People who inject drugs (PWID) experience high HIV incidence, poor access to HIV care, and high mortality in worldwide. Interventions to engage HIV-infected PWID in care and reduce transmission are needed. We report the impact of an integrated systems navigation and psychosocial counseling intervention on HIV and substance use outcomes.
HPTN 074 is a randomized, controlled vanguard study among PWID conducted in Ukraine, Indonesia, and Vietnam. HIV-infected index participant eligibility included age 18-60 years; active injection drug use; viral load ≥1,000 copies/mL, CD4 >50cells/mm3, and ability to identify and enroll at least 1 HIV-uninfected injection partner. Up to 5 HIV-uninfected active injection partners were enrolled per index. Index PWID were randomly assigned to standard of care (SOC) or a systems navigation and psychosocial counseling intervention (SNPC). Session number and topics varied based on indexes’ needs. Antiretroviral therapy (ART) and substance use treatment (SUT) referrals were made to existing local services. Outcome measures included ART uptake (indexes only), SUT uptake, mortality, and HIV incidence (partners only).
Overall, 502 indexes and 806 partners were enrolled over 15 months and followed for 12-24 months. Among indexes, 85% were men; most women enrolled in Ukraine. Median age was 35 years. Retention was high at week 52 (86% index; 75% partners). At week 26, SNPC indexes were twice as likely to report ART use as compared to SOC (77% vs 38%, risk ratio (RR)=2.0, [95% CI: 1.7, 2.5]; Figure 1). The effect persisted at week 52 (77% vs 49%; RR=1.6 [CI: 1.3, 1.8]). Among SNPC indexes, SUT uptake was increased (hazard ratio (HR)=2.7 [CI: 1.8, 4.1]) and mortality was reduced by half (mortality rate=5.6/100 person-years (PY) vs 12.1/100 PY, HR=0.47 (CI: 0.22, 0.90). The survival benefit was also significant among SNPC partners (HR=0.17 (CI: 0.01, 0.84). Incident HIV infections among partners occurred only in the SOC arm (SNPC=0 cases/215.6 PY; SOC=7 cases/683.6 PY).
Facilitating ART and SUT referrals through systems navigation, combined with flexible counseling, doubled ART and SUT uptake. Mortality among HIV-infected PWID and their HIV-uninfected partners was reduced. HIV incidence among uninfected partners of indexes receiving the intervention may have been reduced, but the overall number of incident infections was low.