Table 1.

Sociodemographic, injecting and sexual risk factors associated with HIV positivity among PWID

Author/Year	Geographical Region	Sample/Age	Sampling Strategy	Study design	Population characteristics	Number of HIV + PWID	Sociodemographic factors	Injecting risk factors	Sexual risk factors	Study Strengths	Study Limitations	Quality Assessment score
Ganesh et al. (2020) [19]	Manipur	n = 1594 Aged 15 years and above	Two stage cluster sampling	Community-based, bio-behavioural surveillance	Men who inject drugs in the past 3 months of data collection	Male- 193	Labourers/manual workers, older age > 39 years, did not go to school, living alone or with friends	Injecting at their own house, sharing of needle/syringe, repeated use of needle/syringe, drawing up from same container, longer duration of injecting practices	Having multiple sexual partners	The study gave evidence on important factors associated with HIV transmission among HIV positive PWID	The study did not include female PWID	9
Kumar et al. (2018) [20]	India	n = 19,902, Aged 15 years and above	Conventional cluster sampling	Probability- based, cross-sectional study	Men who inject drugs in the past 3 months of data collection	Male- 1631	Older age (> 25 years), marital status (never married), Occupation (non labourers)	< 24 years of age at initiation of injecting drug use, duration of drug use (five years and above), frequency of injecting (twice/day), type of drugs (buprenorphine, heroin), injected in groups during last injection	Inconsistent condom use, reported STI symptom	The study could be generalizable to the India population due to large sample size used across 29 states in India.-To determine HIV status two test protocols were used -Information were collected by trained personnel who used standardized questionnaire to ensure consistency across all Indian States and territories	Due to the nature of the study there could have been measurement bias on leading to an overestimation or underestimation of factors -No female participants	7
Cepeda et al. (2017) [21]	15 cities in India	n = 14,373 Aged 18 years above	Respondent Driven Sampling (RDS)	Cross-sectional study	People who inject drugs	2915	Not given	Passing a used needle/syringe to more than 3 individuals in the past 30 days	-	The large sample size and low loss to follow up rate confers greater statistical power	Sociometric data were not obtained and because of this homophily was low (between -0.2 and 0.2) for most sites -Generalisability was limited because random sample of underlying population could not be obtained -sexual risk factors were not obtained	8
McFall et al. (2017) [22]	7 cities in Northeast India	n = 796 Aged 18 years above	RDS	Cross-sectional study	Injecting in the previous 2 years of data collection	Female- 368	Older age, widowed, having children, having attended secondary school	Injection of buprenorphine, longer duration of injecting use, less frequency of injection	Higher number of sexual partners	-All female participants as there are few studies that look at female PWID	-Establishment of temporality or causality is not possible due to the cross-sectional nature of the study -Sample or estimates are not representative of the underlying population
Lucas et al. (2015) [23]	India- 15 Indian cities	n = 14,481 Aged 18 years and above	RDS	Cross-sectional study	Reported injecting drug use in the prior 2 years of data collection	2905	Female gender, marital status (currently married or living with a partner), age	Initiation of early injection, type of drugs injected (buprenorphine and heroin), sharing of needle/syringe	Number of lifetime sex partner, exchange of sex for money or goods, being female	RDS was used- a strategy that is suited for ‘hidden’ populations and permits weighing to produce unbiased estimates of factors of interest in the target population -Use of state-of-the-art methods to characterize recent HIV infection across sites permitting HIV incidence estimates	Sites and samples were not selected randomly and so this data cannot be considered a nationally representative. Detailed network-level risk data were not collected	8
Armstrong et al. (2014) [14]	Manipur, India	n = 821 PWID Aged 18 years above	RDS	Cross-sectional study	Long-term heroin injectors	M- 252	Older age(> 25 years), currently married	Sharing of needles, longer duration of injection practice, higher frequency of injection	Did not use condoms at last sex with casual or regular partners, irregular condom use	Adequate sample size. The study gave evidence on important factors associated with HIV transmission among HIV positive PWID	-Female PWID were not included -Low uptake of HIV testing. However, this data was collected in 2009 and anecdotal evidence suggests that uptake of HIV testing is likely to be higher now	7
