Association of injecting drug use and late enrolment in HIV medical care in Odessa Region, Ukraine.

OBJECTIVES Late entry of HIV-positive persons into specialized care is a significant challenge to limiting the spread of the HIV epidemic. In 2008-2010, only 54% of 108,116 persons who tested HIV positive enrolled in care at AIDS Centers in Ukraine, and almost half of new AIDS cases are found in patients with first-time HIV diagnoses. We aimed to identify factors associated with delayed enrolment in HIV care in Odessa Region, Ukraine. METHODS We conducted a retrospective data analysis of patients who enrolled in HIV care in 1995-2010, comparing patients on the basis of the reported route of HIV transmission (injecting drug use or sexual transmission). The nonparametric Mann-Whitney U-test was used to compare the groups. RESULTS During the period analysed, the delay in enrolment in HIV care among people who inject drugs (PWID) in Odessa Region was longer than that among people infected via sexual transmission. The mean delay in enrolment in care among PWID increased over time for men and women; their mean age at the time of enrolment also gradually increased. Urban residents accounted for the majority of HIV cases, with some growth in the proportion of rural residents. CONCLUSIONS People who acquired HIV via injecting drug use showed later enrolment in HIV care compared with people infected via sexual transmission. There is an urgent need to improve HIV counselling and referral services, taking into account differences in the behaviour of drug-using and non-drug-using populations.