BACKGROUND: HIV+ people who inject drugs (PWID) experience inadequate access to antiretroviral treatment (ART) and medication-assisted treatment (MAT) and insufficient viral suppression (VS). HPTN 074 demonstrated that an integrated, systems navigation and psychosocial counseling intervention reduced mortality and increased ART and VS over 52 weeks. We present results from an additional 52 weeks of follow-up.
METHODS: HPTN 074 was conducted in Ukraine, Indonesia and Vietnam. Participants were randomly assigned 3:1 to standard-of-care (SOC) versus intervention. Eligibility criteria included: HIV positive; active injection drug use; 18-60 years of age; '¥1 HIV-uninfected injection partner; and viral load '¥1,000 copies/mL. Re-enrollment to extended follow-up was offered to all available participants. Outcome durability in the intervention arm was estimated over weeks 52 to 104 using longitudinal linear-binomial models. During the extension under-treated (off-ART or off-MAT) SOC arm participants were offered the integrated intervention and uptake was assessed.
RESULTS: Overall, 502 HIV+ PWID were enrolled: 85% were men, median age was 35 years (Q1-Q3: 31-38). In the extension, 327 participants re-enrolled (71% of the intervention arm, 63% of the SOC arm). Death, incarceration, and compulsory rehabilitation accounted for 74% (129/175) of those who did not re-enroll. In the intervention arm at weeks 52 to 104, respectively, 72% and 62% were on ART, 41% and 31% were on MAT, and 50% and 39% had VS <1000 copies/mL. From week 52 to 104, probability of ART decreased at an estimated rate of 7.1% (95% CI: -15.2%, +1.1%), MAT decreased 3.6% (-10.9%, +3.7%), and VS decreased 11.2% (-20.0%, -2.3%) per year (Figure). In the under-treated SOC group, only 49% (82/168) started the integrated intervention.

CONCLUSIONS: Over 104 weeks of follow-up, many participants in the intervention arm reported continued ART and MAT. However, the decline in viral suppression suggests a need for maintenance support. Additional programs are needed for under-treated PWID.