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Voucher incentives improve linkage to and retention in care among HIV-infected drug users in Chennai, India.

ABSTRACT: BACKGROUND:Drug users (DUs), a population that accounts for some of the fastest-growing human immunodeficiency virus (HIV) epidemics globally, lag behind other populations with regard to HIV-related outcomes. We evaluated the role of voucher incentives on linkage and retention in care among DUs in India. METHODS:In this randomized clinical trial, 120 DUs who were aged ?18 years, HIV-infected, antiretroviral therapy (ART) naive, and ART eligible and who reported drug use in the prior month were randomized to incentive (INC) or control (CTL) conditions for 12 months. Participants randomized to the INC arm received incentives (redeemable for food/household goods) ranging in value from USD4 to USD8 for achieving prespecified targets (eg, ART initiation, visits to ART center). Subjects in the CTL group could win vouchers in prize-bowl drawings, but HIV care behaviors were not incentivized. The primary endpoint was time to ART initiation. RESULTS:Sixty participants each were randomized to the INC and CTL arms between December 2009 and September 2010. Participants in the INC arm were more likely to visit the government ART center (49 vs 33; P = .002); 27 participants in the INC and 16 participants in the CTL arm initiated ART (P = .04; hazard ratio for ART = 2.33 [95% confidence interval, 1.15-4.73]). Participants in the INC arm also had significantly more visits to the ART center (median number of visits, 8 vs 3.5; P = .005). However, no difference in viral suppression was observed. CONCLUSIONS:Modest voucher incentives improved linkage to and retention in HIV care, but did not significantly impact viral suppression among DUs in India, a disenfranchised and difficult-to-treat population. CLINICAL TRIALS REGISTRATION:NCT01031745.

SUBMITTER: Solomon SS

PROVIDER: S-EPMC4334837 | biostudies-literature | 2014 Aug

REPOSITORIES: biostudies-literature

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Voucher incentives improve linkage to and retention in care among HIV-infected drug users in Chennai, India.

Solomon Sunil Suhas SS Srikrishnan Aylur K AK Vasudevan Canjeevaram K CK Anand Santhanam S Kumar Muniratnam Suresh MS Balakrishnan Pachamuthu P Mehta Shruti H SH Solomon Suniti S Lucas Gregory M GM

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20140506 4

<h4>Background</h4>Drug users (DUs), a population that accounts for some of the fastest-growing human immunodeficiency virus (HIV) epidemics globally, lag behind other populations with regard to HIV-related outcomes. We evaluated the role of voucher incentives on linkage and retention in care among DUs in India.<h4>Methods</h4>In this randomized clinical trial, 120 DUs who were aged ≥18 years, HIV-infected, antiretroviral therapy (ART) naive, and ART eligible and who reported drug use in the pri ...[more]

PMID: 24803381

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Project description:INTRODUCTION:There is currently no published data on the effectiveness of DAA treatment for elimination of HCV infection in HIV-infected populations at a population level. However, a number of relevant studies and initiatives are emerging. This research aims to report cascade of care data for emerging HCV elimination initiatives and studies that are currently being evaluated in HIV/HCV co-infected populations in the context of implementation science theory. METHODS:HCV elimination initiatives and studies in HIV co-infected populations that are currently underway were identified. Context, intervention characteristics and cascade of care data were synthesized in the context of implementation science frameworks. RESULTS:Seven HCV elimination initiatives and studies were identified in HIV co-infected populations, mainly operating in high-income countries. Four were focused mainly on HCV elimination in HIV-infected gay and bisexual men (GBM), and three included a combination of people who inject drugs (PWID), GBM and other HIV-infected populations. None were evaluating treatment delivery in incarcerated populations. Overall, HCV RNA was detected in 4894 HIV-infected participants (range within studies: 297 to 994): 48% of these initiated HCV treatment (range: 21% to 85%; within studies from a period where DAAs were broadly available the total is 57%, range: 36% to 74%). Among studies with treatment completion data, 96% of 1109 initiating treatment completed treatment (range: 94% to 99%). Among those who could be assessed for sustained virological response at 12 weeks (SVR12), 1631 of 1757 attained SVR12 (93%, range: 86% to 98%). CONCLUSIONS:Early results from emerging research on HCV elimination in HIV-infected populations suggest that HCV treatment uptake is higher than reported levels prior to DAA treatment availability, but approximately half of patients remain untreated. These results are among diagnosed populations and additional effort is required to increase diagnosis rates. Among those who have initiated treatment, completion and SVR rates are promising. More data are required in order to evaluate the effectiveness of these elimination programmes in the long term, assess which intervention components are effective, and whether they need to be tailored to particular population groups.

Project description:Few studies assess built environment correlates of active commuting in low-and-middle-income countries (LMICs), but the different context could yield distinct findings. Policies and investments to promote active commuting remain under-developed in LMICs like India, which grapples with traffic congestion, lack of activity-supportive infrastructure, poor enforcement of traffic rules and regulations, air pollution, and overcrowding. This cross-sectional study investigated associations between home neighborhood environment characteristics and active commuting in Chennai, India. Adults (N = 370, 47.2% female, mean age =37.9 years) were recruited from 155 wards in the metropolitan area of Chennai in southern India between January and June 2015. Participants self-reported their usual mode of commute to work, with responses recoded into three categories: (1) multi-modal or active commuting (walking and bicycling; n = 56); (2) public transit (n = 52); and (3) private transport (n = 111). Environmental attributes around participants' homes were assessed using the Neighborhood Environment Walkability Scale for India (NEWS-India). Associations between environmental characteristics and likelihood of active commuting and public transit use were modeled using logistic regression with private transport (driving alone or carpool) as the reference category, adjusting for age, gender, and household car ownership. Consistent with other international studies, participants living in neighborhoods with a mix of land uses and a transit stop within a 10-minute walk from home were more likely to use active commuting (both p < 0.01). Land-use mix was significantly associated with the use of public transit compared to private transport (adjusted odds ratio (aOR) =5.2, p = 0.002). Contrary to findings in high-income countries, the odds of active commuting were reduced with improved safety from crime (aOR =0.2, p = 0.003), aesthetics (aOR =0.2, p = 0.05), and street connectivity (aOR =0.2, p = 0.003). Different environmental attributes were associated with active commuting, suggesting that these relationships are complex and may distinctly differ from those in high-income countries. Unexpected inverse associations of perceived safety from crime and aesthetics with active commuting emphasize the need for high-quality epidemiologic studies with greater context specificity in the study of physical activity in LMICs. Findings have public health implications for India and suggest that caution should be taken when translating evidence across countries.

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Voucher incentives improve linkage to and retention in care among HIV-infected drug users in Chennai, India.

Publications

Voucher incentives improve linkage to and retention in care among HIV-infected drug users in Chennai, India.

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