MOPED615

Title

Suboptimal engagement in HIV care among persons who inject drugs and their partners in Nairobi, Kenya

Presenter

Brandon Guthrie

Authors

B. Guthrie¹, A. Monroe-Wise², L. Mbogo³, B. Sinkele⁴, D. Bukusi⁵, R. Bosire⁶, M. Dunbar⁷, E. Gitau⁴, N. Ludwig-Barron⁸, B. Sambai⁵, H. Musyoki⁹, S. Masyuko¹⁰, J. Herbeck¹¹, C. Farquhar¹²

Institutions

¹University of Washington, Global Health and Epidemiology, Seattle, United States, ²University of Washington, Globale Health, Seattle, Kenya, ³Kenyatta National Hospital National Hospital, Nairobi, Kenya, ⁴Support for Addictions Prevention and Treatment in Africa (SAPTA), Nairobi, Kenya, ⁵Kenyatta National Hospital, Nairobi, Kenya, ⁶Kenya Medical Research Institute (KEMRI), Nairobi, Kenya, ⁷University of Washington, Center for Studies in Demography and Ecology, Seattle, United States, ⁸University of Washington, Epidemiology, Seattle, United States, ⁹National AIDS & STI Control Program, Ministry of Health, Kenya, Nairobi, Kenya, ¹⁰University of Washington, Global Health, Seattle, United States, ¹¹University of Washington, Seattle, United States, ¹²University of Washington, Global Health, Medicine and Epidemiology, Seattle, United States

Background: Injection drug use is increasing in Kenya, and persons who inject drugs (PWID) are a key population disproportionately affected by HIV. Awareness of HIV status and successful engagement in HIV/AIDS care are critical.
Methods: We are evaluating assisted partner services (APS) among PWID to identify undiagnosed individuals living with HIV and to promote engagement in HIV care. Index participants (indexes) are recruited from needle and syringe programs (NSPs) throughout Nairobi. Indexes confidentially provide contact information for all injection and sexual partners in the past 3 years. Community-embedded peer educators attempt to contact all named partners, by phone and community tracing. Contacted partners are notified of their possible HIV exposure and offered HIV counseling and testing. All participants complete questionnaires and are offered HIV testing.
Results: As of January 2019, 196 HIV-infected PWID have been enrolled as indexes, of whom 111 (57%) are men and 85 (43%) are women. Most (n=182, 93%) were aware of their HIV status prior to study participation and 166 (85%) reported ever being on ART. Overall, 146 (74%) were currently on ART, with women significantly less likely to be on ART (67% vs 80%, p=0.002). Younger age was associated with not being on ART (OR=0.9, p=0.01). Among women, those who reported concerns about their safety were over 5-fold more likely to not be on ART (OR=5.5, p=0.01). 32% of women and no men reported sex work as a source of income and 79% of women and 23% of men reported receiving money or goods in exchange for sex. Through APS, 434 unique partners were successfully traced and enrolled, of whom 82 (19%) were HIV-infected, 9 (2%) were unaware of their HIV status, and 21 (5%) were not currently on ART. Of traced partners, 16% were sexual partners of an index, 68% were an injection partner, and 17% were a sexual and injection partner.
Conclusions: HIV status awareness is high among PWID linked to NSPs in Nairobi; however 26% of indexes and HIV-infected partners are not currently on ART. ART treatment is particularly low among female PWID, among whom transactional sex is common, posing a high risk of HIV transmission.