Providing ART to HIV seropositive persons who inject drugs: Implementing “Treatment as Prevention” in New York City

Objective: Receiving anti-retroviral treatment (ART) can improve the health of HIV positive persons and reduce the likelihood that they will transmit to others (treatment as prevention, TasP).  Persons who use drugs, however, face many obstacles in linking to HIV care, receiving and ART and achieving viral suppression.  We examined progress in placing HIV seropositive persons who inject drugs (PWID) onto antiretroviral treatment (ART) in New York City over the last 15 years.

Methods: We recruited 3511 PWID from persons voluntarily entering drug detoxification and methadone maintenance treatment programs in New York City from 2001 to 2014. Informed consent was obtained, a structured interview was administered and HIV counseling and testing conducted.  Questions included whether the participant had previously tested positive for HIV, and whether the participant had received ART medication in the previous 6 months.  Department of Health surveillance data were utilized to estimate the percentage of PWID on ART who were at viral suppression. 

Results: Heroin (injected) was the primary drug used. HIV prevalence declined significantly from14% in 2001 to 6% in 2012-2014.  The percentage of self-reported HIV seropositive PWID receiving ART increased significantly, from 50% in 2001-2005 to 75% in 2012-2014.  75% of PWID on ART were at viral suppression in surveillance data, indicating that half or more of current HIV positive PWID in the city are at viral suppression.    

Conclusions: Continued improvement in ART/TasP and maintenance of other prevention and care services should lead to an “End of the AIDS Epidemic” for PWID in the city.