Global systematic review and ecological analysis of HIV in people who inject drugs: National population sizes and factors associated with HIV prevalence

Sarah Larney; Janni Leung; Jason Grebely; Matthew Hickman; Peter Vickerman; Amy Peacock; Jack Stone; Adam Trickey; Kostyantyn V. Dumchev; Samantha Colledge; Evan B. Cunningham; Michael Lynskey; Richard P. Mattick; Louisa Degenhardt

doi:10.1016/j.drugpo.2019.102656

Global systematic review and ecological analysis of HIV in people who inject drugs: National population sizes and factors associated with HIV prevalence

Sarah Larney^*, Janni Leung, Jason Grebely, Matthew Hickman, Peter Vickerman, Amy Peacock, Jack Stone, Adam Trickey, Kostyantyn V. Dumchev, Samantha Colledge, Evan B. Cunningham, Michael Lynskey, Richard P. Mattick, Louisa Degenhardt

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

21 Citations (Scopus)

Abstract

Background: People who inject drugs (PWID) are at elevated risk of HIV infection. Data on population sizes of PWID living with HIV are needed to inform the implementation of prevention, treatment and care programs. We estimated national population sizes of people who recently (past 12 months) injected drugs living with HIV and evaluated ecological associations with HIV prevalence in PWID. Methods: We used national data on the prevalence of injecting drug use and of HIV among PWID, derived from systematic reviews, to estimate national population sizes of PWID living with HIV. Uncertainty was estimated using Monte Carlo simulation with 100,000 draws. We extracted data on sample characteristics from studies of HIV prevalence among PWID, and identified national indicators that have been observed or hypothesised to be associated with HIV prevalence in PWID. We used linear regression to evaluate associations between these variables and HIV prevalence in PWID. Results: Four countries comprised 55% of the estimated global population of PWID living with HIV: Russia (572,500; 95% uncertainty interval (UI) 235,500–1,036,500); Brazil (462,000; 95% UI 283,500–674,500); China (316,500; 95% UI 171,500–493,500), and the United States (195,500; 95% UI 80,000–343,000). Greater anti-HCV prevalence and national income inequality were associated with greater HIV prevalence in PWID. Conclusion: The countries with the largest populations of PWID living with HIV will need to dramatically scale up prevention, treatment and care interventions to prevent further increases in population size. The association between anti-HCV prevalence and HIV prevalence among PWID corroborates findings that settings with increasing HCV should implement effective interventions to prevent HIV outbreaks. The association between income inequality and HIV among PWID reinforces the need to implement structural interventions alongside targeted individual-level strategies.

Original language	English
Article number	102656
Journal	International Journal of Drug Policy
Volume	77
Early online date	14 Jan 2020
DOIs	https://doi.org/10.1016/j.drugpo.2019.102656
Publication status	Published - 1 Mar 2020

Keywords

Hepatitis C virus
HIV
Income inequality
People who inject drugs
Population size

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.drugpo.2019.102656

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Larney, S., Leung, J., Grebely, J., Hickman, M., Vickerman, P., Peacock, A., Stone, J., Trickey, A., Dumchev, K. V., Colledge, S., Cunningham, E. B., Lynskey, M., Mattick, R. P., & Degenhardt, L. (2020). Global systematic review and ecological analysis of HIV in people who inject drugs: National population sizes and factors associated with HIV prevalence. International Journal of Drug Policy, 77, Article 102656. https://doi.org/10.1016/j.drugpo.2019.102656

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title = "Global systematic review and ecological analysis of HIV in people who inject drugs: National population sizes and factors associated with HIV prevalence",

abstract = "Background: People who inject drugs (PWID) are at elevated risk of HIV infection. Data on population sizes of PWID living with HIV are needed to inform the implementation of prevention, treatment and care programs. We estimated national population sizes of people who recently (past 12 months) injected drugs living with HIV and evaluated ecological associations with HIV prevalence in PWID. Methods: We used national data on the prevalence of injecting drug use and of HIV among PWID, derived from systematic reviews, to estimate national population sizes of PWID living with HIV. Uncertainty was estimated using Monte Carlo simulation with 100,000 draws. We extracted data on sample characteristics from studies of HIV prevalence among PWID, and identified national indicators that have been observed or hypothesised to be associated with HIV prevalence in PWID. We used linear regression to evaluate associations between these variables and HIV prevalence in PWID. Results: Four countries comprised 55% of the estimated global population of PWID living with HIV: Russia (572,500; 95% uncertainty interval (UI) 235,500–1,036,500); Brazil (462,000; 95% UI 283,500–674,500); China (316,500; 95% UI 171,500–493,500), and the United States (195,500; 95% UI 80,000–343,000). Greater anti-HCV prevalence and national income inequality were associated with greater HIV prevalence in PWID. Conclusion: The countries with the largest populations of PWID living with HIV will need to dramatically scale up prevention, treatment and care interventions to prevent further increases in population size. The association between anti-HCV prevalence and HIV prevalence among PWID corroborates findings that settings with increasing HCV should implement effective interventions to prevent HIV outbreaks. The association between income inequality and HIV among PWID reinforces the need to implement structural interventions alongside targeted individual-level strategies.",

keywords = "Hepatitis C virus, HIV, Income inequality, People who inject drugs, Population size",

author = "Sarah Larney and Janni Leung and Jason Grebely and Matthew Hickman and Peter Vickerman and Amy Peacock and Jack Stone and Adam Trickey and Dumchev, {Kostyantyn V.} and Samantha Colledge and Cunningham, {Evan B.} and Michael Lynskey and Mattick, {Richard P.} and Louisa Degenhardt",

year = "2020",

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doi = "10.1016/j.drugpo.2019.102656",

