Do Injection Drug Networks Inform HIV Prevention Service Utilization among People Who Inject Drugs in India? Exploring the Roles of Network Size, Position & Peer Behaviors

Background: India has one of the largest populations of people who inject drugs (PWID), and injection drug use continues to drive new HIV infections. Despite availability of efficacious HIV-prevention services—HIV testing, medication for opioid use disorder (MOUD), and syringe services—evidence suggests that service uptake is suboptimal. While HIV prevention strategies for PWID traditionally have focused on individual-level risk, injection drug use occurs in the context of injection drug networks. This dissertation aims to characterize the role of injection drug networks (network size, position, and peer behaviors) on the HIV prevention behaviors of PWID in India. Methods: First, we utilized data from over 5,278 HIV-negative and HIV-positive yet undiagnosed PWID collected via respondent driven sampling across eight Indian sites (2016/17), to examine the association between self-reported injection network size in the prior 30 days—(a) number of network peers seen and (b) number of injection partners—and uptake of HIV testing, MOUD and syringe services. We additionally ascertained longitudinal uptake services through biometrically matching participants to programmatic clinic-based data. Second, we used baseline data from a longitudinal sociometric injection drug network of 2,512 PWID in New Delhi, India, enumerated via biometric linkage (2017-2020). We classified PWID network position as central vs. peripheral and assessed HIV testing, MOUD, and syringe service utilization as a function of network position. Ensuing analyses attempted to identify biologic, behavioral, and demographic predictors of network centrality. Finally, the sociometric data were used to evaluate PWID engagement in HIV prevention services as a function of service engagement, HIV/HCV status, or injection drug use behaviors of direct injection partners and socially proximal injection peers (≤3 links from each participant). Results: PWID engagement in HIV prevention services was low across all settings. In the multi-city analysis, we observed increased engagement in HIV testing, MOUD, and syringe services among PWID who reported knowing and seeing more network peers. Contrastingly, we found decreased HIV testing and MOUD engagement, yet increased syringe service utilization, among PWID with more injection partners. In the New Delhi sociometric cohort, using betweenness centrality to parameterize central vs. peripheral network position, baseline data indicated that central PWID exhibited increased HIV prevention service engagement, yet reported riskier injection practices. Although findings were consistent across multiple definitions of centrality, we were unable to accurately predict central vs. peripheral network position with available individual-level demographic and behavioral data. Finally, we found strong associative relationships between individual HIV prevention service utilization and the health or risk-taking behaviors of direct and socially proximal injection peers. Conclusions: To date, HIV prevention strategies for PWID in India have focused on maximizing access and utilization of HIV testing and harm reduction services for the individual. These data suggest that injection drug network size, position, and peer behaviors are important components of individual-level HIV prevention service utilization. Findings of this dissertation point to the possibility of leveraging structural and interpersonal relationships among PWID drug networks to promote HIV prevention behaviors in this vulnerable population

Do Injection Drug Networks Inform HIV Prevention Service Utilization among People Who Inject Drugs in India? Exploring the Roles of Network Size, Position & Peer Behaviors

Background: India has one of the largest populations of people who inject drugs (PWID), and injection drug use continues to drive new HIV infections. Despite availability of efficacious HIV-prevention services—HIV testing, medication for opioid use disorder (MOUD), and syringe services—evidence suggests that service uptake is suboptimal. While HIV prevention strategies for PWID traditionally have focused on individual-level risk, injection drug use occurs in the context of injection drug networks. This dissertation aims to characterize the role of injection drug networks (network size, position, and peer behaviors) on the HIV prevention behaviors of PWID in India. Methods: First, we utilized data from over 5,278 HIV-negative and HIV-positive yet undiagnosed PWID collected via respondent driven sampling across eight Indian sites (2016/17), to examine the association between self-reported injection network size in the prior 30 days—(a) number of network peers seen and (b) number of injection partners—and uptake of HIV testing, MOUD and syringe services. We additionally ascertained longitudinal uptake services through biometrically matching participants to programmatic clinic-based data. Second, we used baseline data from a longitudinal sociometric injection drug network of 2,512 PWID in New Delhi, India, enumerated via biometric linkage (2017-2020). We classified PWID network position as central vs. peripheral and assessed HIV testing, MOUD, and syringe service utilization as a function of network position. Ensuing analyses attempted to identify biologic, behavioral, and demographic predictors of network centrality. Finally, the sociometric data were used to evaluate PWID engagement in HIV prevention services as a function of service engagement, HIV/HCV status, or injection drug use behaviors of direct injection partners and socially proximal injection peers (≤3 links from each participant). Results: PWID engagement in HIV prevention services was low across all settings. In the multi-city analysis, we observed increased engagement in HIV testing, MOUD, and syringe services among PWID who reported knowing and seeing more network peers. Contrastingly, we found decreased HIV testing and MOUD engagement, yet increased syringe service utilization, among PWID with more injection partners. In the New Delhi sociometric cohort, using betweenness centrality to parameterize central vs. peripheral network position, baseline data indicated that central PWID exhibited increased HIV prevention service engagement, yet reported riskier injection practices. Although findings were consistent across multiple definitions of centrality, we were unable to accurately predict central vs. peripheral network position with available individual-level demographic and behavioral data. Finally, we found strong associative relationships between individual HIV prevention service utilization and the health or risk-taking behaviors of direct and socially proximal injection peers. Conclusions: To date, HIV prevention strategies for PWID in India have focused on maximizing access and utilization of HIV testing and harm reduction services for the individual. These data suggest that injection drug network size, position, and peer behaviors are important components of individual-level HIV prevention service utilization. Findings of this dissertation point to the possibility of leveraging structural and interpersonal relationships among PWID drug networks to promote HIV prevention behaviors in this vulnerable population

Demographic dividend-favorable policy environment in two pre-dividend African nations: review of national policies and prospects for policy amendments in Nigeria and Tanzania.

BackgroundIn collaboration with local partners, we reviewed 18 national policy documents across two sub-Saharan African countries identified as pre-dividend nations by the World Bank in 2017: Nigeria and Tanzania. Our aim was to assess national policies in pre-dividend countries and to determine whether national strategies were primed to capitalize on changing demographic structures, maximally attain the demographic dividend, and augment socio-economic growth.MethodsWe conducted policy reviews by focusing on five key sectors of the Gates Institute Demographic Dividend Framework: Family Planning, Maternal and Child Health, Education, Women's Empowerment, and Labor Market. This framework was developed as a tool for countries to apply targeted policies for accelerating the demographic dividend based on their demographic structure. For each component we used a comprehensive list of indicators, defined via a systematic literature review, through which we assessed national policies aimed at maximizing the demographic dividend.ResultsBetween the two countries, we observed persistent gaps in policies targeting family planning. Although more comprehensive, policies addressing maternal and child health, education, women's empowerment, and labor market still lagged in their specificity and measurability. We identified specific policy amendments and alternatives that Nigeria and Tanzania could consider to mitigate these gaps. We also stress the importance of designing measurable policy initiatives across sectors.ConclusionsBased on these recommendations, as Nigeria, Tanzania, and other pre-dividend nations start experiencing rapid demographic changes, they may consider implementing routine policy reviews to strengthen policies across the five key sectors and harness the benefits of a demographic dividend

Additional file 1 of Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil

Supplementary Material

Metadata record for: HIT-COVID, a global database tracking public health interventions to COVID-19

This dataset contains key characteristics about the data described in the Data Descriptor HIT-COVID, a global database tracking public health interventions to COVID-19. Contents: 1. human readable metadata summary table in CSV format 2. machine readable metadata file in JSON forma