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

  1. Steven J Clipman  Is a corresponding author
  2. Shruti H Mehta
  3. Aylur K Srikrishnan
  4. Katie JC Zook
  5. Priya Duggal
  6. Shobha Mohapatra
  7. Saravanan Shanmugam
  8. Paneerselvam Nandagopal
  9. Muniratnam S Kumar
  10. Elizabeth Ogburn
  11. Gregory M Lucas
  12. Carl A Latkin
  13. Sunil S Solomon  Is a corresponding author
  1. Johns Hopkins University School of Medicine, United States
  2. Johns Hopkins Bloomberg School of Public Health, United States
  3. YR Gaitonde Centre for AIDS Research and Education, India

Abstract

Background:People who inject drugs (PWID) account for some of the most explosive HIV and hepatitis C virus (HCV) epidemics globally. While individual drivers of infection are well understood, less is known about network factors, with minimal data beyond direct ties.

Methods:2,512 PWID in New Delhi, India were recruited in 2017-19 using a sociometric network design. Sampling was initiated with 10 indexes who recruited named injection partners (people who they injected with in the prior month). Each recruit then recruited their named injection partners following the same process with cross-network linkages established by biometric data. Participants responded to a survey, including information on injection locations, and provided a blood sample. Factors associated with HIV/HCV infection were identified using logistic regression.

Results:Median age was 26; 99% were male. Baseline HIV prevalence was 37.0% and 46.8% were actively infected with HCV (HCV RNA positive). The odds of prevalent HIV and active HCV infection decreased with each additional degree of separation from an infected alter (HIV AOR: 0.87; HCV AOR: 0.90) and increased among those who injected at a specific location (HIV AOR: 1.50; HCV AOR: 1.69) independent of individual-level factors (p<0.001). Additionally, sociometric factors e.g., network distance to an infected alter, were statistically significant predictors even when considering immediate egocentric ties.

Conclusions:These data demonstrate an extremely high burden of HIV and HCV infection and a highly interconnected injection and spatial network structure. Incorporating network and spatial data into the design/implementation of interventions may help interrupt transmission while improving efficiency.

Funding:National Institute on Drug Abuse and the Johns Hopkins University Center for AIDS Research.

Data availability

An interactive version of the sociospatial network and underlying data are available from: https://github.com/sclipman/sociospatial-baseline.

Article and author information

Author details

  1. Steven J Clipman

    Johns Hopkins University School of Medicine, Baltimore, United States
    For correspondence
    sclipman@jhmi.edu
    Competing interests
    No competing interests declared.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-2366-8420
  2. Shruti H Mehta

    Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
    Competing interests
    Shruti H Mehta, reports personal fees from Gilead Sciences, outside the submitted work..
  3. Aylur K Srikrishnan

    YR Gaitonde Centre for AIDS Research and Education, Chennai, India
    Competing interests
    No competing interests declared.
  4. Katie JC Zook

    Johns Hopkins University School of Medicine, Baltimore, United States
    Competing interests
    No competing interests declared.
  5. Priya Duggal

    Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
    Competing interests
    No competing interests declared.
  6. Shobha Mohapatra

    YR Gaitonde Centre for AIDS Research and Education, Chennai, India
    Competing interests
    No competing interests declared.
  7. Saravanan Shanmugam

    YR Gaitonde Centre for AIDS Research and Education, Chennai, India
    Competing interests
    No competing interests declared.
  8. Paneerselvam Nandagopal

    YR Gaitonde Centre for AIDS Research and Education, Chennai, India
    Competing interests
    No competing interests declared.
  9. Muniratnam S Kumar

    YR Gaitonde Centre for AIDS Research and Education, Chennai, India
    Competing interests
    No competing interests declared.
  10. Elizabeth Ogburn

    Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
    Competing interests
    No competing interests declared.
  11. Gregory M Lucas

    Johns Hopkins University School of Medicine, Baltimore, United States
    Competing interests
    No competing interests declared.
  12. Carl A Latkin

    Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
    Competing interests
    No competing interests declared.
  13. Sunil S Solomon

    Johns Hopkins University School of Medicine, Baltimore, United States
    For correspondence
    sss@jhmi.edu
    Competing interests
    Sunil S Solomon, reports grants/products and advisory board fees from Gilead Sciences and grants/products from Abbott Diagnostics, outside the submitted work..

Funding

National Institute on Drug Abuse (R01DA041736)

  • Sunil S Solomon

National Institute on Drug Abuse (DP2DA040244)

  • Sunil S Solomon

National Institute on Drug Abuse (R01DA041034)

  • Shruti H Mehta
  • Gregory M Lucas

National Institute on Drug Abuse (K24DA035684)

  • Gregory M Lucas

National Institute of Allergy and Infectious Diseases (P30AI094189)

  • Shruti H Mehta

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Reviewing Editor

  1. Jennifer Flegg, The University of Melbourne, Australia

Ethics

Human subjects: The study protocol was approved by institutional review boards at Johns Hopkins Medicine (IRB00110421) and the YR Gaitonde Centre for AIDS Research and Education in India (YRG292). All participants provided written informed consent.

Version history

  1. Received: April 7, 2021
  2. Accepted: July 15, 2021
  3. Accepted Manuscript published: August 3, 2021 (version 1)
  4. Version of Record published: August 17, 2021 (version 2)

Copyright

© 2021, Clipman et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

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  1. Steven J Clipman
  2. Shruti H Mehta
  3. Aylur K Srikrishnan
  4. Katie JC Zook
  5. Priya Duggal
  6. Shobha Mohapatra
  7. Saravanan Shanmugam
  8. Paneerselvam Nandagopal
  9. Muniratnam S Kumar
  10. Elizabeth Ogburn
  11. Gregory M Lucas
  12. Carl A Latkin
  13. Sunil S Solomon
(2021)
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

Share this article

https://doi.org/10.7554/eLife.69174

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