Abstract Body

Background:

Over 1.4 million people with HIV (PWH) live in Russia; only 56% are on antiretroviral therapy (ART). Substance use is associated with delayed linkage to HIV care and suboptimal use of ART. In Russia, routine HIV testing is the norm in addiction treatment systems, but if positive, linkage to HIV care is limited.

Methods:

We conducted a two-arm, randomized controlled trial in St. Petersburg assessing the effectiveness of a multi-faceted intervention (rapid access to ART while admitted to an addiction hospital, provision of depot naltrexone for opioid use disorder, and 12-months of strengths-based case management) compared to usual care. Study eligibility included: PWH, past drug injection, currently not on ART, and an addiction hospital inpatient. The primary outcome was undetectable HIV viral load (HVL) at 12 months. Secondary outcomes included undetectable HVL at 6 months, initiation of ART ≤28 days of randomization, retention in HIV care at 12 months, change in CD4 count, and a composite outcome of HVL suppression and past 30-day opioid abstinence. We performed adjusted logistic and linear regression analyses controlling for past ART use using an intention-to-treat approach.

Results:

Among 225 (N&#3f111 intervention; N&#3f114 control) participants (60% male, mean age 37, mean baseline CD4 count 420 cells/mm3) nearly all (99%) had severe opioid use disorder, 33% reported previous ART use, and 76% had depressive symptoms. Compared to the control group, intervention participants had higher odds of achieving the primary outcome, undetectable HVL at 12 months (48% intervention vs. 22% controls; adjusted odds ratio [AOR] 3.04; 95% confidence interval [CI]: 1.44, 6.44; p=0.004). Secondary outcomes were undetectable HVL at 6 months (35% vs 13%; AOR 3.76; CI: 1.7, 8.34; p=0.001), initiating ART within 28 days of randomization (74% vs. 11%; AOR 23.13; CI: 11.13, 48.07; p< 0.001), retention in HIV care at 12 months (51% vs. 35%; AOR 1.97; CI: 1.15, 3.37; p=0.014), change in CD4 counts (+59 vs. 0; adjusted mean difference 63.95; CI: -2.36, 130.25; p=0.059), and achieving the composite outcome HVL suppression and past 30-day opioid abstinence at 12 months (27% vs. 5%; AOR 6.51; CI: 2.08, 20.40; p=0.001).

Conclusions:

Among PWH who inject drugs in Russia, a multi-faceted intervention combining rapid, in-hospital ART initiation, naltrexone, and case management was more effective than standard of care for achieving undetectable HVL, initiating ART, retention in HIV care, and reducing opioid use.

Effect of LINC-II intervention compared with standard of care on HIV and substance use outcomes, adjusted for history of ART use