HIV treatment outcomes among people who inject drugs: A global systematic review and meta-analysis

Author: Kennedy Kipkoech, Jack Stone, Hannah Fraser, Jaskaran S Cheema, Adam Trickey, Anna L McNaughton , Adelina Artenie, Julie Ambia, Aaron G Lim, Lara Allen, Getahun Molla Kassa, Andrew Scheibe, Natasha Martin, Leigh Johnson, Kennedy Kipkoech, Peter Vickerman, Peter Vickerman

Theme: Epidemiology & Public Health Research Year: 2023

People who inject drugs (PWID) are frequently assumed to have worse HIV treatment outcomes than other population groups, but published data has never been synthesised. We aimed to quantify retention in care and viral suppression among PWID globally and compare outcomes with the general population and men who have sex with men (MSM).

We searched MEDLINE, Embase, and PsycINFO for studies published between 01/01/2010–16/02/2021 assessing: retention in care/on antiretroviral therapy (ART) for PWID on HIV treatment; levels of viral suppression for PWID on HIV treatment or PWID living with HIV; or effect measures for how these outcomes differ compared to other population groups. We pooled outcome data using random-effects meta-analyses. Proportions retained in care/on ART were converted into 12-month retention estimates. Proportions virally suppressed were converted to a <1000 copies/mL threshold, using a Weibull model.

Overall, 133 studies met the inclusion criteria, with 116 and 36 studies having data on viral suppression and retention in care/on ART from 35 and 15 countries, respectively. Nearly, two-thirds of PWID were retained in care/on ART at 12 months (65.6%, 95% confidence interval [CI] 58.0-73.3%), with retention significantly lower than for MSM (odds ratio [OR] 0.61, [95%CI:0.42-0.91]; 20 studies). A third of PWID living with HIV (33.0%, [95%CI:30.0-36.1%]) and half of those on ART (52.8%, [95%CI:46.2-59.3%]) were virally suppressed. Viral suppression among PWID living with HIV was lower compared to general population (OR 0.61, [95%CI:0.49-0.76], 28 studies) and MSM (0.56, [95%CI:0.47-0.67], 35 studies), as was viral suppression among PWID living with HIV on ART (general population OR 0.57, [95%CI:0.50-0.64], 30 studies; MSM OR 0.50, [95%CI:0.43-0.59], 26 studies).

Retention in care/on ART and viral suppression among PWID are suboptimal and much lower than for other population groups. Focussed interventions are needed to improve HIV treatment outcomes among PWID.

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