Role of direct and indirect social and spatial ties in the diffusion of HIV and HCV among people who inject drugs: a cross-sectional community-based network analysis in New Delhi, India
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
- YR Gaitonde Centre for AIDS Research and Education (YRGCARE), India
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, United States
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, United States
Figures
Figure 1
Comparison of (a) egocentric, (b) sociometric, and (c) sociospatial network structure.
Circular nodes represent an individual. Square nodes represent a venue. Solid edges represent a social tie, dashed lines (a) represent a potential tie not captured by an egocentric network, dotted edges represent a spatial tie (c, d); (d) depicts an example of how two independent sociometric networks can merge into a single network when considering space.
Figure 2 with 1 supplement
Baseline sociometric network structure and HIV/HCV infection status of 2512 people who inject drugs in New Delhi, India.
Nodes are colored by infection status and sized by degree. HCV, hepatitis C virus; HIV, human immunodeficiency virus.
Figure 2—figure supplement 1
Baseline sociometric network structure of 2512 people who inject drugs in New Delhi, India with the 10 indexes that initiated recruitment colored green.
Figure 3 with 2 supplements
Baseline sociospatial network structure and HIV/HCV infection status of 2512 people who inject drugs in New Delhi, India.
The nodes in this sociospatial network represent persons (circles) or injection venues (squares), and the edges represent a social tie (in the case of a connection between two person nodes) or a spatial tie (in the case of a connection between a person node and spatial node). Person nodes are colored by HIV/HCV infection status, sized by degree, and are placed by using a degree-dependent force-directed algorithm. Spatial nodes are sized by degree and placed by GPS coordinates to be geographically congruent under a Mercator projection. HCV, hepatitis C virus; HIV, human immunodeficiency virus.
Figure 3—figure supplement 1
Geographic extent of 181 injection venues identified by study participants and kernel density plot of (a) HIV prevalence and (b) HCV prevalence.
While the figure is geospatially congruent, a map is not displayed to protect study participants. HCV, hepatitis C virus; HIV, human immunodeficiency virus.
Figure 3—figure supplement 2
Distribution of the number of people who report injecting drugs across 181 injection venues in New Delhi, India.
Each bar along the x-axis represents a single injection venue.
Author response image 1
Tables
Table 1
Participant baseline characteristics of 2512 people who inject drugs in New Delhi, India (parenthesis denote n unless otherwise specified).
| Overall | HIV mono-infected | Anti-HCV mono-infected | HIV/anti-HCV co-infected | Negative for HIV and HCV | |
|---|---|---|---|---|---|
| Number of participants | 2512 | 31 | 737 | 897 | 847 |
| Median age (IQR) | 26 (22–34) | 24 (20–32) | 27 (22–35) | 26 (22–32) | 26 (22–36) |
| Male gender | 99% (2489) | 97% (30) | 99% (728) | 99% (890) | 99% (837) |
| Self-report of ever having sex with a man | 20% (498) | 26% (8) | 16% (121) | 21% (192) | 21% (177) |
| Self-identify as gay or bisexual | 19% (479) | 23% (7) | 17% (123) | 21% (188) | 20% (167) |
| Highest level of education | |||||
| No schooling | 30% (754) | 32% (10) | 31% (225) | 39% (345) | 21% (174) |
| Primary school (Grades 1–5) | 25% (618) | 26% (8) | 25% (183) | 28% (250) | 21% (177) |
| Secondary school (Grades 6–10) or above | 45% (1130) | 42% (13) | 44% (327) | 33% (300) | 58% (490) |
| Employment | |||||
| Earn daily wage | 62% (1545) | 68% (21) | 60% (442) | 70% (630) | 53% (452) |
| Earn weekly or monthly wage | 28% (714) | 26% (8) | 30% (222) | 21% (190) | 35% (294) |
| Unemployed | 7% (165) | 6% (2) | 6% (45) | 5% (47) | 8% (71) |
| Currently Experiencing homeless | 30% (754) | 32% (10) | 30% (221) | 41% (371) | 18% (152) |
| Median years injecting drugs (IQR) | 5 (2–10) | 4 (1–8) | 5 (2–10) | 5 (2–9) | 3 (2–8) |
| Median injections in prior 6 months (IQR) | 360 (180–540) | 360 (360–540) | 360 (180–540) | 360 (344–540) | 340 (96–360) |
| Mean no. injection partners in prior month | 3.2 | 2.9 | 3.3 | 3.5 | 2.8 |
| Ever shared syringes | 60% (1518) | 74% (23) | 63% (463) | 73% (651) | 45% (381) |
| Shared syringes in prior 6 months | 51% (1284) | 65% (20) | 53% (391) | 61% (547) | 39% (326) |
| Type of drug injected (ever) | |||||
| Heroin only | 4% (89) | 6% (2) | 3% (25) | 2% (17) | 5% (45) |
| Buprenorphine only | 54% (1350) | 58% (18) | 50% (368) | 47% (422) | 64% (542) |
| Heroin and buprenorphine | 42% (1061) | 36% (11) | 46% (342) | 51% (458) | 30% (250) |
| Type of drug injected (prior 6 months) | |||||
| Heroin only | 4% (107) | 7% (2) | 4% (30) | 3% (25) | 6% (50) |
| Buprenorphine only | 73% (1820) | 74% (23) | 71% (521) | 70% (630) | 78% (646) |
| Heroin and buprenorphine | 22% (559) | 19% (6) | 25% (181) | 27% (240) | 16% (132) |
| Access to services | |||||
| Ever tested for HIV | 48% (1203) | 29% (9) | 53% (394) | 49% (440) | 43% (360) |
| Ever tested for HCV | 4% (104) | 0% (0) | 6% (46) | 5% (43) | 2% (15) |
| Ever used medication assisted therapy | 36% (906) | 36% (11) | 37% (272) | 32% (290) | 39% (333) |
| Ever used syringe service program | 17% (427) | 7% (2) | 19% (137) | 21% (191) | 12% (97) |
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Note: anti-HCV, HCV antibody.
