Changes in HIV Incidence among People Who Inject Drugs in Taiwan following Introduction of a Harm Reduction Program: A Study of Two Cohorts

Huang, Yu-Ching; Yang, Jyh Yuan; Nelson, Kenrad E.; Kuo, Hsu Sung; Lew-Ting, Chin Yin; Yang, Chin-Hui; Chen, Chang Hsun; Chang, Feng Yee; Liu, Hui Rong

doi:10.1371/journal.pmed.1001625

PLoS Med

2014

DOI: 10.1371/journal.pmed.1001625

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Changes in HIV Incidence among People Who Inject Drugs in Taiwan following Introduction of a Harm Reduction Program: A Study of Two Cohorts

Yu-Ching Huang

Jyh Yuan Yang

Kenrad E. Nelson

et al.

Abstract: Kenrad Nelson and colleagues report on the association between HIV incidence and exposure to a national harm-reduction program among people who inject drugs in Taiwan. Please see later in the article for the Editors' Summary

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Cited by 32 publications

(28 citation statements)

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“…Injection of illegal drugs has known as a global health problem, mainly because of its relationship with high level of HIV prevalence, blood-borne infections, overdoses, and death (1)(2)(3)(4). People who inject drugs are at a higher risk of HIV and hepatitis C virus (HCV) transmission by sharing of injecting equipments (2)(3)(4)(5).…”

mentioning

confidence: 99%

“…People who inject drugs are at a higher risk of HIV and hepatitis C virus (HCV) transmission by sharing of injecting equipments (2)(3)(4)(5). Injecting drug users now account for one in 10 new HIV infections worldwide (6).…”

mentioning

confidence: 99%

“…Similarly, studies show that HIV/AIDS and HCV infection epidemics among people who inject drugs are high (3)(4)(5) with a range of 10% -15% for HIV and 31% -64% for HCV prevalence (4). Additionally, data come from the Middle East and North Africa suggest a high prevalence of sharing needles and syringes in the last injection (18% -28%), low levels of condom that ever used with (20% -54%), and sexual activities (15% -30%) among injection drug users (4).…”

mentioning

confidence: 99%

“…In response to this challenge, the prevention measurements such as harm reduction programs have been endorsed by some countries (2)(3)(4)(6)(7)(8). Harm reduction is a practical and non-judgmental set of resources and strategies to diminish the individual and community harms that caused by drug usage (3,6).…”

mentioning

confidence: 99%

“…There are sufficient evidences indicating the efficacy of harm reduction strategies on prevention of HIV and HCV transmission among people who inject drugs (2,4,5). A clear example for this is Taiwan cohort study (4) which demonstrated a significant reduction in HIV incidence after introduction and implementation of harm reduction program.…”

mentioning

confidence: 99%

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The Necessity of Enhanced Harm Reduction Programs to Prevent Blood-Borne Infections Amongst Injection Drug Users

2016

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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The Necessity of Enhanced Harm Reduction Programs to Prevent Blood-Borne Infections Amongst Injection Drug Users

2016

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Modelling the impact of HIV and HCV prevention and treatment interventions for people who inject drugs in Dar es Salaam, Tanzania

Fraser

Stone

Wisse³

et al. 2021

J Int AIDS Soc.

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Introduction People who inject drugs (PWID) in Dar es Salaam, Tanzania, have a high prevalence of HIV and hepatitis C virus (HCV). While needle and syringe programmes (NSP), opioid agonist therapy (OAT) and anti‐retroviral therapy (ART) are available in Tanzania, their coverage is sub‐optimal. We assess the impact of existing and scaled up harm reduction (HR) interventions on HIV and HCV transmission among PWID in Dar es Salaam. Methods An HIV and HCV transmission model among PWID in Tanzania was calibrated to data over 2006–2018 on HIV (∼30% and ∼67% prevalence in males and females in 2011) and HCV prevalence (∼16% in 2017), numbers on HR interventions (5254 ever on OAT in 2018, 766–1479 accessing NSP in 2017) and ART coverage (63.1% in 2015). We evaluated the impact of existing interventions in 2019 and impact by 2030 of scaling‐up the coverage of OAT (to 50% of PWID), NSP (75%, both combined termed “full HR”) and ART (81% with 90% virally suppressed) from 2019, reducing sexual HIV transmission by 50%, and/or HCV‐treating 10% of PWID infected with HCV annually. Results The model projects HIV and HCV prevalence of 19.0% (95% credibility interval: 16.4–21.2%) and 41.0% (24.4–49.0%) in 2019, respectively. For HIV, 24.6% (13.6–32.6%) and 70.3% (59.3–77.1%) of incident infections among male and female PWID are sexually transmitted, respectively. Due to their low coverage (22.8% for OAT, 16.3% for NSP in 2019), OAT and NSP averted 20.4% (12.9–24.7%) of HIV infections and 21.7% (17.0–25.2%) of HCV infections in 2019. Existing ART (68.5% coverage by 2019) averted 48.1% (29.7–64.3%) of HIV infections in 2019. Scaling up to full HR will reduce HIV and HCV incidence by 62.6% (52.5–74.0%) and 81.4% (56.7–81.4%), respectively, over 2019–2030; scaled up ART alongside full HR will decrease HIV incidence by 66.8% (55.6–77.5%), increasing to 81.5% (73.7–87.5%) when sexual risk is also reduced. HCV‐treatment alongside full HR will decrease HCV incidence by 92.4% (80.7–95.8%) by 2030. Conclusions Combination interventions, including sexual risk reduction and HCV treatment, are needed to eliminate HCV and HIV among PWID in Tanzania.

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Reaching the Unreached: Treatment as Prevention as a Workable Strategy to Mitigate HIV and Its Consequences in High-Risk Groups

Ogbuagu

Bruce

2014

Curr HIV/AIDS Rep

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While there have been significant advances in curbing the HIV disease epidemic worldwide, there continues to be significant number of incident cases with 2.3 million new infections in the year 2012 alone. Treatment as prevention (TasP), which involves the use of antiretroviral drugs to decrease the likelihood of HIV illness, death and transmission from infected individuals to their noninfected sexual and /or drug paraphernalia-sharing injecting partners, must be incorporated into any HIV prevention strategy that is going to be successful on a large scale. Especially in resource-limited settings, the focus of the prevention approach should be on high-risk groups who contribute disproportionately to community HIV transmission, including people who inject drugs (PWID), men who have sex with men (MSM) and sex workers. Innovative strategies including integrated care services adapted to different patient care settings have to and can be employed to reach these at-risk populations.

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Changes in HIV Incidence among People Who Inject Drugs in Taiwan following Introduction of a Harm Reduction Program: A Study of Two Cohorts

Abstract: Kenrad Nelson and colleagues report on the association between HIV incidence and exposure to a national harm-reduction program among people who inject drugs in Taiwan. Please see later in the article for the Editors' Summary

Cited by 32 publications

References 33 publications

The Necessity of Enhanced Harm Reduction Programs to Prevent Blood-Borne Infections Amongst Injection Drug Users

The Necessity of Enhanced Harm Reduction Programs to Prevent Blood-Borne Infections Amongst Injection Drug Users

Modelling the impact of HIV and HCV prevention and treatment interventions for people who inject drugs in Dar es Salaam, Tanzania

Reaching the Unreached: Treatment as Prevention as a Workable Strategy to Mitigate HIV and Its Consequences in High-Risk Groups

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