Patterns of harm reduction service utilization and HIV incidence among people who inject drugs in Ukraine: A two-part latent profile analysis |
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| Affiliation: | 1. New York University College of Global Public Health, New York, NY, USA;2. Center for Drug Use and HIV Research, New York University, New York, NY, USA;3. Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA;4. Ukrainian Institute on Public Health Policy, Kiev, Ukraine;5. National University of Kyiv-Mohyla Academy, Kiev, Ukraine;6. Alliance for Public Health (Formerly ICF International HIV/AIDS Alliance in Ukraine), Kiev, Ukraine;7. SUNY Downstate Medical Center, Department of Medicine, Brooklyn, NY, USA;1. School of Arts and Humanities, Edith Cowan University,270 Joondalup Drive, Joondalup WA 6027, Australia;2. Department of Psychological Science, Northern Kentucky University,1 Nunn Drive, MEP 355, Highland Heights, KY 41099, United States;1. CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark;2. Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain;3. Cermes3, Inserm U988/CNRS UMR 8211, EHESS, Paris Descartes University, Paris, France;4. Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia;5. European Liver Patients’ Association, Brussels, Belgium;6. Correlation Network, Amsterdam, the Netherlands;7. European AIDS Treatment Group, Brussels, Belgium;8. Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom;1. Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Avenue du Parc, Montréal, QC H3N 1X9, Canada;2. Research Centre, Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 Saint-Denis, Montréal, QC H2X 0A9, Canada;3. School of Population Health, Division of Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia;4. Department of Medicine, St. Vincent’s Hospital, The University of Melbourne, 29 Regent Street, Fitzroy, VIC 3065, Australia;5. Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada;6. Department of Psychiatry, Faculty of Medicine, Université de Montréal, C.P. 6128, Succursale Centre-Ville, Montréal, QC H3C 3J7, Canada;7. Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Côte-des-Neiges, Montréal, QC H3S 1Z1, Canada;1. School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Dublin 4, Ireland;2. British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada;3. Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada;1. The Kirby Institute, UNSW Sydney, Sydney, Australia;2. CHUM Research Centre (CRCHUM), Centre Hospitalier de l’Université de Montréal, Montréal, Canada;3. Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, Canada;4. CHIP, Rigshospitalet, University of Copenhagen, Denmark;5. Barcelona Institute of Global Health (ISGlobal), Hospital Clínic, Barcelona, Spain;6. Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway;7. Arud Centres of Addiction Medicine, Zurich, Switzerland;8. Centre for Social Research in Health, UNSW Sydney, Sydney, Australia;9. School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom;10. Disease Elimination Program, Burnet Institute, Melbourne, Australia;11. Médecins sans Frontières, Geneva, Switzerland;12. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, Australia;13. Institute for Clinical Medicine, University of Oslo, Norway;14. Department of Gastroenterology, Oslo University Hospital, Norway;15. National Drug and Alcohol Research Centre, UNSW Australia, Sydney, Australia;p. University of Helsinki, Helsinki, Finland;q. National Institute for Health and Welfare, Helsinki, Finland;r. Australian Injecting & Illicit Drug Users League, Canberra, Australia;s. Ninewells Hospital and Medical School, Dundee, United Kingdom;t. Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada;u. The Liver Unit, Queen Mary University of London, London, United Kingdom;v. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom;w. Health Protection Scotland, Glasgow, United Kingdom;x. Centre for Interdisciplinary Addiction Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany;y. Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium;z. Department of Hepatology, UZ Leuven, Leuven, Belgium;1. Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium;2. Institute of Neuropsychiatry & Addictions-Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain;3. Spectrum CIC, Wakefield, United Kingdom;4. Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, United States;5. University of Oslo, Oslo, Norway;6. Abdominal Center, Helsinki University Hospital, Helsinki, Finland;7. Santa Chiara University Hospital, University of Pisa, Italy |
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| Abstract: | BackgroundProgram utilization patterns are described within a large network of harm reduction service providers in Ukraine. The relationship between utilization patterns and HIV incidence is determined among people who inject drugs (PWID) controlling for oblast-level HIV incidence and treatment/syringe coverage.MethodsData were extracted from the network’s monitoring and evaluation database (January 2011–September 2014, n = 327,758 clients). Latent profile analysis was used to determine harm reduction utilization patterns using the number of HIV tests received annually and the number of condoms, syringes, and services (i.e., information and counseling sessions) received monthly over a year. Cox proportional hazards regression determined the relations between HIV seroconversion and utilization class membership.ResultsIn the final 4-class model, class 1 (34.0% of clients) received 0.1 HIV tests, 1.3 syringes, 0.6 condom and minimal counseling and information sessions per month; class 2 (33.6%) received 8.6 syringes, 3.2 condoms, and 0.5 HIV tests and counseling and information sessions; class 3 (19.1%) received 1 HIV test, 11.9 syringes, 4.3 condoms, and 0.7 information and counseling sessions; class 4 (13.3%) received 1 HIV test, 26.1 syringes, 10.3 condoms, and 1.8 information and 1.9 counseling sessions. Class 4 clients had significantly decreased risk for HIV seroconversion as compared to those in class 1 after controlling for oblast-level characteristics.ConclusionInjection drug use continues to be a major mode of HIV transmission in Ukraine, making evaluation of harm reduction efforts in reducing HIV incidence among PWID critical. These analyses suggest that receiving more syringes and condoms decreased risk of HIV. Scaling up HIV testing and harm reduction services is warranted. |
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| Keywords: | Opiates Injection drug use Harm reduction Ukraine HIV Needle and syringe programs |
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