A strengths-based case management intervention to link HIV-positive people who inject drugs in Russia to HIV care

OBJECTIVE: To determine whether the Linking Infectious and Narcology Care strengths-based case management intervention was more effective than usual care for linking people who inject drugs (PWID) to HIV care and improving HIV outcomes. DESIGN: Two-armed randomized controlled trial. SETTING: Participants recruited from a narcology hospital in St. Petersburg, Russia. PARTICIPANTS: A total of 349 HIV-positive PWID not on antiretroviral therapy (ART). INTERVENTION: Strengths-based case management over 6 months. MAIN OUTCOME MEASURES: Primary outcomes were linkage to HIV care and improved CD4(+) cell count. We performed adjusted logistic and linear regression analyses controlling for past HIV care using the intention-to-treat approach. RESULTS: Participants (N = 349) had the following baseline characteristics: 73% male, 12% any past ART use, and median values of 34.0 years of age and CD4(+) cell count 311 cells/μl. Within 6 months of enrollment 51% of the intervention group and 31% of controls linked to HIV care (adjusted odds ratio 2.34; 95% confidence interval: 1.49–3.67; P < 0.001). Mean CD4(+) cell count at 12 months was 343 and 354 cells/μl in the intervention and control groups, respectively (adjusted ratio of means 1.14; 95% confidence interval: 0.91, 1.42, P = 0.25). CONCLUSION: The Linking Infectious and Narcology Care strengths-based case management intervention was more effective than usual care in linking Russian PWID to HIV care, but did not improve CD4(+) cell count, likely due to low overall ART initiation. Although case management can improve linkage to HIV care, specific approaches to initiate and adhere to ART are needed to improve clinical outcomes (e.g., increased CD4(+) cell count) in this population.