Transcript AIDS2012_poster_terlikbayeva_160713_FINAL

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
Table 1: Sociodemographic characteristics
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.
Methods
In 2009-2011, 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.
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
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)
43 (5.91)
27 (7.42)
16 (4.40)
629 (86.40)
308 (84.62)
321 (88.19)
56 (7.69)
29 (7.97)
27 (7.42)
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)
Ethnicity (n, %)
Marital Status
Single
Married
Divorced/Separated/Widowed
Table 2: Descriptive Statistics for HIV Testing and Care
Results
Total
•Among total sample, the prevalence rate of HIV was 26%, HCV was 74.2%, and
Male
Female
N
%
n
%
n
%
syphilis was 1.4%
Ever Received an HIV test
544,0
74,7
275,0
75,6
269,0
73,9
•122 participants (16.8%) indicated previous TB infection
Incident HIV cases
42,0
5,8
23,0
6,3
19,0
5,2
•Among HIV-infected participants, 37 (21%) said they had newly diagnosed HIV
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
CD4 count less than 200 (n=13)
6,0
46,2
3,0
33,3
3,0
75,0
CD4 count between 200-350
(n=18)
7,0
38,9
6,0
50,0
1,0
16,7
CD4 count greater than 350
(n=23)
7,0
30,4
4,0
33,3
3,0
27,3
TB in HIV-positive participants
25,0
23,8
18,0
17,0
7,0
6,6
Received medication for TB
24,0
96,0
17,0
68,0
7,0
28,0
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 200-350 (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
Literature Cited
For those who received ART and
knew their cell count
1.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
2.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
3.WHO, UNAIDS, UNICEF. Towards universal access: scaling up priority HIV/AIDS interventions in the
health sector. Progress Report 2009. www.who.int/hiv/pub/2009progressreport/en/ (accessed Dec 18,
2010).
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.
4.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. 2008. www.unodc.org/documents/hiv-aids/WHO%20
UNODC%20UNAIDS%20%20IDU%20Universal%20Access%20Target%20Setting%20Guide%2020FINAL
%20-%20Feb%2009.pdf (accessed Sept 11, 2009).
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
www.ghrcca.columbia.edu.
Presented at AIDS 2012 – Washington, D.C., USA