Mehta et al. (2014) [24]	14 sites across India	n = 801 Aged 18 years and above	Simple random sampling from 14 locations in India by NGO that worked with PWID	Cross-sectional study	HIV positive PWID in the prior 2 years of data collection	Male- 689 Female- 112	Older age(> 30 years), gender (male), married, educational level, unemployment, low monthly wages	Injecting heroin and buprenorphine, needle and syringe sharing, daily injection practices	Men having sex with men, sex with a casual partner, any sexual intercourse	Pre-tested, pre-validated questionnaire was used -Data were collected by trained personnel	Small sample size in each site -Detailed information on sexual and injection related risk behaviour were not collected -Low female representation as most female PWID are confined to the Northeastern region	7
Panda et al. (2014) [25]	Punjab	n = 1155 Aged 18 years and above	Sample collected from Integrated Counselling and Testing centre (ICTC)	Community- based cohort study	injected drugs within the last 3 months of data collection	M- 338	Older age, gender (male), married, educational level, unemployment, low monthly wages	Length of time of injection, irregular supply of syringes and needles, sharing of syringe and needle	Having genital disease symptom within the last year	Wide community based study	Inability to recruit those who are no in contact with Targeted intervention services which may present a biased picture	8
Sarna et al. (2013) [26]	Delhi and neighbouring states	n = 3792 Aged 18 years and above	Samples were recruited through Peer referral, targeted outreach and walk-in clients	Longitudinal cohort study	Injecting drugs in the prior 3 months of data collection	795	Educational status (illiterate and class 1–6), never married, religion (Hindu), accommodation (living in streets or public places), employment status (daily wager), monthly income (1501–5000 INR)	Injecting drugs for longer periods, frequency of injections per day, sharing of needle/syringe, sharing of common container to draw drugs, split/back/front loading	Sexual intercourse in last 3 months, self-reported unsafe sex with regular partners and non-regular/paid female partners	Multiple strategies were used to recruit large number of PWID -Post-test counselling provided by trained nurses to all HIV positive participants -Interview conducted by trained research interviewers	Self-reported risk behaviours which maybe subject to social desirability bias	9
Chakrapani et al. (2011) [27]	Manipur	n = 75 Aged 18 years above	Convenience sample recruitment	Cross-sectional study	People who inject drugs in the past 3 months of data collection	Male- 50 Female- 25	Older age, unemployment among men, low monthly income, low educational level among women (did not complete high school), sex work as an occupation for women	Injection of heroin and methamphetamine, sharing of needles/syringe in past 30 days, type of drug used in past 3 months	Exchange of sex for drugs and money in the past 30 days	Pre-tested, pre- validated questionnaire was used	The use of convenience sample for HIV positive PWID in the survey -Small participants, a small number of indepth interviews and key informant interviews represents limitation in that saturation cannot be ensured	7
Solomon et al. (2008) [28]	Chennai	n = 912, Aged 18 years and above	Convenience sample recruitment	Longitudinal cohort study	Injected drugs at least once in the prior 6 months of data collection	Male- 217	Older age, ethnicity, being married, low educational level (no education or primary level) employment	Heroin injection, higher frequency of injection, sharing of injecting equipment, larger needle sharing network, injecting at dealers’ place	Less sexual activity	All participants received pre and post test counselling -Standardized questionnaire was administered by trained interviewers	-Inability to ascertain temporality of recent risk behaviours and prevalent HIV infection given the cross-sectional design	8
Panda et al (2005) [29]	Chennai, India	n = 226 Aged 18 years and above	Mapping exercise for drug users was done using snowballing technique	Cross-sectional study	Injecting drugs in the previous 6 months of data collection	68	Older age, low educational status, geographical location	Early initiation of injecting drug use, having a tattoo, borrowing and lending injection equipment	Sexual debut with a commercial sex worker, inconsistent condom use	Pre-tested, pre-validated questionnaire was used	The temporality could not be established due to the cross-sectional nature of the study -Due to the small sample size the study findings are not representative of the national population of India -Detailed statistical analysis for determinants of HIV infection in women could not be determined	8