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Prevention and treatment produced large decreases in HIV incidence in a model of people who inject drugs.

ABSTRACT: In the United States, people who inject drugs continue to be at greatly increased risk of HIV infection. To estimate the effectiveness of various prevention scenarios, we modeled HIV transmission in a dynamic network of drug users and people who did not use drugs that was based on the New York Metropolitan Statistical Area population. We compared the projected HIV incidence in 2020 and 2040 if current approaches continue to be used to the incidence if one or more of the following hypothetical interventions were applied: increased HIV testing, improved access to substance abuse treatment, increased use of needle and syringe programs, scaled-up treatment as prevention, and a "high impact" combination scenario, consisting of all of the strategies listed above. No strategy completely eliminated HIV transmission. The high-impact combination strategy produced the largest decrease in HIV incidence-a 62 percent reduction compared to the status quo. Our results suggest that increased resources for and investments in multiple HIV prevention approaches will be required to eliminate HIV transmission among people who inject drugs.

SUBMITTER: Marshall BD

PROVIDER: S-EPMC4469974 | biostudies-literature | 2014 Mar

REPOSITORIES: biostudies-literature

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Prevention and treatment produced large decreases in HIV incidence in a model of people who inject drugs.

Marshall Brandon D L BD Friedman Samuel R SR Monteiro João F G JF Paczkowski Magdalena M Tempalski Barbara B Pouget Enrique R ER Lurie Mark N MN Galea Sandro S

Health affairs (Project Hope) 20140301 3

In the United States, people who inject drugs continue to be at greatly increased risk of HIV infection. To estimate the effectiveness of various prevention scenarios, we modeled HIV transmission in a dynamic network of drug users and people who did not use drugs that was based on the New York Metropolitan Statistical Area population. We compared the projected HIV incidence in 2020 and 2040 if current approaches continue to be used to the incidence if one or more of the following hypothetical in ...[more]

PMID: 24590937

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Project description:BACKGROUND:HIV prevalence among people who inject drugs (PWID) in Ukraine is among the highest in the world. In this study, we aimed to assess whether a social network intervention was superior to HIV testing and counselling in affecting HIV incidence among PWID. Although this was not the primary aim of the study, it is associated with reducing drug and sex risk behaviours, which were primary aims. METHODS:In this clustered randomised trial, PWID who were 16 years of age or older, had used self-reported drug injection in the past 30 days, were willing to be interviewed for about 1 hour and tested for HIV, were not too impaired to comprehend and provide informed consent, and, for this paper, who tested HIV negative at baseline were recruited from the streets by project outreach workers in three cities in southern and eastern Ukraine: Odessa, Donetsk, and Nikolayev. Index or peer leaders, along with two of their network members, were randomly assigned (1:1) by the study statistician to the testing and counselling block (control group) or the testing and counselling plus a social network intervention block (intervention group). No stratification or minimisation was done. Participants in the network intervention received five sessions to train their network members in risk reduction. Those participants assigned to the control group received no further intervention after counselling. The main outcome of this study was HIV seroconversion in the intent-to-treat population as estimated with Cox regression and incorporating a ? frailty term to account for clustering. This trial is registered with ClinicalTrial.gov, number NCT01159704. FINDINGS:Between July 12, 2010, and Nov 23, 2012, 2304 PWIDs were recruited, 1200 of whom were HIV negative and are included in the present study. 589 index or peer leaders were randomly assigned to the control group and 611 were assigned to the intervention group. Of the 1200 HIV-negative participants, 1085 (90%) were retained at 12 months. In 553·0 person-years in the intervention group, 102 participants had seroconversion (incidence density 18·45 per 100 person-years; 95% CI 14·87-22·03); in 497·1 person-years in the control group 158 participants seroconverted (31·78 per 100 person-years; 26·83-36·74). This corresponded to a reduced hazard in the intervention group (hazard ratio 0·53, 95% CI 0·38-0·76, p=0·0003). No study-related adverse events were reported. INTERPRETATION:These data provide strong support for integrating peer education into comprehensive HIV prevention programmes for PWID and suggest the value in developing and testing peer-led interventions to improve access and adherence to pre-exposure prophylaxis and antiretroviral therapy. FUNDING:The National Institute on Drug Abuse.

