Around 16% of HIV infections in the United States are among persons who inject drugs (PWID). PWID have a higher mortality than other persons living with HIV due to delayed diagnosis, lower use of antiretroviral therapy (ART), and other factors. Understanding the specific barriers to virologic suppression, however, is challenging as PWID are less likely to engage in care. Here we present trends in HIV care indicators for PWID in San Francisco from 2009-2015, using a novel system of behavioral health surveys. These data will inform international and local initiatives for population-level HIV control, such as San Franciscos Getting to Zero initiative and UNAIDSs 90-90-90 targets.
We used data from serial cross-sectional surveys of PWID conducted in 2009, 2012, and 2015 as part of the CDC-led National HIV Behavioral Surveillance system. PWID were recruited using respondent-driven sampling, in which PWID refer their peers to the surveys. We tracked the number of PWID who were: 1) living with HIV, 2) knew their HIV status, 3) were on ART, and 4) for 2015 only, were virally suppressed (self-reported).
HIV prevalence among PWID was 11.4% in 2009, 12.0% in 2012, and 16.8% in 2015. The percentage of PWID living with HIV who knew their HIV+ diagnosis remained stable (57.8% in 2009; 57.3% in 2012) before increasing to 83.3% in 2015. Among PWID who knew their HIV status, the proportion reporting they were currently taking ART declined from 73.8% in 2009 to 66.3% in 2012 to 64.1% in 2015. In 2015, the only year the question was asked, 87.2% of HIV+ PWID reported that their most recent viral load was suppressed.
We successfully tracked trends in engagement in HIV care among PWID from 2009 to 2015. Our data are notable for an apparent improvement in HIV diagnosis over time, a persistent gap in treatment with ART, andin 2015a relatively high rate of self-reported viral suppression when on ART. All three measures fall short of the UNAIDS 90-90-90 goals. The decline in getting PWID on ART from 2009-2015 is particularly concerning and warrants additional linkage to care and retention efforts. This is especially important given the high rates of viral suppression PWID can achieve once on ART, as seen in our study and other reports from published literature.
T. Reza, None
D. Sears, None
W. McFarland, None
H. F. Raymond, None