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Individual case management for injection drug users on antiretroviral therapy in St. Petersburg, Russia: success without replacement therapy
A. Shaboltas1, R. Skochilov1, Y. Levchenko1, L. Brown2, G. Volkova3, V. Elharrar4, A. Kozlov1, I. Hoffman2
1The Biomedical Center and St.Petersburg State University, St.Petersburg, Russian Federation, 2University of North Carolina, Chapel Hill, United States, 3City AIDS Center, St.Petersburg, Russian Federation, 4NIH, Division of AIDS, Washington DC, United States
Background: The majority of HIV patients needing antiretroviral therapy (ART) in Russia are Injection Drug Users (IDU). There is no drug replacement therapy in Russia. Past data shows that < 10% of IDU stay drug free following drug treatment and only 40% of IDU on ART remain on treatment at 6 months. Our goal was to determine if individual case management (ICM) can be added to the drug abuse and HIV treatment programs among IDU at the St. Petersburg City AIDS Center to improve outcomes.
Methods: IDU starting ART and able to identify a “supporter” who would assist in their treatment plan were enrolled. ICM included opiate detoxification, bi-monthly psychological counseling with urine drug screening, weekly support group sessions, home visits, social services support, and weekly contact with the supporter. Full follow- up was 8 months (FFU).
Results: Between November 2007 and December 2008, 60 IDU starting ART were enrolled. 25 (42%) were female. 52/60 (87%) remained in FFU. Of the 29/60 (48%) drug free at enrollment, 22/29 (76%) remained drug free at FFU; of the 31/60 (52%) injecting drugs at enrollment, 11/31 (35%) were drug free at FFU. Overall, there was a modest 14% reduction in drug use. However, 40/60 (67%) attended all of their monthly ART clinic visits, 12/60 (20%) missed one or more visits but remained on ART, and only 8/60 (13%) stopped ART before the end of the follow-up period. Overall, 36/60 (60%) had a final 6-8 month HIV RNA viral load (VL) < 1000, 8/60 (13%) had a final VL >1000, and 8/60 (13%) have final VL values pending.
Conclusions: Despite no opiate replacement therapy to assist IDU in drug abuse and ART programs, ICM dramatically improved the adherence and retention of IDU on ART in St. Petersburg, Russia compared to historical data prior to ICM initiation.
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