학술논문
Efficacy of assisted partner services for people who inject drugs in Kenya to identify partners living with HIV and hepatitis C virus infection: a prospective cohort study.
Document Type
Academic Journal
Author
Monroe-Wise A; Department of Global Health, University of Washington, Seattle, WA, USA. Electronic address: alizamw@uw.edu.; Mbogo L; University of Washington Global Assistance Program-Kenya, Nairobi, Kenya.; Sambai B; University of Washington Global Assistance Program-Kenya, Nairobi, Kenya.; Ludwig-Barron N; Department of Global Health, University of Washington, Seattle, WA, USA.; Guthrie BL; Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.; Bukusi D; Kenyatta National Hospital, Nairobi, Kenya.; Chohan BH; Department of Global Health, University of Washington, Seattle, WA, USA; Kenya Medical Research Institute, Nairobi, Kenya.; Masyuko S; Department of Global Health, University of Washington, Seattle, WA, USA; Kenya National AIDS and STI Control Programme, Nairobi, Kenya.; Scott J; Department of Medicine, University of Washington, Seattle, WA, USA.; Juma E; University of Washington Global Assistance Program-Kenya, Nairobi, Kenya.; Macharia P; Strathmore University, Nairobi, Kenya.; Kingston H; Department of Global Health, University of Washington, Seattle, WA, USA.; Sinkele W; Support for Addictions Prevention and Treatment in Africa, Nairobi, Kenya.; Gitau E; Support for Addictions Prevention and Treatment in Africa, Nairobi, Kenya.; Bosire R; Kenya Medical Research Institute, Nairobi, Kenya.; Musyoki H; Kenya National AIDS and STI Control Programme, Nairobi, Kenya.; Herbeck J; Department of Global Health, University of Washington, Seattle, WA, USA.; Farquhar C; Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA.
Source
Publisher: Elsevier Ltd Country of Publication: England NLM ID: 101613665 Publication Model: Print Cited Medium: Internet ISSN: 2214-109X (Electronic) Linking ISSN: 2214109X NLM ISO Abbreviation: Lancet Glob Health Subsets: MEDLINE
Subject
Language
English
Abstract
Background: People who inject drugs are at increased risk of both HIV and hepatitis C virus (HCV) infections but face barriers to testing and engagement in care. Assisted partner services are effective in locating people with HIV but are understudied among people who inject drugs. We assessed whether assisted partner services could be used to find, test for HIV and HCV infections, and link to care the partners of people who inject drugs in Kenya.
Methods: In this prospective study at eight sites offering harm-reduction services in Kenya, we enrolled people aged 18 years or older who inject drugs and were living with HIV (index participants) between Feb 27, 2018, and Nov 1, 2021. Index participants provided information about their sexual and injecting partners (ie, anyone with whom they had had sexual intercourse or injected drugs in the previous 3 years), and then community-embedded peer educators located partners and referred them for enrolment in the study (partner participants). All participants underwent testing for HCV infection, and partner participants also underwent HIV testing. Index and partner participants with HIV but who were not on antiretroviral therapy (ART) were linked with treatment services, and those positive for HCV were linked to treatment with direct-acting antivirals. We calculated the number of index participants whom we needed to interview to identify partner participants with HIV and HCV infection.
Findings: We enrolled 989 people living with HIV who inject drugs, who mentioned 4705 sexual or injecting partners. Of these 4705 partners, we enrolled 4597 participants, corresponding to 3323 unique individuals. 597 (18%) partner participants had HIV, of whom 506 (85%) already knew their status. 358 (71%) of those who knew they were HIV positive were virally suppressed. 393 (12%) partner participants were HCV antibody positive, 213 (54%) of whom had viraemia and 104 (26%) of whom knew their antibody status. 1·66 (95% CI 1·53-1·80) index participants had to be interviewed to identify a partner with HIV, and 4·24 (3·75-4·85) had to be interviewed to find a partner living with HIV who was unaware of their HIV status, not on ART, or not virally suppressed. To find a partner seropositive for HCV who did not know their antibody status, 3·47 (3·11-3·91) index participants needed to be interviewed. Among the 331 index and partner participants living with HIV who were not on ART at enrolment, 238 (72%) were taking ART at 6-month follow-up. No adverse events were attributed to study procedures.
Interpretation: Use of assisted partner services among people with HIV who inject drugs was safe and identified partners with HIV and HCV infections. Assisted partner services was associated with increased uptake of ART for both index participants and partners.
Funding: US National Institutes of Health.
Competing Interests: Declaration of interests AM-W has served as a consultant for WHO and has received financial support from Gilead Sciences. BLG has received financial support from Gilead and has served as an expert witness for the Los Angeles Unified School District. JS has served as a consultant for Gilead, Premera Blue Cross, Guidepoint, and Novo Nordisk, and as an expert witness for the Washington State Medical Commission. All other authors declare no competing interests.
(Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Methods: In this prospective study at eight sites offering harm-reduction services in Kenya, we enrolled people aged 18 years or older who inject drugs and were living with HIV (index participants) between Feb 27, 2018, and Nov 1, 2021. Index participants provided information about their sexual and injecting partners (ie, anyone with whom they had had sexual intercourse or injected drugs in the previous 3 years), and then community-embedded peer educators located partners and referred them for enrolment in the study (partner participants). All participants underwent testing for HCV infection, and partner participants also underwent HIV testing. Index and partner participants with HIV but who were not on antiretroviral therapy (ART) were linked with treatment services, and those positive for HCV were linked to treatment with direct-acting antivirals. We calculated the number of index participants whom we needed to interview to identify partner participants with HIV and HCV infection.
Findings: We enrolled 989 people living with HIV who inject drugs, who mentioned 4705 sexual or injecting partners. Of these 4705 partners, we enrolled 4597 participants, corresponding to 3323 unique individuals. 597 (18%) partner participants had HIV, of whom 506 (85%) already knew their status. 358 (71%) of those who knew they were HIV positive were virally suppressed. 393 (12%) partner participants were HCV antibody positive, 213 (54%) of whom had viraemia and 104 (26%) of whom knew their antibody status. 1·66 (95% CI 1·53-1·80) index participants had to be interviewed to identify a partner with HIV, and 4·24 (3·75-4·85) had to be interviewed to find a partner living with HIV who was unaware of their HIV status, not on ART, or not virally suppressed. To find a partner seropositive for HCV who did not know their antibody status, 3·47 (3·11-3·91) index participants needed to be interviewed. Among the 331 index and partner participants living with HIV who were not on ART at enrolment, 238 (72%) were taking ART at 6-month follow-up. No adverse events were attributed to study procedures.
Interpretation: Use of assisted partner services among people with HIV who inject drugs was safe and identified partners with HIV and HCV infections. Assisted partner services was associated with increased uptake of ART for both index participants and partners.
Funding: US National Institutes of Health.
Competing Interests: Declaration of interests AM-W has served as a consultant for WHO and has received financial support from Gilead Sciences. BLG has received financial support from Gilead and has served as an expert witness for the Los Angeles Unified School District. JS has served as a consultant for Gilead, Premera Blue Cross, Guidepoint, and Novo Nordisk, and as an expert witness for the Washington State Medical Commission. All other authors declare no competing interests.
(Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)