Table 1 Sociodemographic, injecting and sexual risk factors associated with HIV positivity among PWID
From: HIV among people who inject drugs in India: a systematic review
Author/Year | Geographical Region | Sample/Age | Sampling Strategy | Study design | Population characteristics | Number of HIV + PWID | Sociodemographic factors | Injecting risk factors | Sexual risk factors | Study Strengths | Study Limitations | Quality Assessment score |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Ganesh et al. (2020) [19] | Manipur | n = 1594 Aged 15 years and above | Two stage cluster sampling | Community-based, bio-behavioural surveillance | Men who inject drugs in the past 3 months of data collection | Male- 193 | Labourers/manual workers, older age > 39 years, did not go to school, living alone or with friends | Injecting at their own house, sharing of needle/syringe, repeated use of needle/syringe, drawing up from same container, longer duration of injecting practices | Having multiple sexual partners | The study gave evidence on important factors associated with HIV transmission among HIV positive PWID | The study did not include female PWID | 9 |
Kumar et al. (2018) [20] | India | n = 19,902, Aged 15 years and above | Conventional cluster sampling | Probability- based, cross-sectional study | Men who inject drugs in the past 3 months of data collection | Male- 1631 | Older age (> 25 years), marital status (never married), Occupation (non labourers) |  < 24 years of age at initiation of injecting drug use, duration of drug use (five years and above), frequency of injecting (twice/day), type of drugs (buprenorphine, heroin), injected in groups during last injection | Inconsistent condom use, reported STI symptom | The study could be generalizable to the India population due to large sample size used across 29 states in India.-To determine HIV status two test protocols were used -Information were collected by trained personnel who used standardized questionnaire to ensure consistency across all Indian States and territories | Due to the nature of the study there could have been measurement bias on leading to an overestimation or underestimation of factors -No female participants | 7 |
Cepeda et al. (2017) [21] | 15 cities in India | n = 14,373 Aged 18 years above | Respondent Driven Sampling (RDS) | Cross-sectional study | People who inject drugs | 2915 | Not given | Passing a used needle/syringe to more than 3 individuals in the past 30 days | - | The large sample size and low loss to follow up rate confers greater statistical power | Sociometric data were not obtained and because of this homophily was low (between -0.2 and 0.2) for most sites -Generalisability was limited because random sample of underlying population could not be obtained -sexual risk factors were not obtained | 8 |
McFall et al. (2017) [22] | 7 cities in Northeast India | n = 796 Aged 18 years above | RDS | Cross-sectional study | Injecting in the previous 2 years of data collection | Female- 368 | Older age, widowed, having children, having attended secondary school | Injection of buprenorphine, longer duration of injecting use, less frequency of injection | Higher number of sexual partners | -All female participants as there are few studies that look at female PWID | -Establishment of temporality or causality is not possible due to the cross-sectional nature of the study -Sample or estimates are not representative of the underlying population |  |
Lucas et al. (2015) [23] | India- 15 Indian cities | n = 14,481 Aged 18 years and above | RDS | Cross-sectional study | Reported injecting drug use in the prior 2 years of data collection | 2905 | Female gender, marital status (currently married or living with a partner), age | Initiation of early injection, type of drugs injected (buprenorphine and heroin), sharing of needle/syringe | Number of lifetime sex partner, exchange of sex for money or goods, being female | RDS was used- a strategy that is suited for ‘hidden’ populations and permits weighing to produce unbiased estimates of factors of interest in the target population -Use of state-of-the-art methods to characterize recent HIV infection across sites permitting HIV incidence estimates | Sites and samples were not selected randomly and so this data cannot be considered a nationally representative. Detailed network-level risk data were not collected | 8 |
Armstrong et al. (2014) [14] | Manipur, India | n = 821 PWID Aged 18 years above | RDS | Cross-sectional study | Long-term heroin injectors | M- 252 | Older age(> 25 years), currently married | Sharing of needles, longer duration of injection practice, higher frequency of injection | Did not use condoms at last sex with casual or regular partners, irregular condom use | Adequate sample size. The study gave evidence on important factors associated with HIV transmission among HIV positive PWID | -Female PWID were not included -Low uptake of HIV testing. However, this data was collected in 2009 and anecdotal evidence suggests that uptake of HIV testing is likely to be higher now | 7 |
