Drug sharing is commonly reported for other prescription medications, but to date, no studies have examined antiretroviral drug diversion (buying, selling, borrowing, or lending) for therapeutic use among people living with HIV. We previously conducted qualitative interviews with people living with HIV in high-prevalence fishing communities (hotspots) along Lake Victoria in the Rakai region, Uganda. Participants reported frequent, short- term sharing of antiretroviral treatment (ART) with coworkers/friends that was motivated by the desire to keep taking drugs despite challenges to regular clinic attendance and adherence. However, we do not know how common ART diversion is at the population-level, who is most likely to divert antiretroviral drugs, or whether ART diversion affects HIV treatment outcomes such as HIV viral suppression. We therefore propose a mixed methods study to better understand ART diversion and whether it can be leveraged to reach and support sub-optimally adherent, hard-to-reach individuals living with HIV. The study will be conducted through the Rakai Community Cohort Study, a population-based cohort study conducted among all residents aged 15-49 in 40 communities in southcentral Uganda.
Aim 1 will measure the prevalence, distribution, and factors associated with ART diversion in this representative sample.
Aim 2 will assess the association between ART diversion and HIV viral suppression.
Aim 3 will explore acceptability and feasibility of a novel intervention among ART-sharing dyads that builds upon these existing networks of social trust to reach sub-optimally adherent, hard-to-reach HIV patients.

Public Health Relevance

In Uganda, people living with HIV report sharing their antiretroviral drugs when they are unable to get refills in a timely manner. This study seeks to measure antiretroviral drug diversion (buying, selling, borrowing, or lending of antiretroviral drugs) in a large population, assess whether diversion is associated with HIV viral suppression, and explore the possibility of using drug-sharing relationships to develop a new intervention to identify and support individuals with suboptimal antiretroviral drug adherence.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Exploratory/Developmental Grants (R21)
Project #
1R21AI145682-01A1
Application #
9927335
Study Section
HIV/AIDS Intra- and Inter-personal Determinants and Behavioral Interventions Study Section (HIBI)
Program Officer
Bacon, Melanie C
Project Start
2020-09-09
Project End
2022-08-31
Budget Start
2020-09-09
Budget End
2021-08-31
Support Year
1
Fiscal Year
2020
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21205