The feasibility of an intensive case management program for injection drug users on antiretroviral therapy in St. Petersburg, Russia

Harm Reduction Journal

Irving F Hoffman³  Andrei P Kozlov¹  Vanessa N Elharrar²  Lillian B Brown³  Roman V Skochilov¹  Alla V Shaboltas¹ 

[1] The Biomedical Center, Vyborgskaya st. 8, St.Petersburg, Russia;NIAID, NIH, 6700-B Rockledge Drive, 5125, Bethesda, MD 20892, USA;Department of Medicine, University of North Carolina, Manning Drive, Chapel Hill, NC, USA

关键词: Case management;    Antiretroviral therapy;    HIV/AIDS;    Russia;    Injection drug users;   

Others  :  809866
DOI  :  10.1186/1477-7517-10-15

 received in 2012-08-06, accepted in 2013-08-28,  发布年份 2013

【 摘 要 】

Background

The majority of HIV-infected individuals requiring antiretroviral therapy (ART) in Russia are Injection Drug Users (IDU). Substitution therapy used as part of a comprehensive harm reduction program is unavailable in Russia. Past data shows that only 16% of IDU receiving substance abuse treatment completed the course without relapse, and only 40% of IDU on ART remained on treatment at 6 months. Our goal was to determine if it was feasible to improve these historic outcomes by adding intensive case management (ICM) to the substance abuse and ART treatment programs for IDU.

Methods

IDU starting ART and able to involve a “supporter” who would assist in their treatment plan were enrolled. ICM included opiate detoxification, bi-monthly contact and counseling with the case, weekly group sessions, monthly contact with the “supporter” and home visits as needed. Full follow- up (FFU) was 8 months. Stata v10 (College Station, TX) was used for all analysis. Descriptive statistics were calculated for all baseline demographic variables, baseline and follow-up CD4 count, and viral load. Median baseline and follow-up CD4 counts and RNA levels were compared using the Kruskal-Wallis test. The proportion of participants with RNA < 1000 copies mL at baseline and follow-up was compared using Fisher’s Exact test. McNemar’s test for paired proportions was used to compare the change in proportion of participants with RNA < 1000 copies mL from baseline to follow-up.

Results

Between November 2007 and December 2008, 60 IDU were enrolled. 34 (56.7%) were male. 54/60 (90.0%) remained in FFU. Overall, 31/60 (52%) were active IDU at enrollment and 27 (45%) were active at their last follow-up visit. 40/60 (66.7%) attended all of their ART clinic visits, 13/60 (21.7%) missed one or more visit but remained on ART, and 7/60 (11.7%) stopped ART before the end of FFU. Overall, 39/53 (74%) had a final 6–8 month HIV RNA viral load (VL) < 1000 copies/mL.

Conclusions

Despite no substitution therapy to assist IDU in substance abuse and ART treatment programs, ICM was feasible, and the retention and adherence of IDU on ART in St. Petersburg could be greatly enhanced by adding ICM to the existing treatment programs.

