Getting to 90: linkage to HIV care among men who have sex with men and people who inject drugs in India.
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| Title: | Getting to 90: linkage to HIV care among men who have sex with men and people who inject drugs in India. |
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| Authors: | McFall, Allison M. (AUTHOR), Mehta, Shruti H. (AUTHOR), Srikrishnan, Aylur K. (AUTHOR), Lucas, Gregory M. (AUTHOR), Vasudevan, Canjeevaram K. (AUTHOR), Celentano, David D. (AUTHOR), Kumar, Muniratnam S. (AUTHOR), Solomon, Suniti (AUTHOR), Solomon, Sunil S. (AUTHOR) |
| Source: | AIDS Care. Oct2016, Vol. 28 Issue 10, p1230-1239. 10p. 3 Charts, 1 Graph, 1 Map. |
| Subjects: | Diagnosis of HIV infections, HIV infections & psychology, HIV infections, Therapeutics, Confidence intervals, Counseling, Gay men, Health, Health services accessibility, Medical care costs, Medical cooperation, Population geography, Questionnaires, Research, Research funding, Information resources, Logistic regression analysis, Disclosure, Intravenous drug abusers, Cross-sectional method, Receiver operating characteristic curves, Data analysis software, Descriptive statistics, Odds ratio, Economics |
| Geographic Terms: | India |
| Abstract: | UNAIDS set an ambitious target of "90-90-90" by 2020. The first 90 being 90% of those HIV-infected will be diagnosed; the second 90 being 90% of those diagnosed will be linked to medical care and on antiretroviral therapy (ART). While there has been dramatic improvement in HIV testing and ART use, substantial losses continue to occur at linkage-to-care following HIV diagnosis. Data on linkage among men who have sex with men (MSM) and people who inject drugs (PWID) are sparse, despite a greater burden of HIV in these populations. This cross-sectional study was conducted in 27 sites across India. Participants were recruited using respondent-driven sampling and had to be ⩾18 years and self-identify as male and report sex with a man in the prior year (MSM) or injection drug use in the prior 2 years (PWID). Analyses were restricted to HIV-infected persons aware of their status. Linkage was defined as ever visiting a doctor for management of HIV after diagnosis. We explored factors that discriminated between those linked and not linked to care using multi-level logistic regression and area under the receiver operating curves (AUC), focusing on modifiable factors. Of 1726 HIV-infected persons aware of their status, 80% were linked to care. Modifiable factors around the time of diagnosis that best discriminated linkage included receiving assistance with HIV medical care (odds ratio [OR]: 10.0, 95% confidence interval [CI]): 5.6-18.2), disclosure of HIV-positive status (OR: 2.8; 95% CI: 2.4-6.1) and receiving information and counseling on management of HIV (OR: 2.3; 95% CI: 1.1-4.6). The AUC for these three factors together was 0.85, higher than other combinations of factors. We identified three simple modifiable factors around the time of diagnosis that could facilitate linkage to care among MSM and PWID in low- and middle-income countries to achieve UNAIDS targets. [ABSTRACT FROM AUTHOR] |
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| Database: | Psychology and Behavioral Sciences Collection |
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| Abstract: | UNAIDS set an ambitious target of "90-90-90" by 2020. The first 90 being 90% of those HIV-infected will be diagnosed; the second 90 being 90% of those diagnosed will be linked to medical care and on antiretroviral therapy (ART). While there has been dramatic improvement in HIV testing and ART use, substantial losses continue to occur at linkage-to-care following HIV diagnosis. Data on linkage among men who have sex with men (MSM) and people who inject drugs (PWID) are sparse, despite a greater burden of HIV in these populations. This cross-sectional study was conducted in 27 sites across India. Participants were recruited using respondent-driven sampling and had to be ⩾18 years and self-identify as male and report sex with a man in the prior year (MSM) or injection drug use in the prior 2 years (PWID). Analyses were restricted to HIV-infected persons aware of their status. Linkage was defined as ever visiting a doctor for management of HIV after diagnosis. We explored factors that discriminated between those linked and not linked to care using multi-level logistic regression and area under the receiver operating curves (AUC), focusing on modifiable factors. Of 1726 HIV-infected persons aware of their status, 80% were linked to care. Modifiable factors around the time of diagnosis that best discriminated linkage included receiving assistance with HIV medical care (odds ratio [OR]: 10.0, 95% confidence interval [CI]): 5.6-18.2), disclosure of HIV-positive status (OR: 2.8; 95% CI: 2.4-6.1) and receiving information and counseling on management of HIV (OR: 2.3; 95% CI: 1.1-4.6). The AUC for these three factors together was 0.85, higher than other combinations of factors. We identified three simple modifiable factors around the time of diagnosis that could facilitate linkage to care among MSM and PWID in low- and middle-income countries to achieve UNAIDS targets. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 09540121 |
| DOI: | 10.1080/09540121.2016.1168915 |
