Operational Research
Feb 2018
Pakistan is a high tuberculosis (TB) burden country, moving from low human immunodeficiency virus (HIV) prevalence to a concentrated epidemic driven primarily by people who inject drugs (PWID). The Antiretroviral Treatment Adherence Unit (AAU) in
Islamabad, Pakistan, is a residential facility that offers combined treatment for opioid dependence and HIV.
OBJECTIVE AND DESIGN: This retrospective study was conducted to assess TB prevalence among HIV infected PWID referred to the AAU and to evaluate the diagnostic value of cough as a screening symptom. A single sputum sample was collected regardless of symptoms, and examined using smear, Xpertw MTB/ RIF and culture.
An Independent Evaluation Report
April 2016
The ART Adherence Unit (AAU) is a residential rehabilitation facility for HIV+ PWID that combines treatment for opioid dependence with HIV treatment adherence support. It aims at stabilising the client so that HIV treatment becomes a realistic and achievable proposition for them. After just over two years of operation it has achieved considerable success in increasing the flow of PWID into the HIV treatment programme.
The facility is operated by Nai Zindagi, the civil society PR for the Global Fund HIV grant in Pakistan. It operates in the context of an HIV epidemic that is primarily driven by PWID but where treatment coverage for this population is very low. Previous studies have revealed very high rates of loss to follow up for PWID initiating treatment and this has lead to a very cautious and restrictive approach to treatment initiation based on anticipated treatment failure.
A therapeutic community facility that aims to improve HIV treatment outcomes for people who inject drugs in Pakistan
April 2016
The ART Adherence Unit (AAU) is a residential rehabilitation facility for HIV+ PWID that combines treatment for opioid dependence with HIV treatment adherence support. It aims at stabilising the client so that HIV treatment becomes a realistic and achievable proposition for them. After just over two years of operation it has achieved considerable success in increasing the flow of PWID into the HIV treatment programme.
The facility is operated by Nai Zindagi, the civil society PR for the Global Fund HIV grant in Pakistan. It operates in the context of an HIV epidemic that is primarily driven by PWID but where treatment coverage for this population is very low. Previous studies have revealed very high rates of loss to follow up for PWID initiating treatment and this has lead to a very cautious and restrictive approach to treatment initiation based on anticipated treatment failure.
A study of HIV vulnerability, risk factors and prevalence among the wives and intimate partners of men who inject drugs. (Kathmandu), Nepal – June 2011
In Nepal injecting drug use is recognised as a significant driver of the HIV epidemic due to high levels of needle/syringe sharing and insufficient coverage of HIV prevention services. Previous studies have assessed people who inject drugs as a “most at risk population”, and have missed the opportunity to understand the related risks and vulnerability of their wives, intimate partners, children and communities. The “Hidden Truth – Nepal” has revealed previously unrecognised risks and vulnerability of wives, intimate partners and children of men who inject drugs in Kathmandu, Nepal. This study represents a comparison of risk factors between HIV concordant and discordant couples to better assess HIV transmission dynamics between men who inject drugs, their wives, children and intimate partners.
(Mandi Bahaudin . Rawalpindi . Gujranwala . Sheikhupura), Punjab, Pakistan – October 2009
It is estimated that a total number of 2,246 persons inject drugs in the four cities of which 1200 (approximately 50%) were part of this assessment. The highest (53%) HIV prevalence was in the city of Mandi Bahuddin where a majority (93%) inject ‘marfia’ (a morphine based locally fabricated tablet). This is the first time ever that a city has such a high prevalence of HIV among people injecting drugs in Pakistan and where such a large proportion use a drug (marfia) not recorded in significant numbers ever before. Mandi Bahauddin also has the highest (37%) proportion of estimated numbers of persons injecting drugs the four cities, the highest (55.3%) percentage of married respondents and the oldest injecting practices.
A study of HIV vulnerability, risk factors and prevalence among men injecting drugs and their wives. (Sargodha . Faisalabad . Lahore), Pakistan – March 2008
In Pakistan injecting drug use is recognized as the main driver of the HIV epidemic due to high levels of needle/syringe sharing and insufficient HIV prevention services. Previous studies have assessed IDUs as a “most at risk population”, and have missed the opportunity to understand the related risks and vulnerability of their families and communities.The “Hidden Truth” has revealed previously unrecognized risks and vulnerability of wives of injecting drug users (IDUs) in Pakistan.
Of the estimated 120,000 street based IDUs in Pakistan 50% are married. The majority of the married IDUs reported recent, regular and unprotected sexual relations with their wives. Importantly, this study reveals that up to 15% of the wives of HIV positive IDUs are already infected
Rapid situation assessment of HIV prevalence and risk factors among people who inject drugs in four cities of Punjab. (Lahore . Faisalabad . Sargodha . Sialkot) – July 2005
It is evident from the findings of this study that Pakistan no longer has a ‘window of opportunity’ to act in advance in order to prevent the transmission of HIV and AIDS among people injecting drugs. With HIV prevalence among people injecting drugs in Faisalabad and Sargodha as high as 9.5% and 12% respectively the price of ‘in-action’ would be immense. We can no longer deny that although we had to act ‘yesterday’, we MUST at least act NOW in order to minimize further damage. There is sufficient evidence and proof that in settings similar to ours, where people inject drugs and share syringes HIV prevalence can reach pandemic proportions in just a matter of few months. To address this very serious public health threat, lip service, tokenism and pilot boutiques will not work.