The AVHI Project: A Peer-driven Approach to Providing Injecting Drug Users with HIV Prevention Services in New Delhi, India
Council researchers aim to avert HIV infections among injecting drugs users (IDUs) and their sexual and injecting partners in Delhi and increase the coverage and uptake of HIV prevention services, including counseling and testing, through an innovative, peer-driven strategy that recruits and enrolls IDUs into a comprehensive HIV prevention program.
India has one of the largest injecting drug user (IDU) populations in the world, estimated at 1.1 million nationally and 35,000 in Delhi alone. Injection practices such as needle sharing, drawing up drugs from a common container, and low use of bleach to clean needles and equipment fuel the HIV epidemic among IDUs and their partners. Because HIV is efficiently transmitted through these injection practices, HIV seroprevalence among IDUs is high.
In addition to injection risk, IDUs engage in high-risk sexual behaviors, which play a significant role in HIV transmission, including transmission to noninjecting sexual partners.
To date, risk-reduction efforts in India targeted at IDUs have primarily focused on reducing injection-related risks, with less emphasis on sexual risk reduction. Also, IDUs are a hard-to-reach population because of their highly stigmatized behaviors. The Averting HIV Infections Among IDUs (AVHI) project, implemented by the Sahara Centre for Residential Care and Rehabilitation with oversight from the Population Council, will address the injecting and sexual behaviors of IDUs. The goal of the AVHI project is to avert HIV infections among IDUs and their sexual and injecting partners in Delhi by increasing the uptake of HIV counseling and testing (HCT) and increasing HIV prevention and harm reduction service coverage. AVHI will use an innovative, peer-driven strategy to recruit and enroll IDUs into a comprehensive HIV prevention program that includes targeted interventions that have demonstrated success in reducing sexual and injection risk practices among IDUs.
Program activities will include:
- Delivering a comprehensive package of HIV prevention services. Services include HCT; needle and syringe exchange; targeted information, education, and communication materials; condoms for IDUs and their partners; and syndromic management of STIs. Additional services beyond those specified as standard of care for HIV prevention include inpatient care, onsite abscess care, nutrition/hygiene services, and hepatitis B testing and vaccination. In addition, AVHI will foster connections with public-sector health centers and other licensed nongovernmental organizations that provide services (e.g., opioid substitution therapy with buprenorphine).
- Peer-driven recruitment. AVHI will use peer-driven recruitment to enhance the coverage of the project and reach out to the IDU population with HCT and other prevention services.
- Expanding outreach and formalizing peer support to deliver HIV prevention services. AHVI will use a two-tiered system led by experienced and trained outreach workers to continuously monitor and deliver HIV prevention services to IDUs. Outreach workers will regularly visit IDU hotspots to provide risk-reduction information, condoms, and referrals for health services, including HIV testing. In addition, a cadre of peer supporters, managed by outreach workers, will be trained to deliver HIV prevention messages and commodities to peers of IDUs.
AVHI is part of Arise—Enhancing HIV Prevention Programs for At-Risk Populations, which implements innovative HIV prevention initiatives for vulnerable communities, with a focus on determining cost-effectiveness through rigorous evaluations. Financial support is provided by the Canadian government through the Canadian International Development Agency, and via financial and technical support provided by PATH.
The Population Council is evaluating the effectiveness of AVHI through a longitudinal prospective cohort study. Researchers will enroll and follow a cohort of IDUs participating in the AVHI project over 18 months (six months prior to service roll out and 12 months with scaled-up services). HIV incidence will be measured among HIV-negative participants from baseline. A behavioral survey will be conducted among the entire cohort (positive, negative, untested) at three study visits. STI testing will examine STI incidence. Through a combination of peer referral and outreach, AVHI aims to reach 5,000 IDUs and anticipates that around 4,500 IDUS (90%) will be eligible for and will agree to enroll in the cohort study at baseline.Program adherence will be assessed quantitatively and qualitatively from IDUs who successfully access AVHI services and those who do not. Spouses or regular partners of male IDUs will also be recruited for a small, qualitative, nested substudy to explore contextual and psychosocial determinants of sexual risk behaviors, barriers to condom use, health-seeking behaviors, health service needs, and preferences for health care. This substudy will help formulate culturally appropriate individual-, couple-, and group-level interventions that address the barriers to consistent condom use with regular/primary partners.
High HIV incidence among male injection drug users in Delhi, India (PDF)
Tun,Waimar; Saraswati,Lopamudra; Sebastian,Mary Philip; Sharma,Vartika; Yadav,Amita; Madan,Ira; Thior,Ibou; Sarna,Avina
Publication date: 2013
High uptake of HIV testing in a cohort of male injection drug users in Delhi, India: Prevalence and correlates of HIV infection (abstract) (HTML)
Sarna,Avina; Tun,Waimar; Sharma,Vartika; Sebastian,Mary Philip; Madan,Ira; Yadav,Amita; Sheehy,Meredith; Lewis,Dean; Thior,Ibou
AIDS and Behavior 17(7): 2479-2489
Publication date: 2013
Prevalence of HIV, hepatitis B and C, and co-infection in a cohort of male injection drug users in Delhi (PDF)
Saraswati,Lopamudra; Sebastian,Mary Philip; Sarna,Avina; Sharma,Vartika; Madan,Ira; Lewis,Dean; Thior,Ibou; Tun,Waimar
Publication date: 2013
Strategies for recruiting injection drug users for HIV prevention services in Delhi, India (abstract) (HTML)
Tun,Waimar; Sebastian,Mary Philip; Sharma,Vartika; Madan,Ira; Souidi,Samir; Lewis,Dean; Thior,Ibou; Sarna,Avina
Harm Reduction Journal 10: 16-
Publication date: 2013
Prevalence and correlates of HIV infection in a cohort of male injection drug users in Delhi (PDF)
Tun,Waimar; Sharma,Vartika; Sebastian,Mary Philip; Madan,Ira; Yadav,Amita; Sheehy,Meredith; Lewis,Dean; Thior,Ibou; Sarna,Avina
Publication date: 2012
Location: India (New Delhi)
HIV and AIDS
Duration: 6/2010 - 2/2013
Financial support provided by the Canadian Government through the Canadian International Development Agency, and via financial and technical support provided by PATH