the 6 th national scientific conference on hiv/aids prospects for ending the hiv epidemic among...

THE 6TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS

Prospects for Ending the HIV Epidemic among Persons who Inject

Drugs in Haiphong VietnamDon C Des Jarlais PhD1, Huong Duong Thi MD2, Oanh Khuat Thi Hai MD3, Khuê Pham Minh MD2, Giang

Hoang Thi MD2, Thanh Nham Thi Tuyet BA3, Kamyar Arasteh1, Jonathan Feelemyer1, Theodore Hammett PhD4, Marianne Peries5, Laurent Michel6, Vinh Vu Hai7, Marie Jauffret Roustide PhD8, Jean-Pierre Moles PhD5,

Didier Laureillard MD5,9, and Nicolas Nagot MD5 for the DRIVE Study Team

1 Mount Sinai Beth Israel, New York City, USA

2 Hai Phong University of Medicine and Pharmacy, Hai Phong, Viet Nam

3 Supporting Community Development Initiatives, Hanoi, Viet Nam

4 ABT Associates, Boston, USA

5 Inserm U1058, University of Montpellier, France

6 Pierre Nicole Center, Red Cross, Paris, France

7 Infectious Diseases Department, Viet Tiep Hospital, Hai Phong, Viet Nam

8 Inserm, Paris, France

9 Infectious Diseases Department, Caremeau University Hospital, Nîmes, France

The 6th National Scientific Conference on HIV/AIDS

CONTENT OF REPORT

Presentation of HIV situation in Vietnam, specifically Haiphong, and harm reduction response

Methodology for respondent driven sampling (RDS) and data collection of persons who inject drugs (PWID) in Haiphong

Presentation of sample characteristics, HIV prevalence by years injecting, and HIV incidence of new injectors (using two methods)

Comparisons of HIV Epidemic, Interventions in Haiphong and New York City, USA from 1995 to 2020

Recommendations for continued interventions for ending the HIV epidemic among PWID and policy implications


200,000 PWID in Vietnam-focal population for HIV epidemic in country

Framework: harm reduction and substance abuse treatment

Transition to voluntary, community based treatment

Rapid expansion of methadone in 2008-2015

Decriminalization of drug use

Legal policy framework still remains inconsistent

Law on Drug Prevention and Control remains in effect

Background


Background

Haiphong has led movement towards evidence based substance abuse treatment

and HIV prevention in Vietnam

High prevalence of HIV among PWID as high as 66% in 2006

“06” centers for drug users and “05” centers for commercial sex workers still exist

Methadone pilot programs begun in 2008: 3,200 patients

Needle/syringe programs implemented in 2005

Antiretroviral treatment offered free for HIV+ persons


Methods-RDS Recruitment

Three community support groups participated

Included PWID, with focus on female commercial sex worker (FCSW)-PWID, and men who have sex with men (MSM)-PWID

Participants recruited using RDS methodology

Twelve seeds initially used.; each seed received 3 coupons to recruit PWID into study

Target sample size: 600 PWID

Oversampling of MSM-PWID and FCSW-PWID


Methods-Data Collection

Questionnaire examining drug use and sexual behavior.

HIV and HCV testing and counseling

Estimation of HIV incidence among non-MSM male new

injectors (injecting < 2 years) using two methods:

HIV+ new injectors/years injecting among new injectors

Slope of HIV prevalence by years of injecting using

ordinary least squares (OLS) regression


Results-RDS Recruitment

Recruitment from 9/6/2014 through 10/7/2014

603 total participants included in sample

581 PWID recruited through RDS

22 additional MSM-PWID and FCSW-PWID recruited through direct staff

recruitment


Characteristics of Total Sample

N (%)Gender: total (%) 603 (100) Female 61 (10) Male 492 (82) MSM 49 (8)Drug Injection Characteristics 603 (100) Heroin (alone) 602 (~100) Heroin (with other drugs) 3 (<1) (Meth)amphetamine 3 (<1) Receptive Sharing 32 (5) Distributive Sharing 19 (3)


Characteristics of Total Sample(continued)

N (%)Sexual Risk Behaviors 603 (100) Unsafe sex with primary partner 172 (29) Unsafe sex with casual partner 15 (2) Exchanged sex for money 75 (12)Average Age (SD) 37 (8)HIV and HCV Serostatus 603 (100) HIV Seropositive 152 (25) HCV Seropositive 403 (67)

N (%)Sexual Risk Behaviors 603 (100)


Characteristics of New PWID

N (%)Gender: total (%) 178 (100) Female 21 (12) Male 136 (76) MSM 21 (12)Drug Injection Characteristics 178 (100) Heroin (alone) 178 (100) Heroin (with other drugs) 0 (0) (Meth)amphetamine 0 (0) Receptive Sharing 14 (8) Distributive Sharing 7 (4)


Characteristics of New PWID(continued)

N (%)Sexual Risk Behaviors 178 (100) Unsafe sex with primary partner 64 (36) Unsafe sex with casual partner 7 (4) Exchanged sex for money 31 (17)Average Age (SD) 33 (8)HIV and HCV Serostatus 178 (100) HIV Seropositive 9 (5) HCV Seropositive 76 (43)

N (%)Sexual Risk Behaviors 178 (100)


HIV by Years Injecting

Years Injecting N HIV- (%)All 451 (74.79)Less than one year 44 (97.78)1-2 years 62 (93.94)3-4 years 63 (94.03)5-6 years 59 (84.29)7-10 years 83 (69.17)11 years or more 140 (59.57)Years Injecting N HIV- (%)All 451 (74.79)Less than one year 44 (97.78)


HIV Incidence-Non-MSM Male New Injectors

Estimate of HIV incidence by prevalence among non-MSM male “new injectors”

1.2/100 person years (PY) at risk (95% CI: 0.24-3.4)

Estimate of HIV Incidence using slope of prevalence by years injecting

0.8/100 person years (PY) at risk (95% CI: 0.9-2.5)


Measurement of HIV in Population and Interventions in NYC and Hai Phong, 1995-

2020

NYC Hai Phong1995 2005 2014 2020 1995 2005 2014 2020

Measurement of HIV in Population

HIV Prevalence 50% 10% 10% 60% 25% 10%?

HIV Incidence 2/100 PY 1/100 PY 0.1/100 PY ? 1/100 PY0.1/100PY

?

Intervention

MMTP Yes Yes Yes Yes Yes Yes

NSP Yes Yes Yes Yes Yes Yes

ART No Yes Yes No Yes Yes

TasP No No Yes No No Yes?


Discussion-Declining Epidemic

Study found 25% HIV prevalence, a decrease from 68% (2006) and 48% (2009) among PWID

Low HIV prevalence (2.2%) among new PWID suggest further decline in new HIV infections

Compared to NYC Haiphong is approximately 10-15 years behind in ending the HIV epidemic among PWID

Time lag consistent with interventions for PWID


Limitations

Data primarily from large RDS survey

Possible social desirability bias and recall error in self-report data

Not enough MSM and FCSW to estimate HIV incidence for these groups


Conclusions and Recommendations

Maintaining current interventions in Haiphong would eventually lead to an end

of the HIV epidemic among PWID

Scale up of TasP should greatly accelerate decline in HIV infections, and an

end to the HIV epidemic among PWID would occur 5 to 10 years earlier

the 6 th national scientific conference on hiv/aids prospects for ending the hiv epidemic among...

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