Evolution of Illicit Opioid Use Among People With HIV Infection in St Petersburg, Russia, in the Period 2004–2015

E Blokhina; EM Krupitsky; DM Cheng; AY Walley; O Toussova; T Yaroslavtseva; N Gnatienko; C Bridden; LS Forman; S Bendiks; JH Samet


HIV Medicine. 2019;20(7):450-455. 

In This Article


Participants and Study Design

The current study focused on baseline data collected from HIV-positive individuals reporting recent (i.e. in the past 30 days) opioid use; Partnership to Reduce the Epidemic Via Engagement in Narcology Treatment (PREVENT; 2004–2005) included 17 participants who met this criterion (9% of all PREVENT study participants),[10] HIV Evolution in Russia–Mitigating Infection Transmission and Alcoholism in a Growing Epidemic (HERMITAGE; 2007–2010) included 281 participants (40% of all HERMITAGE study participants),[11] Linking Infectious and Narcology Care (LINC; 2013–2014) included 126 (36% of total LINC study participants),[12] and Russia Alcohol Research Collaboration on HIV/AIDS (Russia ARCH; 2012–2015) included 121 (35% of total Russia ARCH study participants).[13]

PREVENT. The PREVENT study was a randomized controlled trial (RCT) to assess the effectiveness of a sexual risk reduction intervention in the Russian narcology (addiction) hospital setting.[10] Participants (n = 181) were recruited from two substance use treatment facilities near St Petersburg. Study activities took place between October 2004 and December 2005. Eligibility criteria for the study included: (1) ≥ 18 years of age; (2) primary diagnosis of alcohol or drug dependence; (3) no alcohol or other substance use for at least 48 h; (3) unprotected anal or vaginal sex in the past 6 months; and (4) willingness to undergo HIV testing or a previous diagnosis of HIV infection.

HERMITAGE. HERMITAGE was an RCT testing a US HIV secondary prevention intervention, adapted for use in Russia, to reduce the rates of sexually transmitted infections, unprotected sex, needle sharing and alcohol use among HIV-positive heavy drinkers.[11] Participants (n = 700) were recruited from four clinical in-patient and out-patient HIV and addiction sites in St Petersburg from October 2007 to April 2010. Eligibility criteria included: (1) ≥ 18 years of age; (2) HIV-positive; (3) reporting 'at risk' drinking levels in the past 30 days (> 14 drinks per week or > 4 drinks on a single occasion for men, and > 7 per week or > 3 on a single occasion for women); and (4) unprotected anal or vaginal sex in the past 6 months.

LINC. LINC was an RCT to test a peer-led strengths-based case management intervention to link HIV-positive PWID hospitalized at a narcology hospital to HIV care in St Petersburg.[12] All 349 participants were recruited from in-patient wards at a narcology hospital in St Petersburg from July 2012 to May 2014. Key eligibility criteria included: (1) age 18–70 years; (2) HIV-positive; (3) hospitalized at the narcology hospital; (4) a history of IDU.

Russia ARCH. Russia ARCH was an observational cohort study to evaluate the longitudinal association between alcohol consumption and biomarkers of microbial translocation and inflammation. Participants (n = 351) were recruited between November 2012 and June 2015 from clinical HIV and addiction sites, nonclinical sites and snowball sampling in St Petersburg. Eligibility criteria included: (1) 18–70 years old; (2) documented HIV infection; (3) documented ART-naïve status.

It is of note that there was some participant overlap in the cohorts (i.e. 10 individuals participated in both HERMITAGE and ARCH, and 24 participated in both ARCH and LINC). The following were assessed via interviewer-administered questionnaires: demographics, hepatitis C virus (HCV) status, smoking, alcohol use and drug use. All study participants provided written informed consent. The Institutional Review Boards of Boston University Medical Campus and First St Petersburg Pavlov State Medical University approved all four studies.

Heroin and Other Opioid use

Information on past 30-day heroin use only, other opioid use only, and heroin and other opioid use was obtained using the Addiction Severity Index (with questions such as 'How many days in the past 30 days have you used heroin?')[14] and the Timeline Follow Back method (which uses reports of total grams of heroin used on each of the past 30 days) in the PREVENT study.[15] In all other cohorts, recent opioid use was measured using a modified Risk Behavior Survey [with questions such as 'Have you used heroin by itself in the past 30 days?' and 'Have you used other opioids (i.e. codeine, china white, methadone or fentanyl) by itself in the past 30 days?'][16,17] (Table 1).

Statistical Analysis

Descriptive statistics [i.e. frequencies and proportions for categorical variables; means, medians, standard deviations (SDs) and interquartile ranges for continuous variables] were calculated for key demographic variables, HCV status and all substance use variables overall and stratified by cohort. χ2, Fisher's exact, analysis of variance (ANOVA) and Kruskal–Wallis tests were used, as appropriate, to describe differences across cohorts. We obtained exact 95% confidence intervals (CIs) for the proportions with heroin and any illicit opioid use. Analyses were conducted using the statistical package SAS 9.3 (SAS Institute, Cary, NC).[18]