Overlap between harm reduction and HIV service utilization among PWID in India: implications for HIV combination prevention

M Kumi Smith, Sunil Solomon, Derek A T Cummings, Aylur Srikrishnan, M Suresh Kumar, C K Vasudevan, Allison McFall, Gregory Lucas, David Celentano, Shruti Mehta

Research output: Contribution to journalArticlepeer-review

2 Scopus citations



In some regions, HIV incidence is rising among people who inject drugs (PWID). Combination prevention approaches are well suited to PWID who face multiple sources of HIV risk. This analysis investigates patterns of utilisation to basic HIV services (HIV counselling and testing [HCT], antiretroviral therapy [ART]) as well as harm reduction programs (needle and syringe exchange programs [NSEP] and opioid agonist therapy [OAT]) among PWID and how utilisation of harm reduction services is associated with HIV-related care seeking behaviours.

Respondent-driven sampling was used to recruit 14,481 PWID across 15 cities in India. Sampling-weighted multilevel logistic regression models assessed associations between utilisation of harm reduction service and HCT and ART use among those indicated (90.3% and 5.0% of full sample, respectively). We considered both recent (prior year) and ever use of services.

Overall, 42.3% reported prior HIV testing and 57.9% of eligible persons reported ART initiation, but overlap with NSEP and OAT use was limited. In adjusted models, recent and ever use of both NSEP and OAT were significantly associated with recent and ever HCT utilisation, respectively; however, harm reduction utilisation was not associated with ART initiation among eligible participants.

Harm reduction services may play a key role in linking PWID with HIV testing; however, they were not associated with ART initiation among eligible individuals. Moreover, a large majority who utilised NSEP and OAT were not engaged in optimal HIV care or prevention, highlighting missed opportunities and a need for stronger linkages between NSEP/OAT and HIV care and treatment, particularly among those actively injecting. These findings provide key insights to better understand how services can be linked or combined to optimise service utilisation among PWID.
Original languageEnglish (US)
Pages (from-to)111-118
JournalInternational Journal of Drug Policy
StatePublished - Jul 2018

Bibliographical note

Funding Information:
The project was funded by the National Institute on Drug Abuse ( R01DA032059 , K24DA035684 ). Other author support was provided by the Johns Hopkins Centre for AIDS Research ( P30AI094189 ), the National Institute of Mental Health ( R01MH89266 ), and the National Institute of Allergy and Infectious Diseases ( T32 AI102623 ).

Publisher Copyright:
© 2018 Elsevier B.V.

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