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
- Johns Hopkins University School of Medicine, United States
- Johns Hopkins Bloomberg School of Public Health, United States
- 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
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
- 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
- Received: April 7, 2021
- Accepted: July 15, 2021
- Accepted Manuscript published: August 3, 2021 (version 1)
- 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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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
Further reading
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- Epidemiology and Global Health
Background:
Circulating omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) have been associated with various chronic diseases and mortality, but results are conflicting. Few studies examined the role of omega-6/omega-3 ratio in mortality.
Methods:
We investigated plasma omega-3 and omega-6 PUFAs and their ratio in relation to all-cause and cause-specific mortality in a large prospective cohort, the UK Biobank. Of 85,425 participants who had complete information on circulating PUFAs, 6461 died during follow-up, including 2794 from cancer and 1668 from cardiovascular disease (CVD). Associations were estimated by multivariable Cox proportional hazards regression with adjustment for relevant risk factors.
Results:
Risk for all three mortality outcomes increased as the ratio of omega-6/omega-3 PUFAs increased (all Ptrend <0.05). Comparing the highest to the lowest quintiles, individuals had 26% (95% CI, 15–38%) higher total mortality, 14% (95% CI, 0–31%) higher cancer mortality, and 31% (95% CI, 10–55%) higher CVD mortality. Moreover, omega-3 and omega-6 PUFAs in plasma were all inversely associated with all-cause, cancer, and CVD mortality, with omega-3 showing stronger effects.
Conclusions:
Using a population-based cohort in UK Biobank, our study revealed a strong association between the ratio of circulating omega-6/omega-3 PUFAs and the risk of all-cause, cancer, and CVD mortality.
Funding:
Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institute of Health under the award number R35GM143060 (KY). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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