Background: Estimated number of people who inject drugs (PWID) living with HIV in Ukraine is 78,400 (IBBS 2017). Out of them, 58% know their status and 38% are receiving treatment. Achieving ambitious 90-90-90 targets called for intensified case detection efforts among PWID. HIV testing / assisted HIV self-testing in outreach implemented by Alliance for Public Health (APH) since 2004 produced up to 18.5% positivity rate among PWID in earlier years (2007); however, in 2018 the yield was only 1.7% (139,980 PWID tested, 2428 found positive). Other HIV testing modalities that produce higher HIV detection rates had to be considered in order to improve HIV case finding among PWID in Ukraine.
Methods: HIV positivity rate obtained through outreach testing among PWID was compared to two new testing modalities: Optimized Case Finding (OCF) and provider-initiated testing services (PITS) to identify the most effective testing strategies among PWID and recommend them for expansion. OCF is a form of incentivized extended risk network testing that uses recently diagnosed HIV-positive and high-risk HIV-negative persons to identify members of their social, sexual, or drug-using networks and recruit them for testing. PITS for PWID started in specialized health facilities in 2018 through identifying potentially high-risk PWID based on a set of screening questions and offering them HIV testing.
Results: In 2018 38,003 PWID were newly tested through OCF, and 4138 were found positive (yield of 10.9%); in the same year 2046 PWID were tested through PITS, and 167 persons were found positive (yield of 8.2%). Both of these strategies produced considerably higher positivity rates than 1.7% obtained through testing in outreach.
Conclusions: Among HIV testing modalities for PWID currently supported by APH, both risk network testing and PITS proved to be comparatively effective strategies, and should thus be considered for expansion. Unless modified to produce higher yield, HIV testing in outreach is not recommended for expansion. Adding cost data to the analysis would allow to refine the results and base the recommendations on cost-effectiveness considerations.