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Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2017

Open Access 01-12-2017 | Research

Role of substance use in HIV care cascade outcomes among people who inject drugs in Russia

Authors: Bulat Idrisov, Karsten Lunze, Debbie M. Cheng, Elena Blokhina, Natalia Gnatienko, Emily Quinn, Carly Bridden, Alexander Y. Walley, Kendall J. Bryant, Dmitry Lioznov, Evgeny Krupitsky, Jeffrey H. Samet

Published in: Addiction Science & Clinical Practice | Issue 1/2017

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Abstract

Background

Engaging people who drink alcohol or inject drugs in HIV care can be challenging, particularly in Eastern Europe. Healthcare facilities in Russia are organized by specialty; therefore linking patients from addiction care to HIV hospitals has been difficult. The HIV care cascade outlines stages of HIV care (e.g., linkage to care, prescribed antiretroviral therapy [ART], and achieving HIV viral suppression). We hypothesized that unhealthy alcohol use, injection drug use, and opioid craving are associated with unfavorable HIV care cascade outcomes.

Methods

We analyzed data from a cohort (n = 249) of HIV-positive Russians who have been in addiction hospital treatment in the past year and had a lifetime history of injection drug use (IDU). We evaluated the association between unhealthy alcohol use (AUDIT score > 7 [both hazardous drinking and dependence]), past-month injection drug use (IDU), and opioid craving (visual analogue scale from 1 to 100) with HIV care cascade outcomes. The primary outcome was linkage to HIV care within 12 months. Other outcomes were prescription of ART (secondary) and achievement of undetectable HIV viral load (HVL < 500 copies/mL) within 12 months (exploratory); the latter was analyzed on a subset in which HVL was measured (n = 48). We assessed outcomes via medical record review (linkage, ART) and serum tests (HVL). To examine the primary outcome, we used multiple logistic regression models controlling for potential confounders.

Results

Among 249 study participants, unhealthy alcohol use (n = 148 [59%]) and past-month IDU (n = 130 [52%]) were common. The mean opioid craving score was 49 (SD: 38). We were unable to detect significant associations between the independent variables (i.e., unhealthy alcohol use, IDU and opioid craving) and any HIV care cascade outcomes in unadjusted and adjusted analyses.

Conclusion

In this cohort of HIV-positive Russians with a history of IDU, individual substance use factors were not significantly associated with achieving HIV care cascade milestones (i.e., linkage to HIV care; prescription for ART; or suppressed viral load). Given no detection of an association of cascade outcomes with recent unhealthy use of alcohol or injection drugs in this cohort, examining systemic factors to understand determinants of HIV care engagement for people with drug use would be important.
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Metadata
Title
Role of substance use in HIV care cascade outcomes among people who inject drugs in Russia
Authors
Bulat Idrisov
Karsten Lunze
Debbie M. Cheng
Elena Blokhina
Natalia Gnatienko
Emily Quinn
Carly Bridden
Alexander Y. Walley
Kendall J. Bryant
Dmitry Lioznov
Evgeny Krupitsky
Jeffrey H. Samet
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2017
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-017-0098-5

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