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A strengths-based case management intervention to link HIV-positive PWID in Russia to HIV care - results from a randomized controlled trial.
AIDS 2019 April 6
OBJECTIVE: To determine whether the LINC strengths-based case management intervention was more effective than usual care for linking people who inject drugs (PWID) to HIV care and improving HIV outcomes.
DESIGN: Two-armed randomized controlled trial.
SETTING: Participants recruited from a narcology hospital in St. Petersburg, Russia.
PARTICIPANTS: 349 HIV-positive PWID not on antiretroviral therapy (ART).
INTERVENTION: Strengths-based case management over 6 months.
MAIN OUTCOME MEASURES: Primary outcomes were linkage to HIV care and improved CD4 count. We performed adjusted logistic and linear regression analyses controlling for past HIV care using the intention-to-treat approach.
RESULTS: Participants (N=349) had the following baseline characteristics: 73% male, 12% any past ART use, and median values of 34.0 years of age and CD4 count 311. Within 6 months of enrollment 51% of the intervention group and 31% of controls linked to HIV care (AOR 2.34; 95% CI: 1.49-3.67; p < 0.001). Mean CD4 count at 12 months was 343 and 354 in the intervention and control groups, respectively (adjusted ratio of means 1.14; 95% CI: 0.91, 1.42, p = 0.25).
CONCLUSION: The LINC strengths-based case management intervention was more effective than usual care in linking Russian PWID to HIV care, but did not improve CD4 count, likely due to low overall ART initiation. While case management can improve linkage to HIV care, specific approaches to initiate and adhere to ART are needed to improve clinical outcomes (e.g., increased CD4 cell count) in this population.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. https://creativecommons.org/licenses/by-nc-nd/4.0.
DESIGN: Two-armed randomized controlled trial.
SETTING: Participants recruited from a narcology hospital in St. Petersburg, Russia.
PARTICIPANTS: 349 HIV-positive PWID not on antiretroviral therapy (ART).
INTERVENTION: Strengths-based case management over 6 months.
MAIN OUTCOME MEASURES: Primary outcomes were linkage to HIV care and improved CD4 count. We performed adjusted logistic and linear regression analyses controlling for past HIV care using the intention-to-treat approach.
RESULTS: Participants (N=349) had the following baseline characteristics: 73% male, 12% any past ART use, and median values of 34.0 years of age and CD4 count 311. Within 6 months of enrollment 51% of the intervention group and 31% of controls linked to HIV care (AOR 2.34; 95% CI: 1.49-3.67; p < 0.001). Mean CD4 count at 12 months was 343 and 354 in the intervention and control groups, respectively (adjusted ratio of means 1.14; 95% CI: 0.91, 1.42, p = 0.25).
CONCLUSION: The LINC strengths-based case management intervention was more effective than usual care in linking Russian PWID to HIV care, but did not improve CD4 count, likely due to low overall ART initiation. While case management can improve linkage to HIV care, specific approaches to initiate and adhere to ART are needed to improve clinical outcomes (e.g., increased CD4 cell count) in this population.This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. https://creativecommons.org/licenses/by-nc-nd/4.0.
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