Patterns of harm reduction service utilization and HIV incidence among people who inject drugs in Ukraine: A two-part latent profile analysis.
Program utilization patterns are described within a large network of harm reduction service providers in Ukraine. The relationship between utilization patterns and HIV incidence is determined among people who inject drugs (PWID) controlling for oblast-level HIV incidence and treatment/syringe coverage.



Data were extracted from the network's monitoring and evaluation database (January 2011-September 2014, n=327,758 clients). Latent profile analysis was used to determine harm reduction utilization patterns using the number of HIV tests received annually and the number of condoms, syringes, and services (i.e., information and counseling sessions) received monthly over a year. Cox proportional hazards regression determined the relations between HIV seroconversion and utilization class membership.



In the final 4-class model, class 1 (34.0% of clients) received 0.1 HIV tests, 1.3 syringes, 0.6 condom and minimal counseling and information sessions per month; class 2 (33.6%) received 8.6 syringes, 3.2 condoms, and 0.5 HIV tests and counseling and information sessions; class 3 (19.1%) received 1 HIV test, 11.9 syringes, 4.3 condoms, and 0.7 information and counseling sessions; class 4 (13.3%) received 1 HIV test, 26.1 syringes, 10.3 condoms, and 1.8 information and 1.9 counseling sessions. Class 4 clients had significantly decreased risk for HIV seroconversion as compared to those in class 1 after controlling for oblast-level characteristics.



Injection drug use continues to be a major mode of HIV transmission in Ukraine, making evaluation of harm reduction efforts in reducing HIV incidence among PWID critical. These analyses suggest that receiving more syringes and condoms decreased risk of HIV. Scaling up HIV testing and harm reduction services is warranted.
New York University College of Global Public Health, New York, NY, USA; Center for Drug Use and HIV Research, New York University, New York, NY, USA; Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA. Electronic address: dco2@nyu.edu.
Danielle C
DC
Ompad
Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA.
Jiayu
J
Wang
Ukrainian Institute on Public Health Policy, Kiev, Ukraine.
Konstantin
K
Dumchev
National University of Kyiv-Mohyla Academy, Kiev, Ukraine.
Julia
J
Barska
Alliance for Public Health (Formerly ICF International HIV/AIDS Alliance in Ukraine), Kiev, Ukraine.
Maria
M
Samko
Ukrainian Institute on Public Health Policy, Kiev, Ukraine.
Oleksandr
O
Zeziulin
Alliance for Public Health (Formerly ICF International HIV/AIDS Alliance in Ukraine), Kiev, Ukraine.
Tetiana
T
Saliuk
Alliance for Public Health (Formerly ICF International HIV/AIDS Alliance in Ukraine), Kiev, Ukraine.
Olga
O
Varetska
SUNY Downstate Medical Center, Department of Medicine, Brooklyn, NY, USA.
Jack
J
DeHovitz
D017280:Condoms / Q000706:statistics & numerical data; D003376:Counseling / Q000706:statistics & numerical data*; D016208:Databases, Factual; D015658:HIV Infections / Q000453:epidemiology*; D040261:Harm Reduction; D006801:Humans; D015994:Incidence; D008962:Models, Theoretical; D016016:Proportional Hazards Models; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D013594:Syringes / Q000706:statistics & numerical data; D014455:Ukraine / Q000453:epidemiology
HIV; Harm reduction; Injection drug use; Needle and syringe programs; Opiates; Ukraine