Table 2
Factors associated with prevalent HIV infection in a sample of 2512 PWID in New Delhi, India.
Columns represent a logistic regression model and depict the odds ratios/adjusted odds ratios and 95% confidence intervals for the included variables.
| Factors associated with prevalent HIV | Univariable OR (95% CI) | Multivariable AOR (95% CI) | Multivariable AOR (95% CI) | Multivariable AOR (95% CI) | Multivariable AOR (95% CI) | Multivariable AOR (95% CI) |
|---|---|---|---|---|---|---|
| Age per 5 year increase | 0.88 (0.84–0.92) | 0.88 (0.84–0.92) | 0.90 (0.84–0.93) | 0.88 (0.84–0.92) | 0.88 (0.84–0.93) | 0.88 (0.84–0.93) |
| Education | ||||||
| No schooling (ref.) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Primary school | 0.80 (0.65–0.99) | 0.89 (0.71–1.13) | 0.92 (0.73–1.15) | 0.93 (0.74–1.17) | 0.95 (0.75–1.20) | 0.95 (0.75–1.20) |
| Secondary school or above | 0.43 (0.35–0.52) | 0.54 (0.44–0.67) | 0.55 (0.44–0.68) | 0.56 (0.45–0.69) | 0.57 (0.46–0.70) | 0.57 (0.46–0.71) |
| Experiencing Homelessness | 2.27 (1.91–2.71) | 1.54 (1.27–1.87) | 1.52 (1.25–1.85) | 1.48 (1.22–1.80) | 1.30 (1.07–1.60) | 1.32 (1.07–1.62) |
| Sexual activity vaginal or anal sex in prior 6 months | 0.42 (0.35–0.51) | 0.53 (0.44–0.65) | 0.53 (0.43–0.68) | 0.53 (0.43–0.64) | 0.53 (0.43–0.64) | 0.52 (0.43–0.63) |
| Ever shared syringes | 2.34 (1.96–2.78) | 1.78 (1.48–2.15) | 1.76 (1.45–2.12) | 1.76 (1.46–2.13) | 1.73 (1.43–2.10) | 1.75 (1.44–2.11) |
| Injection frequency per 50 injections in prior 6 months | 1.10 (1.08–1.11) | 1.06 (1.04–1.08) | 1.06 (1.04–1.08) | 1.06 (1.04–1.08) | 1.06 (1.04–1.08) | 1.06 (1.04–1.07) |
| Type of drug injected (ever) | ||||||
| Buprenorphine only (ref.) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Heroin only | 0.56 (0.33–0.94) | 0.58 (0.34–1.01) | 0.59 (0.34–1.03) | 0.58 (0.33–1.01) | 0.61 (0.35–1.07) | 0.61 (0.35–1.06) |
| Heroin and buprenorphine | 1.64 (1.39–1.94) | 1.39 (1.16–1.68) | 1.35 (1.12–1.63) | 1.34 (1.11–1.62) | 1.33 (1.10–1.60) | 1.31 (1.08–1.58) |
| Number infected injection partners per one person increase in anti-HIV-positive injection partners | 1.25 (1.13–1.37) | – | 1.20 (1.08–1.34) | 1.15 (1.03–1.28) | 1.16 (1.04–1.29) | 1.14 (1.02–1.27) |
| Network distance from an HIV-infected participant | 0.83 (0.78–0.88) | – | – | 0.87 (0.82–0.95) | 0.90 (0.82–0.96) | 0.92 (0.85–0.99) |
| Injecting at venue #40 | 2.22 (1.88–2.62) | – | – | – | 1.50 (1.24–1.82) | 1.10 (0.85–1.43) |
| Network distance from venue #40 | 0.79 (0.75–0.83) | – | – | – | – | 0.86 (0.82–0.91) |
Table 3
Factors associated with active HCV infection (HCV RNA positive) in a sample of 2512 PWID in New Delhi, India.