Project description:INTRODUCTION:Emerging HIV epidemics have been documented among people who inject drugs (PWID) in the Middle East and North Africa (MENA). This study estimates the HIV incidence among PWID due to sharing needles/syringes in MENA. It also delineates injecting drug use role as a driver of the epidemic in the population, and estimates impact of interventions. METHODS:A mathematical model of HIV transmission among PWID was applied in seven MENA countries with sufficient and recent epidemiological data and HIV prevalence ?1% among PWID. Estimations of incident and/or prevalent infections among PWID, ex-PWID and sexual partners of infected current and ex-PWID were conducted. RESULTS:The estimated HIV incidence rate for 2017 among PWID ranged between 0.7% per person-year (ppy) in Tunisia and 7.8% ppy in Pakistan, with Libya being an outlier (24.8% ppy). The estimated number of annual new infections was lowest in Tunisia (n = 79) and Morocco (n = 99), and highest in Iran and Pakistan (approximately n = 6700 each). In addition, 20 to 2208 and 5 to 837 new annual infections were estimated across the different countries among sexual partners of PWID and ex-PWID respectively. Since epidemic emergence, the number of total ever acquired incident infections across countries was 706 to 90,015 among PWID, 99 to 18,244 among sexual partners of PWID, and 16 to 4360 among sexual partners of ex-PWID. The estimated number of prevalent infections across countries was 341 to 23,279 among PWID, 119 to 16,540 among ex-PWID, 67 to 10,752 among sexual partners of PWID, and 12 to 2863 among sexual partners of ex-PWID. Increasing antiretroviral therapy (ART) coverage to the global target of 81% - factoring in ART adherence and current coverage - would avert about half of new infections among PWID and their sexual partners. Combining ART with harm reduction could avert over 90% and 70% of new infections among PWID and their sexual partners respectively. CONCLUSIONS:There is considerable HIV incidence among PWID in MENA. Of all new infections ultimately due to injecting drug use, about 75% are among PWID and the rest among sexual partners. Of all prevalent infections ultimately attributed to injecting drug use as epidemic driver, about half are among PWID, 30% among ex-PWID and 20% among sexual partners of PWID and ex-PWID. These findings call for scale-up of services for PWID, including harm reduction as well as testing and treatment services.

Project description:IntroductionHIV and hepatitis C virus (HCV) are major health concerns globally. This systematic review and meta-analysis protocol study aims to estimate the incidence of HIV and HCV among people who inject drugs (PWIDs) by reviewing studies that have applied mathematical modelling. The primary purpose of this systematic review is to identify and review mathematical modelling studies of HIV and HCV incidence in PWIDs.Methods and analysis cohort, cross-sectional and clinical trial studies conducted to estimate the incidence of HIV and HCV based on mathematical models or have evaluated the effectiveness of mathematical models will be considered for inclusion in the review. A comprehensive search applying a Cochrane approach will be used to identify relevant primary studies, published between January 2000 and July 2020, and indexed in PubMed, EMBASE, Opengrey, WOS, SCOPUS and Cochrane Library with no restriction on language. This protocol was prepared according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Study selection and data extraction will be performed by two independent reviewers. Assessment of risk of bias will be implemented using forms of the Critical Appraisal Skills Programme. Publication bias will be assessed by funnel plots, Begg's and Egger's tests. A meta-analysis will be conducted to answer the first research question, 'What is the incidence of HIV and HCV when applying mathematical model in PWID?'. Clinical heterogeneity will be assessed by looking at the characteristics of participants, method of diagnosis and case definitions in the included primary studies. In addition, subgroup analyses will be conducted for population and secondary outcomes.Ethics and disseminationThere are no ethical issues related to this study. The findings will be published in peer-reviewed scientific journals and presented at international and national conferences.Prospero registration numberCRD42019126476.

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Prevention and treatment produced large decreases in HIV incidence in a model of people who inject drugs.

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Prevention and treatment produced large decreases in HIV incidence in a model of people who inject drugs.

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