High HIV incidence in a cohort of male injection drug users in Delhi, India
Background: India has an estimated 177,000 injection drug users (IDU) with a national HIV prevalence of 7.14%. Reliable estimates of HIV incidence are not available for this population. Methods: We report HIV incidence in a cohort of male, HIV-negative IDUs recruited through peer-referral, targeted outreach and as walk-in clients in Delhi from May to October, 2011. Fourth-generation Antigen–Antibody tests were used to diagnose new infections and results were confirmed using Western blot tests. HIV incidence based on HIV seroconversion was calculated as number of events/person-years. Cox regression was used to identify significant (p < 0.05) seroconversion predictors. Results: A total of 2790 male HIV-negative IDUs were recruited at baseline; 67.4% (n = 1880) returned for their first follow-up visit and 96% (n = 1806) underwent HIV testing. Participants were followed for a median of 9.7 months. A total of 112 new HIV infections occurred over a cumulative 1398.5 person-years of follow-up resulting in an incidence rate of 8.01 new infections/100 person-years (95% CI: 6.65–9.64); 74% of these participants reported risky injection practices in the past month. In multivariate analysis, moderate-high risk injection behaviors (Adjusted Hazard Ratio [AHR] 2.59; 95% CI 1.45–4.62) were associated with a higher risk of new infections. Conclusions: Male IDUs in Delhi continue to practice unsafe injection practices leading to high sero-incidence despite the availability of HIV prevention services offered through targeted intervention programs.
Sarna, Avina, Lopamudra Saraswati, Mary Philip Sebastian, Vartika Sharma, Ira Madan, Dean Lewis, Julie Pulerwitz, Ibou Thior, and Waimar Tun. 2014. "High HIV incidence in a cohort of male injection drug users in Delhi, India," Drug and Alcohol Dependence 139: 106–114.
Averting HIV Infections Among People Who Inject Drugs: The AVHI Project