Background: The U.S. Centers for Disease Control and Prevention sponsored a Key Population Implementation Sciencestudy in Ukraine (2015-2018) to evaluate HIV care cascade outcomes among people who inject drugs (PWID) enrolled in the Community Initiated Treatment Intervention (CITI) compared with those enrolled in standard HIV care (SoC).
Methods: We conducted a non-randomized cluster study in 14 regions among HIV-positive PWID who had never been linked to HIV care or who were lost to follow-up at enrollment. Depending on their region, participants were enrolled into 2 study groups: 1 group received SoC and the other received CITI. Participants were interviewed at 0, 6, 12, and 18 months during follow-up visits. We also collected clinical data on antiretroviral treatment (ART) initiation, retention in care, and viral suppression.Our study included 885 PWID (CITI, n=597; SoC, n=288) who completed 18-month follow-up.
Results: The CITI group (37%) had significantly higher rates of ART initiation at the 6-month follow-up than the SoC group (25%; p=0.001). Adjusting for demographics, drug use frequency, harm reduction services, time to AIDS center visit, and opioid substitution therapy, CITI was associated with shorter time to ART initiation than SoC.Among participants who initiated ART, significantly more CITI participants (70%) were retained on ART at the 18-month follow-up than SoC (44%; p< 0.001). CITI effectively helped participants attain viral suppression at all follow-up assessments. The CITI group had significantly higher rates of undetectable viral load (< 40 copies/mL) than the SoC group: 8% vs. 4% at 6 months (p=0.019); 24% vs. 17% at 12 months (p=0.014); and 33% vs. 26% at 18 months (p=0.039).
Conclusions: HIV-positive PWID who received CITI were more likely to start ART and had a shorter time to treatment initiation compared to those who received SoC. CITI improved retention in care and is associated with viral load suppression among PWID.