Background
While India has made significant progress towards UNAIDS 95-95-95 targets, there are still gaps in HIV testing, particularly among people who inject drugs (PWID). HIV testing in India is provided free-of-charge through government-supported integrated care and testing centers (ICTCs). Additionally, beginning in 2013, our team established PWID-focused integrated care centers (ICC) in several cities across India that provide free HIV testing alongside other services (e.g., medication for opioid use disorder). We evaluate whether proximity to one of these services was associated with recent HIV testing.
Methods
752 PWID in Churachandpur, India, were recruited via respondent-driven sampling November 2022–February 2023. Participants were ≥18 years and reported injection drug use in the past 2 years. Via interviewer-administered surveys, participants provided locations for their primary residence and up to 4 places in which they injected drugs in the past year, HIV testing history and other related behaviors, and completed onsite HIV testing. Catchment areas within a 30-minute walking radius from ICTCs (N=10) and the ICC (N=1) were calculated using service area network analysis. Among those that self-reported living without HIV, logistic regression was used to assess the association between being within an ICC or ICTC catchment area and testing for HIV in the past year or past 6 months, with age, daily injection, and undiagnosed HIV as potential covariates.
Results
Among 538 PWID who did not self-report living with HIV, the median age was 27, 84% reported daily injection in the past 6 months and 6% were living with undiagnosed HIV. 66% reported living or regularly injecting within a catchment area for the ICCs, while 70% were within the catchment for ICTCs. After adjustment, those within a catchment for the ICC had 2.02 (95% CI 1.17-3.48) times the odds of testing for HIV in the past year and 1.97 (95% CI 1.03-3.76) times the odds of testing in the past 6 months compared to those not within a catchment area. Those within the ICTC catchment had higher odds of testing in the past year and in the past 6 months, though this was not statistically significant (Table).
Conclusions
Proximity to a community-based testing location (ICC) appeared important for regular HIV testing. Despite the presence of multiple government ICTCs, proximity to ICTCs did not impact recent testing, potentially reflecting additional barriers. Centers specifically oriented toward PWID populations may facilitate HIV testing.
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