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HIGH HIV INCIDENCE AMONG PWID AND MSM ATTENDING INTEGRATED CARE CENTERS IN INDIA
Allison M. McFall1, Sunil S. Solomon1, Gregory M. Lucas1, Aylur K. Srikrishnan2, Muniratnam S. Kumar2, Santhanam Anand2, Canjeevaram K. Vasudevan2, David D. Celentano1, Shruti H. Mehta1
1The Johns Hopkins Univ, Baltimore, MD, USA,2YR Gaitonde Cntr for AIDS Rsr and Educ, Chennai, India
In India, similar to other lower- and middle-income countries, HIV incidence has declined over the past decade following scale-up of HIV prevention and treatment services for heterosexual populations. While prevalence data among people who inject drugs (PWID) and men who have sex with men (MSM) suggest increasing burden, HIV incidence data among these groups are sparse.
As part of a cluster-randomized trial among PWID and MSM in India, integrated care centers (ICCs) were established in 11 cities (6 PWID and 5 MSM) and have been running for nearly two years. ICCs provide core and PWID- or MSM-focused HIV prevention and treatment services, including HIV counseling and testing, in a single venue. HIV negative clients are actively tracked to promote annual HIV testing. HIV incidence rates were calculated for clients with ≥2 HIV tests and negative on the first test. Multi-level Poisson regression models were used to explore correlates of HIV incidence.
5,012 ICC clients (3,430 PWID and 1,582 MSM) who were initially HIV negative were included. Median age was 28 years and 8.9% of PWID were women. There were 48 PWID and 13 MSM seroconverters resulting in HIV incidence rates of 1.30 per 100 person-years (PY) (95% confidence interval [CI]: 0.98 - 1.73) and 0.99 per 100 PY (95% CI: 0.58 - 1.71), respectively. There was considerable variability across cities with a range of 0 - 6.71 for PWID and 0 - 1.99 for MSM (Figure). Among PWID, HIV incidence was higher among women (adjusted incidence rate ratio [aIRR]: 2.54) and those with traditional risk factors - recent injection drug use (aIRR: 2.77), sharing needles/syringes (aIRR: 17.7), and a higher number of sexual partners (aIRR for ≥3 partners vs. none: 3.05). Lower incidence was observed among those receiving opioid substitution therapy >2 times/week (aIRR: 0.21) and receiving at least one session of safe sex counseling (aIRR: 0.23); however, those using needle/syringe exchange were at higher risk (aIRR: 2.41). Among MSM, the only factor significantly associated with HIV incidence was a recent sexually transmitted infection diagnosis (aIRR: 9.51).
PWID and MSM attending HIV-focused care centers in India experience high HIV incidence. Specific sub-groups of clients continue to engage in high-risk behaviors and should be targeted for additional harm reduction services and biomedical prevention approaches such as pre-exposure prophylaxis (PrEP), particularly PWID who have not been the focus of PrEP programs thus far.