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Larney, S, Leung, J, Grebely, J, Hickman, M, Vickerman, P, Peacock, A, Stone, J, Trickey, A, Dumchev, KV, Colledge, S, Cunningham, EB, Lynskey, M, Mattick, RP & Degenhardt, L 2020, 'Global systematic review and ecological analysis of HIV in people who inject drugs: National population sizes and factors associated with HIV prevalence', International Journal of Drug Policy, vol. 77, 102656. https://doi.org/10.1016/j.drugpo.2019.102656

TY - JOUR

T1 - Global systematic review and ecological analysis of HIV in people who inject drugs

T2 - National population sizes and factors associated with HIV prevalence

AU - Larney, Sarah

AU - Leung, Janni

AU - Grebely, Jason

AU - Hickman, Matthew

AU - Vickerman, Peter

AU - Peacock, Amy

AU - Stone, Jack

AU - Trickey, Adam

AU - Dumchev, Kostyantyn V.

AU - Colledge, Samantha

AU - Cunningham, Evan B.

AU - Lynskey, Michael

AU - Mattick, Richard P.

AU - Degenhardt, Louisa

PY - 2020/3/1

Y1 - 2020/3/1

N2 - Background: People who inject drugs (PWID) are at elevated risk of HIV infection. Data on population sizes of PWID living with HIV are needed to inform the implementation of prevention, treatment and care programs. We estimated national population sizes of people who recently (past 12 months) injected drugs living with HIV and evaluated ecological associations with HIV prevalence in PWID. Methods: We used national data on the prevalence of injecting drug use and of HIV among PWID, derived from systematic reviews, to estimate national population sizes of PWID living with HIV. Uncertainty was estimated using Monte Carlo simulation with 100,000 draws. We extracted data on sample characteristics from studies of HIV prevalence among PWID, and identified national indicators that have been observed or hypothesised to be associated with HIV prevalence in PWID. We used linear regression to evaluate associations between these variables and HIV prevalence in PWID. Results: Four countries comprised 55% of the estimated global population of PWID living with HIV: Russia (572,500; 95% uncertainty interval (UI) 235,500–1,036,500); Brazil (462,000; 95% UI 283,500–674,500); China (316,500; 95% UI 171,500–493,500), and the United States (195,500; 95% UI 80,000–343,000). Greater anti-HCV prevalence and national income inequality were associated with greater HIV prevalence in PWID. Conclusion: The countries with the largest populations of PWID living with HIV will need to dramatically scale up prevention, treatment and care interventions to prevent further increases in population size. The association between anti-HCV prevalence and HIV prevalence among PWID corroborates findings that settings with increasing HCV should implement effective interventions to prevent HIV outbreaks. The association between income inequality and HIV among PWID reinforces the need to implement structural interventions alongside targeted individual-level strategies.

AB - Background: People who inject drugs (PWID) are at elevated risk of HIV infection. Data on population sizes of PWID living with HIV are needed to inform the implementation of prevention, treatment and care programs. We estimated national population sizes of people who recently (past 12 months) injected drugs living with HIV and evaluated ecological associations with HIV prevalence in PWID. Methods: We used national data on the prevalence of injecting drug use and of HIV among PWID, derived from systematic reviews, to estimate national population sizes of PWID living with HIV. Uncertainty was estimated using Monte Carlo simulation with 100,000 draws. We extracted data on sample characteristics from studies of HIV prevalence among PWID, and identified national indicators that have been observed or hypothesised to be associated with HIV prevalence in PWID. We used linear regression to evaluate associations between these variables and HIV prevalence in PWID. Results: Four countries comprised 55% of the estimated global population of PWID living with HIV: Russia (572,500; 95% uncertainty interval (UI) 235,500–1,036,500); Brazil (462,000; 95% UI 283,500–674,500); China (316,500; 95% UI 171,500–493,500), and the United States (195,500; 95% UI 80,000–343,000). Greater anti-HCV prevalence and national income inequality were associated with greater HIV prevalence in PWID. Conclusion: The countries with the largest populations of PWID living with HIV will need to dramatically scale up prevention, treatment and care interventions to prevent further increases in population size. The association between anti-HCV prevalence and HIV prevalence among PWID corroborates findings that settings with increasing HCV should implement effective interventions to prevent HIV outbreaks. The association between income inequality and HIV among PWID reinforces the need to implement structural interventions alongside targeted individual-level strategies.

KW - Hepatitis C virus

KW - HIV

KW - Income inequality

KW - People who inject drugs

KW - Population size

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DO - 10.1016/j.drugpo.2019.102656

M3 - Article

AN - SCOPUS:85077739029

SN - 0955-3959

VL - 77

JO - International Journal of Drug Policy

JF - International Journal of Drug Policy

M1 - 102656

ER -

Global systematic review and ecological analysis of HIV in people who inject drugs: National population sizes and factors associated with HIV prevalence

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