title: HIV care continuum among men who have sex with men and persons who inject drugs in India: barriers to successful engagement.
abstract: BACKGROUND
  We characterize the human immunodeficiency virus (HIV) care continuum for men who have sex with men (MSM) and persons who inject drugs (PWID) across India.
  
  
  METHODS
  We recruited 12 022 MSM and 14 481 PWID across 26 Indian cities, using respondent-driven sampling (September 2012 to December 2013). Participants were aged ≥18 years and either self-identified as male and reported sex with a man in the prior year (MSM) or reported injection drug use in the prior 2 years (PWID). Correlates of awareness of HIV-positive status were characterized using multilevel logistic regression.
  
  
  RESULTS
  A total of 1146 MSM were HIV infected, of whom a median of 30% were aware of their HIV-positive status, 23% were linked to care, 22% were retained before antiretroviral therapy (ART), 16% had started ART, 16% were currently receiving ART, and 10% had suppressed viral loads. There was site variability (awareness range, 0%-90%; suppressed viral load range, 0%-58%). A total of 2906 PWID were HIV infected, of whom a median of 41% were aware, 36% were linked to care, 31% were retained before ART, 20% had started ART, 18% were currently receiving ART, and 15% had suppressed viral loads. Similar site variability was observed (awareness range: 2%-93%; suppressed viral load range: 0%-47%). Factors significantly associated with awareness were region, older age, being married (MSM) or female (PWID), use of other services (PWID), more lifetime sexual partners (MSM), and needle sharing (PWID). Ongoing injection drug use (PWID) and alcohol use (MSM) were associated with lower awareness.
  
  
  CONCLUSIONS
  In this large sample, the major barrier to HIV care engagement was awareness of HIV-positive status. Efforts should focus on linking HIV testing to other essential services.
  
  
  BACKGROUND
  NCT01686750.
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health.
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Lucas
authors.affiliation: Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu.
authors.forename: Suniti
authors.initials: S
authors.lastname: Solomon
authors.affiliation: Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu.
authors.forename: Aylur K
authors.initials: AK
authors.lastname: Srikrishnan
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health.
authors.forename: Allison M
authors.initials: AM
authors.lastname: McFall
authors.affiliation: National AIDS Control Organisation, New Delhi, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Dhingra
authors.affiliation: Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu.
authors.forename: Paneerselvam
authors.initials: P
authors.lastname: Nandagopal
authors.affiliation: Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu.
authors.forename: M Suresh
authors.initials: MS
authors.lastname: Kumar
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health.
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu.
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Solomon
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D018451:Homosexuality, Male; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D016485:Needle Sharing; D012307:Risk Factors; D012309:Risk-Taking; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous / Q000150:complications*
keywords: HIV care continuum; India; men who have sex with men; people who inject drugs