Prospects for ending the HIV epidemic among persons who inject drugs in Haiphong, Vietnam

Abstract

Background To examine the prospects for “ending the HIV epidemic” among persons who inject drugs (PWID) in Haiphong, Vietnam. Reaching an incidence of < 0.5/100 person-years at risk (PY) was used as an operational definition for “ending the epidemic.” Methods A respondent driven sampling study of 603 PWID was conducted from September to October 2014. Current heroin use (verified with urine testing and marks of injection) was an eligibility requirement. A structured questionnaire was administered by trained interviewers to obtain demographic, drug use, and risk behavior data; HIV counseling and testing and HCV testing was also conducted. Two methods (by assuming all new injectors were HIV negative at first injection and by slope of prevalence by years injecting) were used for estimating HIV among persons injecting for < 5 years (“new injectors”). Comparisons were made to the HIV epidemic among PWID in New York City and modeling of the HIV epidemic in Can Tho province. Results HIV prevalence was 25% in 2014, down from 68% in 2006 and 48% in 2009; overall HCV prevalence in the study was 67%. Among HIV seropositive PWID, 33% reported receiving antiretroviral treatment. The great majority (83%) of subjects reported pharmacies as their primary source of needles and syringes and self-reported receptive and distributive syringe sharing were quite low (< 6%). Estimating HIV incidence among non-MSM male new injectors with the assumption that all were HIV negative at first injection gave a rate of 1.2/100 person-years (95% CI −0.24, 3.4). Estimating HIV incidence by the slope of prevalence by years injecting gave a rate of 0.8/100 person-years at risk (95% CI −0.9, 2.5) Conclusions The current HIV epidemic among PWID in Haiphong is in a declining phase, but estimated incidence among non-MSM new injectors is approximately 1/100 person-years and there is a substantial gap in provision of ART for HIV seropositives. Scaling up interventions, particularly HIV counseling and testing and antiretroviral treatment for all seropositive PWID, should accelerate the decline. Ending the epidemic is an attainable public health goal.

Regional differences between people who inject drugs in an HIV prevention trial integrating treatment and prevention (HPTN 074): a baseline analysis

“…For PWID in Vietnam, low levels of education may serve as a barrier for HIV and substance use treatment . We believe the limited number of females in Indonesia and Vietnam accurately reflects the population of PWID in these countries based on culture and historic precedence . The gender distribution in Ukraine is similar to the distribution in Russia and the Baltic States .…”

A New Era of HIV Risk: It's Not What You Know, It's Who You Know (and How Infectious)

“…For example, a rural community in the Midwestern US state of Indiana had a major outbreak of HIV in 2016 that reached 190 confirmed cases, with the estimated HIV prevalence going from 0% to 5% in just 2 years (Kalichman 2017). Similar outbreaks among injection drug users have occurred in Athens, Greece; Dublin, Ireland; and Tel Aviv, Israel, indicating the urgency of a unified approach to injection-related HIV prevention (Des Jarlais et al 2016b).…”

Test and Start for People Living With HIV and Who Use Drugs in Low and Middle Income Countries

“…35,36 People who use drugs face barriers to accessing antiretroviral treatment for HIV infection resulting in not only less receipt of anti-retroviral treatment but also poorer clinical outcomes when provided anti-retroviral treatment late in care. [37][38][39] For people who inject drugs, access to anti-retroviral treatment is very low with only one in three reported to receive treatment. 38 For those being released from incarceration back into the community, only one in ten may be receiving antiretroviral treatment.…”

“…[37][38][39] For people who inject drugs, access to anti-retroviral treatment is very low with only one in three reported to receive treatment. 38 For those being released from incarceration back into the community, only one in ten may be receiving antiretroviral treatment. 40 However, the integration of substance abuse treatment and HIV primary care can enhance the access to anti-retroviral treatment for people who use drugs, as well as, enhance the efficacy of anti-retroviral treatment for people who inject drugs.…”