Leveraging Injection Networks to Prevent HIV and Other Blood Borne Infections Among People Who Inject Drugs in Kenya: Design and Rationale

Background HIV and Hepatitis C (HCV) are blood borne infections (BBIs) that remain a significant cause of global morbidity and mortality among people who inject drugs (PWID). UNAIDS and WHO have set goals for the elimination of viral hepatitis and HIV as major public health threats by 2030. To achieve these targets, innovative strategies are required among marginalized populations such as PWID, especially in resource-limited countries where coverage of harm reduction services is often limited. The goal of this study is to inform targeted strategies to prevent transmission of BBIs among PWID. Methods We will use respondent driven sampling (RDS) to recruit PWID from needle and syringe programs in Kenya. Participants will complete biobehavioral and social network surveys and receive point-of-care HCV, HIV, and hepatitis B (HBV) testing. Participants will return for at least one follow-up visit to complete additional surveys and testing. We will use network data from RDS, egocentric, and viral phylogenetics to identify how highly central PWID contribute to transmission networks and use mathematical modelling to investigate the impact of targeted interventions based on network characteristics. Discussion This study will provide important information for policymakers and researchers designing strategies for BBI elimination. Network- and molecular epidemiologic-informed tools to guide targeted strategies may be critical to maximizing the impact of treatment and prevention efforts in resource-limited settings. This approach may provide a durable template for future studies, including prospective assessments of targeted prevention and elimination strategies among PWID, and assist with monitoring elimination progress in resource-limited settings.