【 授权许可】

   
2013 Shaboltas et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Kalichman SC, Kelly JA, Sikkema KJ, Koslov AP, Shaboltas AV, Granskaya JV: The emerging AIDS crisis in Russia: review of enabling factors and prevention needs. Int J STD AIDS 2000, 11(2):71-75.
• [2]Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, Wodak A, Panda S, Tyndall M, Toufik A, Mattick RP: Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet 2008, 372(9651):1733-1745.
• [3]Heimer R, White E: Estimation of the number of injection drug users in St. Petersburg, Russia. Drug Alcohol Depend 2010, 109(1–3):79-83.
• [4]Gyarmathy VA, Li N, Tobin KE, Hoffman IF, Sokolov N, Levchenko J, Batluk J, Kozlov AA, Kozlov AP, Latkin CA: Injecting equipment sharing in Russian drug injecting dyads. AIDS Behav 2010, 14(1):141-151.
• [5]Toussova O, Shcherbakova I, Volkova G, Niccolai L, Heimer R, Kozlov A: Potential bridges of heterosexual HIV transmission from drug users to the general population in St. Petersburg, Russia: is it easy to be a young female? J Urban Health 2009, 86(Suppl 1):121-130.
• [6]Kozlov AP, Shaboltas AV, Toussova OV, Verevochkin SV, Masse BR, Perdue T, Beauchamp G, Sheldon W, Miller WC, Heimer R, Ryder RW, Hoffman IF: HIV incidence and factors associated with HIV acquisition among injection drug users in St Petersburg, Russia. AIDS 2006, 20(6):901-906.
• [7]Shaboltas AV, Toussova OV, Hoffman IF, Heimer R, Verevochkin SV, Ryder RW, Khoshnood K, Perdue T, Masse BR, Kozlov AP: HIV prevalence, sociodemographic, and behavioral correlates and recruitment methods among injection drug users in St. Petersburg, Russia. J Acquir Immune Defic Syndr 2006, 41(5):657-663.
• [8]Niccolai LM, Verevochkin SV, Toussova OV, White E, Barbour R, Kozlov AP, Heimer R: Estimates of HIV incidence among drug users in St. Petersburg, Russia: continued growth of a rapidly expanding epidemic. Eur J Public Health 2010, 21(5):613-619.
• [9]Verevochkin SV, Shaboltas AV, Gagarina SN, Skochilov RV, Toussova OV, Krasnoselskih TV, Malov SV, Kozlov AP: High HIV incidence rate in St. Petersburg IDU cohort. In Proceedings of the 6th IAS conference on HIV pathogenesis, treatment and prevention: 17–20 July 2011. Rome, Italy: TUPE346; 2011.
• [10]Wolfe D: Paradoxes in antiretroviral treatment for injecting drug users: access, adherence and structural barriers in Asia and the former Soviet Union. Int J Drug Policy 2007, 18(4):246-254.
• [11]Krupitsky EM, Zvartau EE, Masalov DV, Tsoi MV, Burakov AM, Egorova VY, Didenko TY, Romanova TN, Ivanova EB, Bespalov AY, Verbitskaya EV, Neznanov NG, Grinenko AY, O'Brien CP, Woody GE: Naltrexone for heroin dependence treatment in St. Petersburg, Russia. J Subst Abuse Treat 2004, 26(4):285-294.
• [12]Amirkhanian YA, Kelly JA, Kuznetsova AV, DiFranceisco WJ, Musatov VB, Pirogov DG: People with HIV in HAART-era Russia: transmission risk behavior prevalence, antiretroviral medication-taking, and psychosocial distress. AIDS Behav 2011, 15(4):767-777.
• [13]WHO Regional Office for Europe: WHO, HIV/AIDS treatment and care for injecting drug users. Copenhagen: Clinical Protocol for the WHO European region; 2006.
• [14]Harrigan PR, Hogg RS, Dong WW, Yip B, Wynhoven B, Woodward J, Brumme CJ, Brumme ZL, Mo T, Alexander CS, Montaner JS: Predictors of HIV Drug-Resistance Mutations in a Large Antiretroviral-Naive Cohort Initiating Triple Antiretroviral Therapy. J Infect Dis 2005, 191:339-347.
• [15]Bouhnik AD, Chesney M, Carrieri P, Gallais H, Moreau J, Moatti JP, Obadia Y, Spire B, MANIF 2000 Study Group: Nonadherence among HIV-infected injecting drug users: the impact of social instability. J Acquir Immune Defic Syndr 2002, 31(Suppl 3):149-153.
• [16]Hinkin CH, Barclay TR, Castellon SA, Levine AJ, Durvasula RS, Marion SD, Myers HF, Longshore D: Drug use and medication adherence among HIV-1 infected individuals. AIDS Behav 2007, 11(2):185-194.
• [17]Nolan S, Milloy M-J, Zhang R, Kerr T, Hogg RS, Montaner JS, Wood E: Adherence and plasma HIV RNA response to antiretroviral therapy among HIV-seropositive injection drug users in a Canadian setting. AIDS Care 2011, 23(8):980-987.
• [18]Hicks PL, Mulvey KP, Chander G, Fleishman JA, Josephs JS, Korthuis PT, Hellinger J, Gaist P, Gebo KA, HIV Research Network: The impact of illicit drug use and substance abuse treatment on adherence to HAART. AIDS Care 2007, 19(9):1134-1140.
