ArticlePloS one2013
High HIV incidence among persons who inject drugs in Pakistan: greater risk with needle sharing and injecting frequently among the homeless.
Article in PloS one, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 3 of them syntheses that pooled it.
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Who cites it
13 citing papers in PubMed, 3 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis.The lancet. Gastroenterology & hepatology · 2023Pooled it
- Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis.The Lancet. Public health · 2021Pooled it
- Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs.The Cochrane database of systematic reviews · 2017Pooled it
- Notable transmitted HIV drug resistance among people who inject drugs in Pakistan.The Journal of antimicrobial chemotherapy · 2026Article
- Trends in HIV incidence following scale-up of harm reduction interventions among people who inject drugs in Kachin, Myanmar, 2008-2020: analysis of a retrospective cohort dataset.The Lancet regional health. Western Pacific · 2023Article
- HIV screening and retention in care in people who use drugs in Madrid, Spain: a prospective study.Infectious diseases of poverty · 2021Article
- The association of HIV and easy access to narcotics in Pakistan; calling drug policy makers.Journal of pharmaceutical policy and practice · 2019Article
- Frequency and factors associated with providing injection initiation assistance in Tallinn, Estonia.Drug and alcohol dependence · 2018Article
- Syringe Sharing Among a Prospective Cohort of Street-Involved Youth: Implications for Needle Distribution Programs.AIDS and behavior · 2017Article
- Sharing of Needles and Syringes among Men Who Inject Drugs: HIV Risk in Northwest Bangladesh.PloS one · 2016Article
- Risk Factors for Loss to Follow-Up among People Who Inject Drugs in a Risk Reduction Program at Karachi, Pakistan. A Case-Cohort Study.PloS one · 2016Article
- Drug-related HIV epidemic in Pakistan: a review of current situation and response and the way forward beyond 2015.Harm reduction journal · 2015Review
- Global HIV epidemiology: A guide for strategies in prevention and care.Current HIV/AIDS reports · 2014Article
Corrections and comments
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Authors and funding
10 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundThe incidence of HIV among persons who inject drugs (PWIDU) has fallen in many nations, likely due to successes of clean needle/syringe exchange and substance abuse treatment and service programs. However in Pakistan, prevalence rates for PWID have risen dramatically. In several cities, prevalence exceeded 20% by 2009 compared to a 2003 baseline of just 0.5%. However, no cohort study of PWID has ever been conducted.
methodsWe enrolled a cohort of 636 HIV seronegative PWID registered with three drop-in centers that focus on risk reduction and basic social services in Karachi. Recruitment began in 2009 (March to June) and PWID were followed for two years. We measured incidence rates and risk factors associated with HIV seroconversion.
resultsIncidence of HIV was 12.4 per 100 person-years (95% exact Poisson confidence interval [CI]: 10.3-14.9). We followed 474 of 636 HIV seronegative persons (74.5%) for two years, an annual loss to follow-up of <13 per 100 person years. In multivariable Cox regression analysis, HIV seroconversion was associated with non-Muslim religion (Adjusted risk ratio [ARR] = 1.7, 95%CI:1.4, 2.7, p = 0.03), sharing of syringes (AR = 2.3, 95%CI:1.5, 3.3, p<0.0001), being homeless (ARR = 1.7, 95%CI:1.1, 2.5, p = 0.009), and daily injection of drugs (ARR = 1.1, 95%CI:1.0, 1.3, p = 0.04).
conclusionsEven though all members of the cohort of PWID were attending risk reduction programs, the HIV incidence rate was very high in Karachi from 2009-2011. The project budget was low, yet we were able to retain three-quarters of the population over two years. Absence of opiate substitution therapy and incomplete needle/syringe exchange coverage undermines success in HIV risk reduction.
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