1. Seek, test and treat continuum among a cohort of injecting drug users (IDUs) and their sexual partners in HIV prevention project in Kazakhstan
Assel Terlikbayeva, Nabila El-Bassel, Louisa Gilbert, Yelena Rozental, Saltanat Yegeubayeva, Leyla Ismailova, Leyla Famouri
Columbia University Global Health Research Center of Central Asia Almaty, Kazakhstan
Introduction
Recent reviews of access to treatment and care among injecting drug users (IDUs) in low-income and middle-income countries revealed a disproportionately low coverage of IDUs by HIV testing, treatment, and care. Central Asia and Kazakhstan are experiencing one of the most rapidly progressing IDU-driven HIV epidemics in the world, and have a particularly low coverage of IDUs by HIV testing, treatment, and care programs.
Table 1: Sociodemographic characteristics
Total (N=728)
Male (n=364)
Female (n=364)
Age (mean, std)
35.75, 7.8
36.75, 7.82
34.75, 7.67
Years of education completed
(mean, std)
11.41, 3.3
11.19, 3.53
11.62, 3.05
Ethnicity (n, %)
Kazakh
85 (11.68)
45 (12.36)
40 (10.99)
Russian
478 (65.66)
247 (67.86)
231 (63.46)
Other
165 (22.66)
72 (19.78)
93 (25.55)
Marital Status
Single
43 (5.91)
27 (7.42)
16 (4.40)
Married
629 (86.40)
308 (84.62)
321 (88.19)
Divorced/Separated/Widowed
56 (7.69)
29 (7.97)
Individuals who are intravenous drug users
580 (79.67)
351 (96.43)
229 (62.91)
Ever lived with study partner
577 (79.26)
284 (78.02)
293 (80.49)
Has children
385 (52.88)
167 (45.88)
218 (59.89)
Homeless in past 90 days
98 (13.46)
60 (16.48)
38 (10.44)
Ever arrested in past 90 days
488 (67.03)
311 (85.44)
177 (48.63)
Ever convicted of a drug related offense
406 (55.77)
256 (70.33)
150 (41.21)
Attended drug or psychiatric treatment facility
73 (10.03)
42 (11.54)
31 (8.52)
Had a routine medical checkup in the past year
605 (83.10)
292 (80.22)
313 (85.99)
Methods
In , a cohort of 718 IDUs and their heterosexual partners was recruited through a snow-ball sampling into HIV/STI prevention randomized controlled clinical trial in Almaty, Kazakhstan. Rates of access to HIV testing among IDUs and highly active antiretroviral therapy (HAART) among HIV-infected IDUs were analyzed.
Table 2: Descriptive Statistics for HIV Testing and Care
Results
Among total sample, the prevalence rate of HIV was 26%, HCV was 74.2%, and syphilis was 1.4%
122 participants (16.8%) indicated previous TB infection
Among HIV-infected participants, 37 (21%) said they had newly diagnosed HIV infection, and 141 (80%) knew about their HIV infection from past tests
Among HIV positive participants, 106 (68%) reported being prescribed HAART, however among them only 22 (21%) reported receiving HAART at the moment
Among them, participants who said their CD4 count was less than 200 (n=13), 6(46%) received HAART; with CD4 count (n=54), HAART was received by 7 (39%), and with CD4 more than 350 (n=23), 7 (30%) received therapy
Among HIV-positive participants, 25 (24%) also reported having TB and all of them, except for one received medications for TB
Total
Male
Female N % n
Ever Received an HIV test
544,0
74,7
275,0
75,6
269,0
73,9
Incident HIV cases
42,0
5,8
23,0
6,3
19,0
5,2
HIV positive persons who ever accessed care
73,0
68,9
39,0
69,6
34,0
68,0
Currently prescribed medications for HIV
29,0
27,4
17,0
30,4
12,0
24,0
HIV positive persons currently on ART
22,0
20,8
14,0
25,0
8,0
16,0
For those who received ART and knew their cell count
CD4 count less than 200 (n=13)
6,0
46,2
3,0
33,3
75,0
CD4 count between (n=18)
7,0
38,9
50,0
1,0
16,7
CD4 count greater than 350 (n=23)
4,0
27,3
TB in HIV-positive participants
23,8
18,0
6,6
Received medication for TB
96,0
28,0
Literature Cited
Mathers, B., Degenhardt L., Ali H., Wiessing, L., Hickman M., Mattick R., Myers B., Ambekar A., Strathdee S. for the 2009 Reference Group to the UN on HIV and Injecting Drug Use. (2010). HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage Lancet 2010; 375: 1014–28
Daniel Wolfe, M Patrizia Carrieri, Donald Shepard (2010). Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward Lancet 2010; 376: 355–66
WHO, UNAIDS, UNICEF. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. Progress Report (accessed Dec 18, 2010).
World Health Organization, United Nations Office on Drugs and Crime, Joint United Nations Program on HIV/AIDS. Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users UNODC%20UNAIDS%20%20IDU%20Universal%20Access%20Target%20Setting%20Guide%2020FINAL%20-%20Feb%2009.pdf (accessed Sept 11, 2009).
Conclusions
Despite the improvement in coverage of HIV-infected IDUs with HAART in Kazakhstan, access to HIV treatment and care among IDUs in Kazakhstan remains low. The results of this study underscore a critical need in expansion of access to HAART among IDUs as an effective treatment and prevention approach in this high-risk group.
Acknowledgments
We thank NIDA for funding the research for this work. We especially are grateful for the contributions of the participants and couples, without whom the research would not have been possible. The content presented does not necessarily represent the official views of the funders or the Columbia University School of Social Work.
For more information about the Global Health Research Center of Central Asia, please visit
Presented at AIDS 2012 – Washington, D.C., USA