title: The HIV care continuum among men who have sex with men in Moscow, Russia: a cross-sectional study of infection awareness and engagement in care.
abstract: OBJECTIVE
  Early diagnosis and treatment of HIV infection is critical to improving clinical outcomes for HIV-infected individuals. We sought to characterise the HIV care continuum and identify correlates of being unaware of one's HIV infection among men who have sex with men (MSM) in Moscow, Russia.
  
  
  METHODS
  Participants (N=1376) were recruited via respondent-driven sampling and completed a sociobehavioural survey and HIV testing from 2010 to 2013. Sample and population estimates were calculated for key steps along the HIV care continuum for HIV-infected MSM and logistic regression methods were used to examine correlates of being unaware of one's HIV infection.
  
  
  RESULTS
  15.6% (184/1177; population estimate: 11.6%; 95% CI 8.5% to 14.7%) of participants were HIV infected. Of these, only 23.4% (43/184; population estimate: 13.2; 95% CI 11.0 to 15.4) were previously aware of their infection, 8.7% (16/184 population estimate: 4.7; 95% CI 1.0 to 8.5) were on antiretroviral therapy (ART), and 4.4% (8/164; population estimate: 3.0; 95% CI 0.3 to 5.6) reported an undetectable viral load. Bisexual identity (reference: homosexual; adjusted odds ratio (AOR): 3.69; 95% CI 1.19 to 11.43), having ≥5 sexual partners in the last 6 months (reference: ≤1; AOR: 4.23; 95% CI 1.17 to 15.28), and employer HIV testing requirements (reference: no; AOR: 15.43; 95% CI 1.62 to 147.01) were associated with being unaware of one's HIV infection. HIV testing in a specialised facility (reference: private; AOR: 0.06; 95% CI 0.01 to 0.53) and testing ≥2 times in the last 12 months (reference: none; AOR: 0.17; 95% CI 0.04 to 0.73) were inversely associated with being unaware of HIV infection.
  
  
  CONCLUSIONS
  There is a steep gradient along the HIV care continuum for Moscow-based MSM beginning with low awareness of HIV infection. Efforts that improve access to acceptable HIV testing strategies, such as alternative testing facilities, and linkage to care are needed for key populations.
authors: Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, Maryland, USA.
authors: A L
authors: AL
authors: Wirtz
authors: Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors: C E
authors: CE
authors: Zelaya
authors: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors: C
authors: C
authors: Latkin
authors: AIDS Infoshare, Moscow, Russian Federation.
authors: A
authors: A
authors: Peryshkina
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Department of Statistics, University of Haifa, Israel.
authors: N
authors: N
authors: Galai
authors: AIDS Infoshare, Moscow, Russian Federation.
authors: V
authors: V
authors: Mogilniy
authors: AIDS Infoshare, Moscow, Russian Federation.
authors: P
authors: P
authors: Dzhigun
authors: AIDS Infoshare, Moscow, Russian Federation.
authors: I
authors: I
authors: Kostetskaya
authors: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors: S H
authors: http://orcid.org/0000-0002-2523-0959
authors: SH
authors: Mehta
authors: Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors: C
authors: C
authors: Beyrer
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy; D006297:Health Services Accessibility / Q000458:organization & administration*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008403:Mass Screening; D009031:Moscow / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D012309:Risk-Taking; D012426:Russia / Q000453:epidemiology; D012725:Sexual Behavior; D012747:Sexual Partners
keywords: ANTIRETROVIRAL THERAPY; BEHAVIOURAL SCIENCE; DIAGNOSIS; HIV; HOMOSEXUALITY