Columns represent a logistic regression model and depict the odds ratios/adjusted odds ratios and 95% confidence intervals for the included variables.
| Factors associated with active HCV infection (HCV RNA positive) | Univariable OR (95% CI) | Multivariable AOR (95% CI) | Multivariable AOR (95% CI) | Multivariable AOR (95% CI) | Multivariable AOR (95% CI) | Multivariable AOR (95% CI) |
|---|---|---|---|---|---|---|
| Age per 5 year increase | 0.96 (0.92–0.99) | 0.97 (0.93–1.01) | 0.97 (0.93–1.01) | 0.97 (0.93–1.01) | 0.97 (0.93–1.01) | 0.97 (0.93–1.02) |
| Education | ||||||
| No schooling (ref.) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Primary school | 0.91 (0.73–1.14) | 1.04 (0.82–1.32) | 1.06 (0.84–1.34) | 1.06 (0.84–1.35) | 1.09 (0.86–1.38) | 1.09 (0.86–1.39) |
| Secondary school or above | 0.56 (0.46–0.67) | 0.70 (0.57–0.85) | 0.70 (0.57–0.86) | 0.70 (0.57–0.86) | 0.71 (0.58–0.88) | 0.72 (0.59–0.89) |
| Experiencing Homelessness | 1.97 (1.64–2.36) | 1.45 (1.19–1.77) | 1.40 (1.15–1.71) | 1.41 (1.15–1.72) | 1.17 (0.95–1.45) | 1.18 (0.95–1.45) |
| Sexual activity vaginal or anal sex in prior 6 months | 0.58 (0.49–0.69) | 0.69 (0.58–0.83) | 0.69 (0.58–0.83) | 0.70 (0.58–0.84) | 0.70 (0.58–0.84) | 0.69 (0.57–0.83) |
| Ever shared syringes | 2.08 (1.75–2.45) | 1.65 (1.38–1.98) | 1.65 (1.38–1.98) | 1.67 (1.40–2.00) | 1.62 (1.35–1.94) | 1.62 (1.36–1.95) |
| Injection frequency per 50 injections in prior 6 months | 1.08 (1.06–1.10) | 1.05 (1.03–1.07) | 1.05 (1.03–1.07) | 1.05 (1.03–1.07) | 1.04 (1.02–1.06) | 1.04 (1.02–1.06) |
| Type of drug injected (ever) | ||||||
| Buprenorphine only | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Heroin only | 0.80 (0.51–1.24) | 0.85 (0.53–1.35) | 0.85 (0.53–1.35) | 0.84 (0.53–1.34) | 0.91 (0.57–1.45) | 0.90 (0.56–1.44) |
| Heroin and buprenorphine | 1.75 (1.48–2.07) | 1.48 (1.23–1.78) | 1.45 (1.20–1.74) | 1.45 (1.21–1.75) | 1.43 (1.18–1.72) | 1.41 (1.17–1.70) |
| Number infected injection partners per one person increase in HCV RNA positive injection partners | 1.25 (1.14–1.36) | – | 1.21 (1.10–1.34) | 1.13 (1.00–1.28) | 1.12 (0.99–1.27) | 1.11 (0.98–1.26) |
| Network distance from an HCV RNA+ participant | 0.82 (0.77–0.80) | – | – | 0.90 (0.82–0.99) | 0.93 (0.84–1.03) | 0.96 (0.85–1.00) |
| Injecting at location #40 | 2.29 (1.94–2.70) | – | – | – | 1.69 (1.40–2.03) | 1.31 (1.03–1.68) |
| Network distance from location #40 | 0.81 (0.77–0.84) | – | – | – | – | 0.90 (0.85–0.97) |
Additional files
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Supplementary file 1
Baseline characteristics of 10 indexes that initiated network recruitment (parenthesis denote n unless otherwise specified).
- https://cdn.elifesciences.org/articles/69174/elife-69174-supp1-v2.docx
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Reporting standard 1
STROBE Checklist for Cross-sectional Studies.
- https://cdn.elifesciences.org/articles/69174/elife-69174-repstand1-v2.docx
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Reporting standard 2
STROBE Flowchart.
- https://cdn.elifesciences.org/articles/69174/elife-69174-repstand2-v2.pdf
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Transparent reporting form
- https://cdn.elifesciences.org/articles/69174/elife-69174-transrepform-v2.pdf
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Role of direct and indirect social and spatial ties in the diffusion of HIV and HCV among people who inject drugs: a cross-sectional community-based network analysis in New Delhi, India
eLife 10:e69174.
https://doi.org/10.7554/eLife.69174