Mehta et al. (2014) [24] | 14 sites across India | n = 801 Aged 18 years and above | Simple random sampling from 14 locations in India by NGO that worked with PWID | Cross-sectional study | HIV positive PWID in the prior 2 years of data collection | Male- 689 Female- 112 | Older age(> 30 years), gender (male), married, educational level, unemployment, low monthly wages | Injecting heroin and buprenorphine, needle and syringe sharing, daily injection practices | Men having sex with men, sex with a casual partner, any sexual intercourse | Pre-tested, pre-validated questionnaire was used -Data were collected by trained personnel | Small sample size in each site -Detailed information on sexual and injection related risk behaviour were not collected -Low female representation as most female PWID are confined to the Northeastern region | 7 |
Panda et al. (2014) [25] | Punjab | n = 1155 Aged 18 years and above | Sample collected from Integrated Counselling and Testing centre (ICTC) | Community- based cohort study | injected drugs within the last 3 months of data collection | M- 338 | Older age, gender (male), married, educational level, unemployment, low monthly wages | Length of time of injection, irregular supply of syringes and needles, sharing of syringe and needle | Having genital disease symptom within the last year | Wide community based study | Inability to recruit those who are no in contact with Targeted intervention services which may present a biased picture | 8 |
Sarna et al. (2013) [26] | Delhi and neighbouring states | n = 3792 Aged 18 years and above | Samples were recruited through Peer referral, targeted outreach and walk-in clients | Longitudinal cohort study | Injecting drugs in the prior 3 months of data collection | 795 | Educational status (illiterate and class 1–6), never married, religion (Hindu), accommodation (living in streets or public places), employment status (daily wager), monthly income (1501–5000 INR) | Injecting drugs for longer periods, frequency of injections per day, sharing of needle/syringe, sharing of common container to draw drugs, split/back/front loading | Sexual intercourse in last 3 months, self-reported unsafe sex with regular partners and non-regular/paid female partners | Multiple strategies were used to recruit large number of PWID -Post-test counselling provided by trained nurses to all HIV positive participants -Interview conducted by trained research interviewers | Self-reported risk behaviours which maybe subject to social desirability bias | 9 |
Chakrapani et al. (2011) [27] | Manipur | n = 75 Aged 18 years above | Convenience sample recruitment | Cross-sectional study | People who inject drugs in the past 3 months of data collection | Male- 50 Female- 25 | Older age, unemployment among men, low monthly income, low educational level among women (did not complete high school), sex work as an occupation for women | Injection of heroin and methamphetamine, sharing of needles/syringe in past 30 days, type of drug used in past 3 months | Exchange of sex for drugs and money in the past 30 days | Pre-tested, pre- validated questionnaire was used | The use of convenience sample for HIV positive PWID in the survey -Small participants, a small number of indepth interviews and key informant interviews represents limitation in that saturation cannot be ensured | 7 |
Solomon et al. (2008) [28] | Chennai | n = 912, Aged 18 years and above | Convenience sample recruitment | Longitudinal cohort study | Injected drugs at least once in the prior 6 months of data collection | Male- 217 | Older age, ethnicity, being married, low educational level (no education or primary level) employment | Heroin injection, higher frequency of injection, sharing of injecting equipment, larger needle sharing network, injecting at dealers’ place | Less sexual activity | All participants received pre and post test counselling -Standardized questionnaire was administered by trained interviewers | -Inability to ascertain temporality of recent risk behaviours and prevalent HIV infection given the cross-sectional design | 8 |
Panda et al (2005) [29] | Chennai, India | n = 226 Aged 18 years and above | Mapping exercise for drug users was done using snowballing technique | Cross-sectional study | Injecting drugs in the previous 6 months of data collection | 68 | Older age, low educational status, geographical location | Early initiation of injecting drug use, having a tattoo, borrowing and lending injection equipment | Sexual debut with a commercial sex worker, inconsistent condom use | Pre-tested, pre-validated questionnaire was used | The temporality could not be established due to the cross-sectional nature of the study -Due to the small sample size the study findings are not representative of the national population of India -Detailed statistical analysis for determinants of HIV infection in women could not be determined | 8 |