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The HIV care continuum among men who have sex with men in Moscow, Russia: a cross-sectional study of infection awareness and engagement in care
  1. A L Wirtz1,2,
  2. C E Zelaya1,
  3. C Latkin3,
  4. A Peryshkina4,
  5. N Galai5,6,
  6. V Mogilniy4,
  7. P Dzhigun4,
  8. I Kostetskaya4,
  9. S H Mehta5,
  10. C Beyrer1
  1. 1Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Department of Emergency Medicine, Johns Hopkins Medical Institute, Baltimore, Maryland, USA
  3. 3Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4AIDS Infoshare, Moscow, Russian Federation
  5. 5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  6. 6Department of Statistics, University of Haifa, Israel
  1. Correspondence to Dr A L Wirtz, Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 615 N. Wolfe St. Room E7141, Baltimore, MD 21205 USA; awirtz1{at}jhu.edu

Abstract

Objectives Early diagnosis and treatment of HIV infection is critical to improving clinical outcomes for HIV-infected individuals. We sought to characterise the HIV care continuum and identify correlates of being unaware of one's HIV infection among men who have sex with men (MSM) in Moscow, Russia.

Methods Participants (N=1376) were recruited via respondent-driven sampling and completed a sociobehavioural survey and HIV testing from 2010 to 2013. Sample and population estimates were calculated for key steps along the HIV care continuum for HIV-infected MSM and logistic regression methods were used to examine correlates of being unaware of one's HIV infection.

Results 15.6% (184/1177; population estimate: 11.6%; 95% CI 8.5% to 14.7%) of participants were HIV infected. Of these, only 23.4% (43/184; population estimate: 13.2; 95% CI 11.0 to 15.4) were previously aware of their infection, 8.7% (16/184 population estimate: 4.7; 95% CI 1.0 to 8.5) were on antiretroviral therapy (ART), and 4.4% (8/164; population estimate: 3.0; 95% CI 0.3 to 5.6) reported an undetectable viral load. Bisexual identity (reference: homosexual; adjusted odds ratio (AOR): 3.69; 95% CI 1.19 to 11.43), having ≥5 sexual partners in the last 6 months (reference: ≤1; AOR: 4.23; 95% CI 1.17 to 15.28), and employer HIV testing requirements (reference: no; AOR: 15.43; 95% CI 1.62 to 147.01) were associated with being unaware of one's HIV infection. HIV testing in a specialised facility (reference: private; AOR: 0.06; 95% CI 0.01 to 0.53) and testing ≥2 times in the last 12 months (reference: none; AOR: 0.17; 95% CI 0.04 to 0.73) were inversely associated with being unaware of HIV infection.

Conclusions There is a steep gradient along the HIV care continuum for Moscow-based MSM beginning with low awareness of HIV infection. Efforts that improve access to acceptable HIV testing strategies, such as alternative testing facilities, and linkage to care are needed for key populations.

  • HIV
  • DIAGNOSIS
  • ANTIRETROVIRAL THERAPY
  • HOMOSEXUALITY
  • BEHAVIOURAL SCIENCE

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