THE 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV AIDS

THE 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS 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, Ph. D. Hai Phong University of Medicine and Pharmacy November 24 th, 2015 On behalf of DRIVE IN study group

Outline • Background • Objectives • Methodology • Results • Discussion & conclusion The 6 th National Scientific Conference on HIV/AIDS

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 The 6 th National Scientific Conference on HIV/AIDS

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 The 6 th National Scientific Conference on HIV/AIDS

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) The 6 th National Scientific Conference on HIV/AIDS

RIVE-IN Drugs and viral Infections in Vietnam ANRS 12299 The 6 th National Scientific Conference on HIV/AIDS

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 The 6 th National Scientific Conference on HIV/AIDS

HIV cascade of care The 6 th National Scientific Conference on HIV/AIDS

HIV prevalence 603 Participants 45 FSW 49 MSM 90 Early Injectors 419 Other PWID 394 have never been tested for HIV 152 HIV+ (25. 2%) 51 (33. 6%) Currently taking ART 101 (66. 4%) not on ART 2/3 HIV+ are not treated, of those 53 (52. 5%) have CD 4 count ≤ 350 The 6 th National Scientific Conference on HIV/AIDS

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 The 6 th National Scientific Conference on HIV/AIDS

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

Longitudinal phase Participants enrolled 250 RDS participants enroled - 51 HIV positive - 97 HCV uninfected - 27 FSW - 28 MSM - 41 early injectors (<2 years history of injection) - 1/3 single, 1/3 married, 1/3 divorced The 6 th National Scientific Conference on HIV/AIDS

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 The 6 th National Scientific Conference on HIV/AIDS

Peer support outcomes HIV referral for care Number of participants CD 4 < 350 CD 4>350 Total 11 0 9 (23. 1%) 1 9 12 (30. 8%) Started on ART Registered for OPC but did not start ART Not registered in OPC Total 5 17 13 22 18 (46. 1%) 39 (100%) Methadone clinics W 0 W 24 Total Participants on MMT 20 94 114/247 (46%) - Interrupted MMT Registered but not initiated Not registered Total 0 20 4 23 110 227 4/114 (3. 5%) 23/247 (9. 3%) 110/247 (44, 5%) 247 The 6 th National Scientific Conference on HIV/AIDS

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 at baseline, 86 retested at week 24, 14 seroconverted => 31. 8/100 pers-yrs (95%, 15. 2 -48. 5) - Risk factors; no clear profile, not only recent injectors The 6 th National Scientific Conference on HIV/AIDS

Acknowledgements France Vietnam University of Montpellier Nicolas Nagot Didier Laureillard Jean-Pierre Moles Marianne Peries Roselyne Vallo Patricia Tabernero Center for Supporting Community Development Initiatives (SCDI), Hanoi Khuat Thi Hai Oanh Nguyen Hoai Huong Nham Thi Tuyet Thanh 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 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 The 6 th National Scientific Conference on HIV/AIDS