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Kai Wang Hongyun Fu Kim Longfield Shilpa Modi Gary Mundy Rebecca Firestone Evaluation 2013

Evaluating a HIV Prevention Program AMONG People Who Inject Drugs in Southwest China Using Coarsened Exact Matching (CEM). Kai Wang Hongyun Fu Kim Longfield Shilpa Modi Gary Mundy Rebecca Firestone Evaluation 2013 October 17, 2013. Overview of the Presentation. Background Methods

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Kai Wang Hongyun Fu Kim Longfield Shilpa Modi Gary Mundy Rebecca Firestone Evaluation 2013

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  1. Evaluating a HIV Prevention Program AMONG People Who Inject Drugs in SouthwestChina Using Coarsened Exact Matching (CEM) Kai Wang Hongyun Fu Kim Longfield ShilpaModi Gary Mundy Rebecca Firestone Evaluation 2013 October 17, 2013

  2. Overview of the Presentation Background Methods Results Conclusions

  3. HIV/AIDs in Yunnan and Guangxi • 1989: China reported first AIDS cases among 146 heroin users in Yunnan • Yunnan is located near the golden triangle. • The overall HIV prevalence in China is low (0.06%), however, the prevalence rates of HIV were among people who inject drugs (PWID) was 6.4%, with prevalence higher than 50% in parts of southwest China. • Yunnan and Guangxi Provinces account for 22% the total HIV cases in China despite making up only 6.9% of the national population in the country

  4. HXH - PSI directly implements community-based IDU CPP interventions (including Drop-In-Center based and outreach activities and outreach into MMT clinics and communities) and provide TA to the community rehabilitation and recovery centers run by the local government SAA– PSI, Pact and RTI provides capacity building to SAA to promote long-term sustainability of CPP interventions through local CBOs Daguan, Lianmeng , Xiyuanliangyuan , JinmaCHC – member of the Clinical Health Network (CHN), which provide HIV, STI, TB, Hepatitis screening and counseling for MARPs, in collaboration with Kunming Municipal AIDS Bureau Pact and RTI – Pact working with SAA to implement capacity development plans for 3 CBOs. RTI working with Yunnan Govt to operationalize the social Service Outsourcing (SSO) initiative Yunnan program sites map Poplar Tree- PSI providing TA and financial support to this IDU peer-led grassroots group to promote community based IDU CPP interventions KUNMING GEJIU MENGZI KangxinHome – PSI provided TA and financial support to this IDU peer-led grassroots group to promote community based IDU CPP interventions – support completed December 2012

  5. Background: Comprehensive HIV/AIDS Prevention Package (CPP) targeting MARPs Policy Stigma and Discrimination Behavioral Change CommunityMobilization HIV Counseling and Testing STI Treatment MARPsPLHA HarmReduction CondomDistribution StrategicInformation Livelihood Development Linkages to Careand Support CapacityBuilding

  6. Methods Summary of method: A behavioral tracking survey in 2012 (cross-sectional survey) Face to face interview (self-report data) Structured questionnaire Yunnan Institute for Drug Abuse IRB Review Respondent-driven sampling 1035 samples in four cities

  7. Methods - Sampling Respondent-driven Sampling (RDS) • Seeds Number: • 8 seeds in Kunming; 7 seeds in Nanning; • 4 seeds in Gejiu; 4 seeds in Luzhai. Wave: 12 waves (the best seed) Seeds selection Criteria: Age: <24; 24-40; >40. Gender: Male; Female. Current IDUs and Former IDUs. Current MMT user and non-user. Exposed; Non-exposed

  8. Methods - Including Criteria Study population: Participants were recruited from the social networks of PWID which were living in the local communities, and not residing in compulsory detox centers. • Aged 18-49 (as measured according to the Western calendar and determined by participant self report) • Had injected drugs in past 12 months • Resident in the communities in either Kunming city, Gejiu, Luzhai or Nanning city for a minimum of 1 month. • Can speak and comprehend Mandarin to a sufficient level to respond to survey questions

  9. Methods – Sample size Gejiu 204 Kunming 336 Nanning 355 Luzhai 11 140 In total: 1035

  10. Methods – Data Analysis RDS weights City weights Coarsened Exact Matching (CEM) weights Matching variables：1) Age; 2) Gender; 3) City 4); Working time (whether convenient to attend program activities); 5) Ever MMT use Results: 975 cases matched /1035 samples, L1 distance : 2.83 E-16 Logistic regression

  11. Results: Population Characteristics

  12. Results: Behaviors outcomes

  13. Results: Exposure to DiC and outreach

  14. Results: Effectiveness of DiC and outreach

  15. Results: Effectiveness of DiC and outreach

  16. Results: Effectiveness of DiC and outreach

  17. Results: Effectiveness of DiC and outreach

  18. Conclusion Peer-led programs reduced HIV risk among PWID. The DiC-based activities in Yunnan and Guangxi were successful at increasing safe injecting practices, HTC, and consistent condom use. Outreach coverage was low, especially in Guangxi province where the implementation model required building the technical capacity of government partners and grass roots organizations. Outreach was most effective for referring PWID into HTC, and appears to increase awareness of DiCs where PWID can receive more intensive services and private HTC. The CEM procedure improved the causal inference and gave stronger evidence for evaluating the impact.

  19. Thank you!Questions? PSI

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