title: Understanding HIV Risk Behavior among Tuberculosis Patients with Alcohol Use Disorders in Tomsk, Russian Federation.
abstract: Russian Federation's (RF) HIV epidemic is the fastest growing of any country. This study explores factors associated with high HIV risk behavior in tuberculosis (TB) patients with alcohol use disorders in Tomsk, RF. This analysis was nested within the Integrated Management of Physician-delivered Alcohol Care for TB Patients (IMPACT, trial number NCT00675961) randomized controlled study of integrating alcohol treatment into TB treatment in Tomsk. Demographics, HIV risk behavior (defined as participant report of high-risk intravenous drug use and/or multiple sexual partners with inconsistent condom use in the last six months), clinical data, alcohol use, depression and psychosocial factors were collected from 196 participants (161 male and 35 female) at baseline. Forty-six participants (23.5%) endorsed HIV risk behavior at baseline. Incarceration history(Odds Ratio (OR)3.93, 95% confidence interval (CI) 1.95, 7.95), age under 41 (OR:2.97, CI:1.46, 6.04), drug addiction(OR: 3.60 CI:1.10, 11.77), history of a sexually transmitted disease(STD)(OR 2.00 CI:1.02, 3.90), low social capital (OR:2.81 CI:0.99, 8.03) and heavier alcohol use (OR:2.56 CI: 1.02, 6.46) were significantly more likely to be associated with HIV risk behavior at baseline. In adjusted analysis, age under 41(OR: 4.93, CI: 2.10, 11.58), incarceration history(OR: 3.56 CI:1.55, 8.17) and STD history (OR: 3.48, CI: 1.5, 8.10) continued to be significantly associated with HIV risk behavior. Understanding HIV transmission dynamics in Russia remains an urgent priority to inform strategies to address the epidemic. Larger studies addressing sex differences in risks and barriers to protective behavior are needed.
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Miller
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States of America.
authors.forename: A Katrina
authors.initials: AK
authors.lastname: Nelson
authors.affiliation: Partners In Health Representative Office in Russian Federation, Moscow, Russia.
authors.forename: Viktoria
authors.initials: V
authors.lastname: Livchits
authors.affiliation: Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, MA United States of America.|Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.|Division of Women's Mental Health, McLean Hospital, Belmont, MA, United States of America.
authors.forename: Shelly F
authors.initials: SF
authors.lastname: Greenfield
authors.affiliation: Tomsk Oblast Tuberculosis Hospital, Tomsk, Russian Federation.
authors.forename: Galina
authors.initials: G
authors.lastname: Yanova
authors.affiliation: Tomsk Oblast Tuberculosis Hospital, Tomsk, Russian Federation.
authors.forename: Sergei
authors.initials: S
authors.lastname: Yanov
authors.affiliation: Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, MA United States of America.|Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America.
authors.forename: Hilary S
authors.initials: HS
authors.lastname: Connery
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States of America.
authors.forename: Sidney
authors.initials: S
authors.lastname: Atwood
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States of America.
authors.forename: Charmaine S
authors.initials: CS
authors.lastname: Lastimoso
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America.|Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States of America.
authors.forename: Sonya S
authors.initials: SS
authors.lastname: Shin
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology*; D001294:Attitude to Health; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D012426:Russia / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology / Q000523:psychology*; D047568:Unsafe Sex