Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States.
Johns Hopkins University School of Medicine, Infectious Diseases Department, Baltimore, MD, United States.
Drug Alcohol Depend. 2023 Aug 1;249:110834. doi: 10.1016/j.drugalcdep.2023.110834. Epub 2023 Jun 16.
Injection drug use drives HIV epidemics in many low-resource settings, yet many people who inject drugs (PWID) living with HIV are not diagnosed. We assessed the ability of respondent-driven sampling (RDS) - which uses peer network connections - to identify undiagnosed PWID living with HIV compared to a facility-based strategy in India.
In six Indian cities from 2014 to 2017, integrated care centers (ICCs) provided HIV testing. From 2016 to 2017, RDS samples of PWID in these same cities were conducted. Using biometric matching, characteristics associated with identification by RDS only and both RDS and ICC, compared to ICC only were explored. Undiagnosed individuals tested positive and did not report a prior diagnosis. The number needed to recruit (NNR) (average number recruited to find one undiagnosed PWID living with HIV) and the identification rate (average number undiagnosed PWID identified per week) assessed the efficiency of RDS vs. ICCs.
There were 10,759 ICC clients and 6012 RDS participants; 40% of RDS participants were also ICC clients resulting in 14,397 unduplicated PWID. PWID identified by RDS vs. ICC only were more likely to be male (adjusted odds ratios [aOR] RDS only: 6.8, both: 2.7) and living with HIV but undiagnosed (aOR RDS only: 2.5, both: 1.5). Overall, the RDS NNR was 11 and the ICC NNR was 26. The RDS identification rate (18.6/week) was faster than the ICC identification rate (2.7/week) overall and in all cities.
RDS required screening fewer PWID and more rapidly identified undiagnosed PWID living with HIV as compared to ICCs.
在许多资源匮乏的环境中，注射毒品是导致 HIV 流行的主要原因，但许多感染 HIV 的注射毒品使用者（PWID）并未被诊断出来。我们评估了基于受访者驱动抽样（RDS）的方法——利用同伴网络联系——与印度的基于机构的策略相比，该方法在识别感染 HIV 的未被诊断的 PWID 方面的能力。
在 2014 年至 2017 年期间，六个印度城市的综合关怀中心（ICC）提供 HIV 检测。2016 年至 2017 年，对这些城市的 PWID 进行了 RDS 抽样。利用生物特征匹配，探索了仅通过 RDS 识别、RDS 和 ICC 均识别与仅通过 ICC 识别的特征之间的关联。未被诊断的个体检测结果呈阳性，且未报告先前的诊断。招募人数需求（NNR）（平均招募人数以发现一名感染 HIV 的未被诊断的 PWID）和识别率（平均每周发现的未被诊断的 PWID 人数）评估了 RDS 与 ICC 的效率。
ICC 客户有 10759 人，RDS 参与者有 6012 人；40%的 RDS 参与者也是 ICC 客户，共计 14397 名 PWID。与仅通过 ICC 识别的 PWID 相比，通过 RDS 识别的 PWID 更有可能是男性（调整后的优势比[OR]仅 RDS：6.8，均 RDS：2.7）和感染 HIV 但未被诊断（调整后的 OR 仅 RDS：2.5，均 RDS：1.5）。总体而言，RDS 的 NNR 为 11，而 ICC 的 NNR 为 26。RDS 的识别率（18.6/周）总体上以及在所有城市均快于 ICC 的识别率（2.7/周）。
与 ICC 相比，RDS 筛查的 PWID 人数更少，但更快地识别出感染 HIV 的未被诊断的 PWID。