• [19]Werb D, Mills EJ, Montaner JS, Wood E: Risk of resistance to highly active antiretroviral therapy among HIV-positive injecting drug users: a meta-analysis. Lancet Infect Dis 2010, 10(7):464-469.
• [20]Hesse M, Vanderplasschen W, Rapp R, Broekaert E, Fridell M: Case management for persons with substance use disorders. Cochrane Database Syst Rev 2007, 4:CD006265.
• [21]Vanderplasschen W, Wolf J, Rapp RC, Broekaert E: Effectiveness of different models of case management for substance-abusing populations. J Psychoactive Drugs 2007, 39(1):81-95.
• [22]Shelton RC, Golin CE, Smith SR, Eng E, Kaplan A: Role of the HIV/AIDS case manager: analysis of a case management adherence training and coordination program in North Carolina. AIDS Patient Care STDS 2006, 20(3):193-204.
• [23]Katz MH, Cunningham WE, Fleishman JA, Andersen RM, Kellogg T, Bozzette SA, Shapiro MF: Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons. Ann Intern Med 2001, 135(8 Pt 1):557-565.
• [24]Gardner LI, Metsch LR, Anderson-Mahoney P, Loughlin AM, del Rio C, Strathdee S, Sansom SL, Siegal HA, Greenberg AE, Holmberg SD, Antiretroviral Treatment and Access Study Study Group: Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS 2005, 19(4):423-431.
• [25]Kushel MB, Colfax G, Ragland K, Heineman A, Palacio H, Bangsberg DR: Case management is associated with improved antiretroviral adherence and CD4+ cell counts in homeless and marginally housed individuals with HIV infection. Clin Infect Dis 2006, 43(2):234-242.
• [26]Malta M, Carneiro-da-Cunha C, Kerrigan D, Strathdee SA, Monteiro M, Bastos FI: Case management of human immunodeficiency virus-infected injection drug users: a case study in Rio de Janeiro, Brazil. Clin Infect Dis 2003, 37(Suppl 5):386-391.
• [27]Cohen R, Lynch S, Bygrave H, Eggers E, Vlahakis N, Hilderbrand K, Knight L, Pillay P, Saranchuk P, Goemaere E, Makakole L, Ford N: Antiretroviral treatment outcomes from a nurse-driven, community-supported HIV/AIDS treatment programme in rural Lesotho: observational cohort assessment at two years. J Int AIDS Soc 2009, 12:23. BioMed Central Full Text
• [28]Marazzi MC, Bartolo M, Emberti Gialloreti L, Germano P, Guidotti G, Liotta G, Magnano San Lio M, Mancinelli S, Modolo MA, Narciso P, Perno CF, Scarcella P, Tintisona G, Palombi L: Improving adherence to highly active anti-retroviral therapy in Africa: the DREAM programme in Mozambique. Health Educ Res 2006, 21(1):34-42.
• [29]Remien RH, Bastos FI, Terto V Jr, Raxach JC, Pinto RM, Parker RG, Berkman A, Hacker MA: Adherence to antiretroviral therapy in a context of universal access, in Rio de Janeiro, Brazil. AIDS Care 2007, 19(6):740-748.
• [30]Siegal HA, Li L, Rapp RC: Case management as a therapeutic enhancement: Impact on post-teatment criminality. J Addict Dis 2002, 21(4):37-46.
• [31]Siegal HA, Rapp RC, Kelliher CW, Fisher JH, Wagner JH, Cole PA: The strengths perspective of case management: A promising inpatient substance abuse treatment enhancement. J Psychoactive Drugs 1995, 27(1):67-72.
• [32]Vaughan-Sarrazin MS, Hall JA, Rick GS: Impact of case management on use of health services by rural clients in substance abuse treatment. J Drug Issues 2000, 30(2):435-463.
• [33]Menezes P, Miller WC, Wohl DA, Adimora AA, Leone PA, Miller WC, Eron JJ Jr: Does HAART efficacy translate to effectiveness? Evidence for a trial effect. PLoS One 2011, 6(7):e21824.
• [34]Krupitsky E, Nunes EV, Ling W, Illeperuma A, Gastfriend DR, Silverman BL: Injectable extended-release naltrexone for opioid dependence: a double-blind, placebo-controlled, multicentre randomised trial. Lancet 2011, 377(9776):1506-1513.
• [35]Zaller N, Gillani FS, Rich JD: A model of integrated primary care for HIV-positive patients with underlying substance use and mental illness. AIDS Care 2007, 19(9):1128-1133.
• [36]Bouis S, Reif S, Whetten K, Scovil J, Murray A, Swartz M: An integrated, multidimensional treatment model for individuals living with HIV, mental illness, and substance abuse. Health Soc Work 2007, 32(4):268-278.
• [37]Smith-Rohrberg D, Mezger J, Walton M, Bruce RD, Altice FL: Impact of enhanced services on virologic outcomes in a directly administered antiretroviral therapy trial for HIV-infected drug users. J Acquir Immune Defic Syndr 2006, 43(Suppl 1):48-53.
• [38]Lum PJ, Tulsky JP: The medical management of opioid dependence in HIV primary care settings. Curr HIV/AIDS Rep 2006, 3(4):195-204.