title: Factors associated with injection cessation, relapse and initiation in a community-based cohort of injection drug users in Chennai, India.
abstract: OBJECTIVE
  To characterize factors associated with injection cessation, relapse and initiation.
  
  
  METHODS
  The Madras Injection Drug User and AIDS Cohort Study (MIDACS) is a prospective cohort of injection drug users (IDUs) recruited in 2005-06 with semi-annual follow-up to 2009. Discrete-time survival models were used to characterize predictors of time to first injection cessation and relapse.
  
  
  METHODS
  Chennai, India.
  
  
  METHODS
  A total of 855 IDUs who reported injecting in the 6 months prior to baseline and had >1 follow-up visit.
  
  
  METHODS
  Cessation was defined as the first visit where no injection drug use was reported (prior 6 months) and relapse as the first visit where drug injection (prior 6 months) was reported after first cessation.
  
  
  RESULTS
  All participants were male; median age was 35 years. Over 3 years, 92.7% reported cessation [incidence rate (IR): 117 per 100 person-years]. Factors associated positively with cessation included daily injection and incarceration and factors associated negatively with cessation included marriage, alcohol and homelessness. Of those who reported cessation, 23.6% relapsed (IR: 19.7 per 100 person-years). Factors associated positively with relapse included any education, injection in the month prior to baseline, sex with a casual partner, non-injection drug use, incarceration and homelessness. Alcohol was associated negatively with relapse. The primary reasons for cessation were medical conditions (37%) and family pressure (22%). The majority initiated with non-injection drugs, transitioning to injection after a median 4 years.
  
  
  CONCLUSIONS
  Injection drug users in southern India demonstrate a high rate of injection cessation over 3 years, but relapse is not uncommon. Compensatory increases in alcohol use indicate that cessation of injection does not mean cessation of all substance use. Family pressure, concerns about general health, fear of human immunodeficiency virus infection and a history of non-injection drug use are important correlates of cessation.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. shmehta@jhsph.edu
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: Darshan
authors.initials: D
authors.lastname: Sudarshi
authors.forename: Aylur K
authors.initials: AK
authors.lastname: Srikrishnan
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
authors.forename: Canjeevaram K
authors.initials: CK
authors.lastname: Vasudevan
authors.forename: Santhanam
authors.initials: S
authors.lastname: Anand
authors.forename: Muniratnam Suresh
authors.initials: MS
authors.lastname: Kumar
authors.forename: Carl
authors.initials: C
authors.lastname: Latkin
authors.forename: Suniti
authors.initials: S
authors.lastname: Solomon
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Solomon
mesh_terms: D000328:Adult; D017668:Age of Onset; D004522:Educational Status; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D011329:Prisoners / Q000706:statistics & numerical data; D011446:Prospective Studies; D012008:Recurrence; D057566:Self Report; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000534:rehabilitation; D047568:Unsafe Sex / Q000706:statistics & numerical data