1 / 16

Duong Thi Huong, MD, PhD. Hai Phong University of Medicine and Pharmacy N ovember 24 th , 2015

The gaps in HIV control among people who inject drugs (PWID) in Hai Phong : Opportunities for interventions- findings from the DRIVE-IN study. Duong Thi Huong, MD, PhD. Hai Phong University of Medicine and Pharmacy N ovember 24 th , 2015 On behalf of DRIVE IN study group. Outline.

tobias
Download Presentation

Duong Thi Huong, MD, PhD. Hai Phong University of Medicine and Pharmacy N ovember 24 th , 2015

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The gaps in HIV control among people who inject drugs (PWID) in Hai Phong: Opportunities for interventions- findings from the DRIVE-IN study Duong Thi Huong, MD, PhD. Hai Phong University of Medicine and Pharmacy November 24th, 2015 On behalf of DRIVE IN study group

  2. Outline Background Objectives Methodology Results Discussion & conclusion

  3. Background In Vietnam, the HIV epidemic remains highly concentrated among people who inject drugs (PWID) despite the methadone maintenance therapy programme, harm reduction strategies and ARV treatment being available

  4. Objectives To provide an epidemiological assessment of the HIV and HCV epidemic To assess the cascade of care for HIV To study HIV/HCV risk behaviours: sexual health & drug use To assess the feasibility of implementing a cohort study of PWID in Hai Phong to demonstrate the efficacy of a community based intervention - combining prevention and care - to reduce HIV and HCV transmission

  5. Methodology • An international multidisciplinary consortium was built to study the feasibility of implementing a cohort study of PWIDs in Hai Phong • First phase: respondent-driven sampling (RDS) survey • Second phase: A longitudinal study with a 12 month follow-up of study participants (visits at week 4, 12, 24 and 52)

  6. RIVE-IN Drugs and viral Infections in Vietnam ANRS 12299

  7. Study population • RDS survey • Inclusion criteria • PWID, age > 18 years , with history of injecting drug use and confirmed by a positive urine test • Longitudinal study • Inclusion criteria • Having participated to the RDS survey (active PWID) • Exclusion criteria • Taking methadone maintenance therapy • Taking antiretroviral therapy • Health status not compatible with study follow-up • Plan to move away from Hai Phong in the next two years • Having been recently sentenced to a prison term

  8. HIV cascade of care

  9. HIV prevalence 603 Participants 45 FSW 49 MSM 90 EarlyInjectors 419 Other PWID  394 have never been tested for HIV 152 HIV+ (25.2%) 51 (33.6%) Currentlytaking ART 101 (66.4%) not on ART • 2/3 HIV+ are not treated, of those 53 (52.5%) have CD4 count ≤ 350

  10. Hypotheses • RDS used as a mass screening tool • Linkage to HIV outpatient clinics (OPC) and after positive HIV testing could be much improved by strong peer support • Access to methadone facilitated by peer groups • Peer network, supported by a local NGO • Feasibility / pilot study required • In addition, need estimates of HIV and HCV incidence • Feasibility to follow-up PWIDs in view of a future full scale intervention

  11. Lessons learned from the RDS • Vietnam has adopted the WHO guidelines: universal ART for HIV-positive PWIDs, but…. • Linkage to HIV outpatient clinics (OPC) after positive HIV testing unsatisfactory for asymptomatic patients: • Lack of family or social support to overcome logistical or regulatory challenges and obstacles • low motivation • low self-esteem • lack of information

  12. Longitudinal phase Participants enrolled 250 RDS participants enroled - 51HIV positive - 97 HCV uninfected - 27 FSW - 28 MSM - 41 earlyinjectors (<2 yearshistory of injection) - 1/3 single, 1/3 married, 1/3 divorced

  13. Follow-up results - Week 4: 95% follow-up (240/250) - Week 12: 92% follow-up (230/250) - Week 24: 86% follow-up (214/250) Reasons for discontinued follow-up at week 24: - 5 deaths: 1 AIDS-related, 2 suicides, 2 overdoses = annual mortality rate of 4% - 9 moved out to another province - 10 were jailed, 1 sent to ‘rehabilitation centre’ - 8 lost contact - 3 stopped their participation

  14. Peer support outcomes HIV referral for care Methadoneclinics

  15. HIV and HCV incidence HIV incidence - No seroconversion among 80 pers-years of follow-up - HIV Incidence ranging between 0 and 4.4/100 pers-years HCV incidence - 98 HCV-negative PWID atbaseline, 86 retestedatweek 24, 14 seroconverted => 31.8/100 pers-yrs (95%, 15.2-48.5) - Risk factors; no clear profile, not only recent injectors

  16. Acknowledgements France University of Montpellier Nicolas Nagot Didier Laureillard Jean-Pierre Moles Marianne Peries Roselyne Vallo Patricia Tabernero Centre Pierre Nicole, French Red Cross, Paris Laurent Michel UMR 988, Université Paris Descartes, Paris Marie Jauffret-Roustide Hôpital Européen Georges Pompidou, Paris Laurence Weiss USA Beth Israel Medical Center, New York Don Des Jarlais Vietnam Center for Supporting Community Development Initiatives (SCDI), Hanoi Khuat Thi Hai Oanh Nguyen Hoai Huong Nham Thi Tuyet Thanh Hai Phong University of Medicine & Pharmacy, Hai Phong Duong Thi Huong Hoang Thi Giang Pham Minh Khue Laboratory of the Provincial HIV/AIDS Center, Hai Phong Nguyen Thi Thoa Viettiep Hospital, Hai Phong Vu Hai Vinh Hai Phong Health Services, Hai Phong Vu Van Cong Institute for Social Development Studies, Hanoi Le Bach Duong Trang Giang Linh Nguyen Thi Phuong Thao

More Related