Yale University

Test and Linkage to Care (TLC-IDU) Kenya

Principle Investigator(s):

Funder: National Institute on Drug Abuse
Project period: 01/01/2016 - 04/30/2017
Grant Type: Research
Further Detail

Abstract Text:

HIV infections in sub-Saharan Africa increasingly occur among injecting drug users (IDUs), a most-at-risk population (MARP). Evidence-based services for IDUs such as needle and syringe exchange programs (NSPs), opioid substitution therapy (OST), and IDU-specific antiretroviral therapy (ART) adherence support have been non-existent in this region. Kenya is conducting size estimations of IDUs and is preparing to launch first-ever NSPs. Our team of Kenyan policy leaders, addiction/behavioral scientists and modelers will leverage Kenya's new MARPs/NSP platform to seek out IDUs, deliver rapid HIV testing, point of care CD4 count and link to ART, and evaluate community viral load in Nairobi and coastal Mombasa, where most IDUs in Kenya reside. Aim 1: Evaluate seek test treat retain - 'Testing & Linkage to Care for IDUs' (TLC-IDU Kenya) - using a stepped wedge cluster-randomized design. Clusters will be the planned n=20 MARP service sites and n=5 NSPs. We will initiate respondent-driven sampling (RDS) to reach IDUs in Nairobi and Mombasa for baseline HIV-1 prevalence determination, and then collect seven waves of study data as service sites roll out, including behavioral data on PDAs. Teams will do rapid HIV testing and refer for addiction/mental health and OST. HIV-positives will receive prevention with positives (PwP) counseling and point of care CD4 counts. Those with CD4 <350/