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Harm Reduction Journal

, 14:38

First Online: 14 June 2017Received: 15 February 2017Accepted: 05 June 2017DOI: 10.1186-s12954-017-0165-y

Cite this article as: Sebastian, M.P., Dasgupta, A., Saraswati, L.R. et al. Harm Reduct J 2017 14: 38. doi:10.1186-s12954-017-0165-y


BackgroundWHO, UNODC, and UNAIDS recommend a comprehensive package for prevention, treatment, and care of HIV among people who inject drugs PWID. We describe the uptake of services and the cost of implementing a comprehensive package for HIV prevention, treatment, and care services in Delhi, India.

MethodsA cohort of 3774 PWID were enrolled for a prospective HIV incidence study and provided the comprehensive package: HIV and hepatitis testing and counseling, hepatitis B HB vaccination, syndromic management of sexually transmitted infections, clean needles-syringes, condoms, abscess care, and education. Supplementary services comprising tea and snacks, bathing facilities, and medical consultations were also provided. PWID were referred to government services for antiretroviral therapy ART, TB care, opioid substitution therapy, and drug dependence treatment-rehabilitation.

ResultsThe project spent USD 1,067,629.88 over 36 months of project implementation: 1.7% on capital costs, 3.9% on participant recruitment, 26.7% for project management, 49.9% on provision of services, and 17.8% on supplementary services. Provision of HIV prevention and care services cost the project USD 140.41-PWID-year. 95.3% PWID were tested for HIV. Of the HIV-positive clients, only 17.8% registered for ART services after repeated follow-up. Reasons for not seeking ART services included not feeling sick, need for multiple visits to the clinic, and long waiting times. 61.8% of the PWID underwent HB testing. Of the 2106 PWID eligible for HB vaccination, 81% initiated the vaccination schedule, but only 29% completed all three doses, despite intensive follow-up by outreach workers. PWID took an average of 8 clean needles-syringes-PWID-year over the project duration, with a mid-project high of 16 needles-syringes-PWID-year. PWID continued to also procure needles from other sources, such as chemists. One hundred five PWID were referred to OST services and 267 for rehabilitation services.

ConclusionsA comprehensive HIV prevention, treatment, and care package is challenging to implement. Extensive efforts are needed to ensure the uptake of and retention in services for PWID; peer educators and outreach workers are required on a continuous basis. Services need to be tailored to client needs, considering clinic timing and distance from hotspots. Programs may consider provision of ART services at selected drop-in centers to increase uptake.

KeywordsHIV PWID Harm reduction Needle-syringe program HIV Hepatitis B Hepatitis C AbbreviationsARTAntiretroviral therapy

AVHIAverting HIV infection

DICDrop-in center

HBVHepatitis B virus

HCVHepatitis C virus

HTCHIV testing and counseling

IECInformation Education and Communication

NACONational AIDS Control Organization

NGONon-governmental organization

ORWsOutreach workers

OSTOpioid substitution therapy

PWIDPeople who inject drugs

STISexually transmitted infections


UNODCUnited Nations Office on Drugs and Crime

WHOWorld Health Organization

Autor: Mary Philip Sebastian - Aparajita Dasgupta - Lopamudra Ray Saraswati - Asha Singh - Vartika Sharma - Ira Madan - Waimar T


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