Harm reduction services as the platform for increasing access to HIV treatment for PWID

Pavlo Smyrnov, Iana Sazonova, Tetiana Mykhalchuk, Olga Denisiuk, Susie McLean

Background: Harm reduction programs became an important base for reaching to people at high risk of HIV, providing them an opportunity to get HIV test and support ART initiation. In Ukraine harm reduction programs have reached 212,817 PWID in 2015 which is 62% of estimated population size. Estimated number of HIV positive PWID is 75,000, only 26% are receiving ART.

Methods: In 2015 Alliance for Public Health started assisted HIV testing for PWID, which allowed conducting HIV tests without involvement of medical personnel and thus lowered threshold for HIV testing. In 2016 APH introduced optimized case finding which is employing chain referral mechanism to recruit people from extended risk networks of HIV positive people who inject drugs. Both interventions for HIV case finding are outreach based and are linked with peer case-management intervention (Community Initiated Treatment Intervention –CITI) to link HIV positive people to ART.

Results: During 2015 assisted testing allowed to test 149,473 PWID with 3,313 (2.2%) of HIV-positive results (this is 1,134 more than for similar period of 2014). The percentage of positive tests among new clients was 4.7 comparing to 0.7 among previously reached. OCF introduced in 2016 allowed increasing HIV case finding. In 2015 CITI services helped to enroll in care 1,708 PWID and 723 PWID started ART. Also CITI helped to start ART for 822 PWID who were lost to follow up from medical HIV care. CITI increased percentage enrolled in care among newly diagnosed to 75% vs. 24% for non-CITI clients as well as percentage of ART initiation to 32% vs. 4% for non-CITI clients.

Conclusion: Described programs and interventions should be introduced in harm reduction programs to improve HIV case finding and linkage to HIV care and treatment, which remains insufficient for PWID, especially among those who are not reached by harm reduction.