title: Getting to 90: linkage to HIV care among men who have sex with men and people who inject drugs in India.
abstract: UNAIDS set an ambitious target of "90-90-90" by 2020. The first 90 being 90% of those HIV-infected will be diagnosed; the second 90 being 90% of those diagnosed will be linked to medical care and on antiretroviral therapy (ART). While there has been dramatic improvement in HIV testing and ART use, substantial losses continue to occur at linkage-to-care following HIV diagnosis. Data on linkage among men who have sex with men (MSM) and people who inject drugs (PWID) are sparse, despite a greater burden of HIV in these populations. This cross-sectional study was conducted in 27 sites across India. Participants were recruited using respondent-driven sampling and had to be ≥18 years and self-identify as male and report sex with a man in the prior year (MSM) or injection drug use in the prior 2 years (PWID). Analyses were restricted to HIV-infected persons aware of their status. Linkage was defined as ever visiting a doctor for management of HIV after diagnosis. We explored factors that discriminated between those linked and not linked to care using multi-level logistic regression and area under the receiver operating curves (AUC), focusing on modifiable factors. Of 1726 HIV-infected persons aware of their status, 80% were linked to care. Modifiable factors around the time of diagnosis that best discriminated linkage included receiving assistance with HIV medical care (odds ratio [OR]: 10.0, 95% confidence interval [CI]): 5.6-18.2), disclosure of HIV-positive status (OR: 2.8; 95% CI: 2.4-6.1) and receiving information and counseling on management of HIV (OR: 2.3; 95% CI: 1.1-4.6). The AUC for these three factors together was 0.85, higher than other combinations of factors. We identified three simple modifiable factors around the time of diagnosis that could facilitate linkage to care among MSM and PWID in low- and middle-income countries to achieve UNAIDS targets.
authors.affiliation: a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: McFall
authors.affiliation: a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.affiliation: b YR Gaitonde Centre for AIDS Research and Education , Chennai , India.
authors.forename: Aylur K
authors.initials: AK
authors.lastname: Srikrishnan
authors.affiliation: c Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Lucas
authors.affiliation: b YR Gaitonde Centre for AIDS Research and Education , Chennai , India.
authors.forename: Canjeevaram K
authors.initials: CK
authors.lastname: Vasudevan
authors.affiliation: a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
authors.affiliation: b YR Gaitonde Centre for AIDS Research and Education , Chennai , India.
authors.forename: Muniratnam S
authors.initials: MS
authors.lastname: Kumar
authors.affiliation: a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Suniti
authors.initials: S
authors.lastname: Solomon
authors.affiliation: a Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.|c Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Solomon
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D037001:Directive Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008297:Male; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D014342:Truth Disclosure; D055815:Young Adult
keywords: HIV care continuum; India; MSM; linkage to care; men who have sex with men; people who inject drugs