Program Cuts Drug User Deaths in Half

An innovative program has been shown to drastically reduce the number of deaths among people living with HIV who also use injection drugs, reports The Lancet. The study was funded by the U.S. National Institutes of Health, but was based in three countries where injection drug use is the primary mode of HIV transmission (Ukraine, Vietnam, and Indonesia).

People who use injection drugs have disproportionate rates of HIV. According to the Centers for Disease Control and Prevention, approximately 10 percent of new HIV diagnoses in the United States are attributable to the use of injection drugs. Although annual HIV diagnoses among injection drug users decreased by 48 percent between 2008–2014, the current opioid addiction crisis threatens to undermine those successes. A 2013 global meta-study published in the Bulletin of the World Health Organization demonstrated that poz people who use injection drugs have higher mortality rates than those who do not (most common causes of death were overdoses and AIDS-related conditions).

In addition, “People living with HIV who inject drugs often encounter multiple obstacles to beginning and adhering to treatment for HIV infection and substance use,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases in a press release.

The new clinical study, HPTN 074, examined whether offering more services and interventions to poz injection drug users would help them get into care and achieve greater viral suppression than the existing options. Researchers recruited 502 HIV-positive men and women ages 18–60 years old who were injection drug users, and 806 of their non-poz injection partners (people they shared needles with).

Some of the study participants received the improved intervention while others only received their country’s basic standard of care for people who use injection drugs: referrals to substance use treatment, needle or syringe exchange programs (if available), risk reduction counseling for both sexual and injection risks, HIV counseling and testing (for non-poz partners), HIV treatment (for poz participants), and testing and treatment for sexually transmitted infections, hepatitis, and tuberculosis, as appropriate.

The participants assigned to the new, more intensive interventions received all of the above as well as being immediately prescribed antiretrovirals (if poz) or PrEP (if negative). They were also connected with a systems navigator to help them overcome structural barriers to care for both HIV and substance use, as well as psychosocial counselors to help them overcome psychological obstacles that often interfere with treatment.

The experiment proved remarkably successful, lowering mortality rates by over 50 percent. While 15 percent of poz participants who only received the standard of care died, only seven percent who had received the intensive intervention did.

“Providing guidance and counseling can help such individuals overcome barriers to starting and staying in care and treatment, leading to a significantly higher rate of HIV suppression and a much lower rate of death,” Fauci said.

In addition to dramatically reducing deaths, the intervention also helped poz participants achieve lower viral loads. After a year, 41 percent of those participants had achieved undetectable levels, compared to 24 percent of participants who received only the standard of care. Also, 72 percent of participants who received the intensive intervention reported still being in treatment at the end of the year, compared to 43 percent for the other group.

Maintaining treatment and reaching undetectable levels are important not only for long-term health of the poz person, but also to HIV prevention efforts.

Also of note: none of the new diagnoses in the trial occurred among injection partners of people living with HIV who received the intensive intervention. The seven injection partners who did become poz during the course of the study had not received PrEP. Due to the success of the program, at the end of the study researchers offered the intensive intervention to study participants who’d been previously limited to the standard of care.