Linking HIV-infected patients to HIV

Researchers from the Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) were recently awarded a $3.5 million grant from the National Institute on Drug Abuse (NIDA), to improve upon the ""seek, test, treat, and retain"" paradigm in Eastern Europe among HIV-infected Russian and Eastern European injection drug users (IDUs) in narcology (addiction) care. The project will be known as LINC, Linking Infectious and Narcology Care. Russia and Eastern Europe have one of the fastest growing HIV epidemics in the world, with transmission risk primarily from injection drug use. Russia, Ukraine and other countries in the region have implemented routine HIV testing within established addiction treatment systems (narcology hospitals). The narcology system of care, however, works largely independent of other medical care systems and hence has not adopted strategies to link HIV-infected patients to HIV care. The research will be conducted under the direction of Jeffrey H. Samet, MD, a professor of medicine and community health sciences at BUSM and BU School of Public Health and chief of the Section of General Internal Medicine at BMC. Samet was recently selected as a NIDA International Program 2011 Awards of Excellence winner. According to the researchers, the narcology system of care works largely independent of other medical care systems and hence has not adopted strategies to link HIV-infected patients to HIV care. As in the United States in the 1990s, delayed or non-receipt of HIV medical care, particularly among IDUs, is common in Russia. According to Samet, the principal investigator of the study, this is a missed opportunity since up to 45 percent of Russian IDUs in narcology treatment are HIV infected, yet as few as 20 percent of those infected are in care. "The objective of this study is to implement and assess a behavioral and structural intervention in Russia designed to support and motivate HIV-infected heroin dependent narcology patients to engage in HIV medical care and ultimately improve their HIV outcomes,"" said Samet. LINC is a clinical model designed to coordinate narcology and HIV systems of care using an intervention inclusive of staff from both systems and composed of elements shown to facilitate engagement in medical care: HIV case management and nurse home visits. The central hypothesis is that an intervention that involves coordination between the narcology and HIV systems will lead to increased engagement in HIV medical care. "Coordination will involve HIV case management delivered by a peer to help motivate and reduce barriers to HIV care engagement and enhanced outpatient narcology treatment delivered by an addiction nurse with communication between these providers,"" added Samet. The project will be undertaken by an international research team experienced in addressing HIV, substance use, and clinical interventions in Russia.