1016/j.lanwpc.2023.100744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/05/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Aridoss S, David JK, Jaganathasamy N, Mathiyazhakan M, Balasubramanian G, Natesan M, V.M. P, Kumar P, Rajan S, Arumugam E. Spatial heterogeneity of risk factors associated with HIV prevalence among men who inject drugs in India: An analysis of the data from the integrated bio-behavioral surveillance, India. Medicine (Baltimore) 2022; 101:e31688. [PMID: 36482574 PMCID: PMC9726355 DOI: 10.1097/md.0000000000031688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
People who inject drugs (PWID) are India's third-largest vulnerable population to human immunodeficiency virus (HIV) infection. PWID in India are confined to certain geographic locations and exhibit varying injecting and sexual risk behaviors, contributing considerably to increasing HIV trends in specific regions. Spatial heterogeneity in risk factors among vulnerable PWID influences HIV prevalence, transmission dynamics, and disease management. Stratified analysis of HIV prevalence based on risk behaviors and geographic locations of PWID will be instrumental in strategic interventions. To stratify the male PWID based on their risk behaviors in each state and determine the HIV prevalence for each stratum. The behavioral data and HIV prevalence of the national integrated biological and behavioural surveillance (IBBS), a nationwide cross-sectional community-based study conducted in 2014 to 2015, was analyzed. Data from 19,902 men who inject drugs across 53 domains in 29 states of India were included. Women who inject drugs were excluded at the time of IBBS, and hence PWID in this study refers to only men who inject drugs. PWID were categorized based on their risk profile, and the corresponding HIV prevalence for each state was determined. HIV prevalence was the highest (29.6%) in Uttar Pradesh, with a high prevalence of risk behaviors among PWID. High HIV prevalence ranging between 12.1% and 22.4% was observed in a few states in East and North-East India and most states in central and North India. Unsafe injecting and sexual practices were significantly (P < .05) associated with higher HIV prevalence and more significantly in National Capital Territory of Delhi (P < .001). Unsafe injecting practices among PWID were proportionally higher in Western and Central India, whereas unsafe sexual behaviors were widespread among most states. Unsafe sexual practices among male PWID were common. The high prevalence of unsafe injecting had significant HIV infection and transmission risks in Western and Central India. The results emphasize the need for stratified, region-specific interventions and combination approaches for harm reduction among PWID. Strengthening the measures that facilitate the reduction of high-risk behaviors, adoption of safe practices, and utilization of HIV services will positively impact HIV prevention measures among PWID.
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Affiliation(s)
- Santhakumar Aridoss
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Nagaraj Jaganathasamy
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Malathi Mathiyazhakan
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Ganesh Balasubramanian
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Manikandan Natesan
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Padmapriya V.M.
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Pradeep Kumar
- National AIDS Control Organisation, Department of Health & Family Welfare, Government of India, New Delhi, India
| | - Shobini Rajan
- National AIDS Control Organisation, Department of Health & Family Welfare, Government of India, New Delhi, India
| | - Elangovan Arumugam
- Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
- * Correspondence: Elangovan Arumugam, Scientist-G, Division of Computing and Information Science, ICMR-National Institute of Epidemiology, R-127, 2nd Main Road, TNHB, Ayapakkam, Chennai 600 077, Tamil Nadu, India (e-mail: )
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