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Moulis L, Le SM, Hai VV, Huong DT, Minh KP, Oanh KTH, Rapoud D, Quillet C, Thi TTN, Vallo R, Hoang GT, Moles JP, Laureillard D, Feelemyer J, Des Jarlais DC, Michel L, Nagot N. Gender, homelessness, hospitalization and methamphetamine use fuel depression among people who inject drugs: implications for innovative prevention and care strategies. Front Psychiatry 2023; 14:1233844. [PMID: 38025448 PMCID: PMC10661402 DOI: 10.3389/fpsyt.2023.1233844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background The co-occurrence of substance use disorder and mental disorder, known as dual diagnosis, has a distressingly high prevalence among individuals grappling with either of these conditions. Mood disorders, especially depression, constitute a substantial burden for People Who Inject Drugs (PWID) and a significant public health concern in Vietnam. Identifying risk factors for depression in PWID is imperative for the development of targeted interventions. Methods We enrolled PWID into a cohort using the respondent-driven sampling method. Over a 36-month period, we systematically tracked the emergence of depression and employed multiple imputation in conjunction with a mixed nonlinear model to pinpoint risk factors for depression in this demographic. At inclusion, depression was screened using the PHQ-2 questionnaire, and subsequent episodes of depression were assessed semi-annually using the CES-D8. Results Three hundred and ninety-one PWID (26.6%) were depressed. Major risk factors for depression included being female, not having a permanent residency, having been hospitalized and using methamphetamine more than weekly. Other risk factors included age, being single, not having a health insurance card and not being on methadone. Limitations The exclusion of missing visits and social desirability could have led to selection and information biases. In this observational study, confusion biases are possible despite our best efforts. Conclusion Depression is alarmingly frequent in PWID. In this study taking in account the chronological relationship between sociodemographic and clinical factors and depression, risk factors were identified in this specific setting of low-to-middle income country. The findings highlight the need to develop innovative targeted psychiatric interventions with the help of supporting peers.
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Affiliation(s)
- Lionel Moulis
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Sao Mai Le
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Vinh Vu Hai
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Haiphong, Vietnam
| | - Duong Thi Huong
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Khuê Pham Minh
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | | | - Delphine Rapoud
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Catherine Quillet
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | | | - Roselyne Vallo
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Giang Thi Hoang
- Haiphong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Jean-Pierre Moles
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
| | - Didier Laureillard
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Nîmes, France
| | | | | | - Laurent Michel
- CESP Inserm UMRS, Pierre Nicole Center, Paris Saclay University, Fench Red Cross, Paris, France
| | - Nicolas Nagot
- PCCEI, University of Montpellier, INSERM, EFS, University of Antilles, Montpellier, France
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Wang H, Jonas KJ, Guadamuz TE. Chemsex and chemsex associated substance use among men who have sex with men in Asia: A systematic review and meta-analysis. Drug Alcohol Depend 2023; 243:109741. [PMID: 36630807 PMCID: PMC10435892 DOI: 10.1016/j.drugalcdep.2022.109741] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/11/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The prevalence of chemsex has been reported by multiple systematic reviews among men who have sex with men (MSM) focussing predominantly on the Global North. An Asian perspective with meta-analytical evidence is missing. This meta-analysis summarised the prevalence of substance use associated with chemsex, and chemsex activity among MSM and MSM sub-populations in Asia, as well as the likelihood for chemsex among MSM living with or without HIV. METHODS We utilized PubMed, Web of Science and medRxiv to search for literature describing chemsex and its associated substance use among MSM and MSM sub-populations in Asia from January 1, 2010 to November 1, 2021 to conduct three meta-analyses with both frequentist and Bayesian approaches. RESULTS We identified 219 studies and included 23 in the meta-analysis. Based on the frequentist models, methamphetamine was the default substance associated with chemsex among MSM in Asia (prevalence = 0.16, 95 %CI:0.09-0.22), followed by GHB/GBL (prevalence = 0.15, 95 %CI:0.03-0.27) and ketamine (prevalence = 0.08, 95 %CI:0.04-0.12), but hardly any cocaine (prevalence = 0.01, 95 %CI:0.00-0.03). Compared to a general MSM population (prevalence = 0.19, 95 %CI:0.15-0.23), MSM engaging in transactional sex showed a higher prevalence of chemsex (MSM sex work clients [prevalence = 0.28, 95 %CI:0.11-0.45]; MSM sex worker [prevalence = 0.28, 95 %CI:0.17-0.26]). MSM living with HIV also showed higher odds of chemsex activity (OR = 3.35, 95 %CI:1.57-7.10), compared to MSM living without HIV. Both meta-analytic models converged, indicating robust evidence. CONCLUSIONS Our meta-analyses showed that chemsex is not uncommon among MSM, and MSM engaging in transactional sex in Asia. We confirmed that MSM living with HIV have a higher likelihood of engaging in chemsex, too. Chemsex prevention and management strategies in Asia should be adjusted accordingly.
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Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.
| | - Thomas E Guadamuz
- Faculty of Social Sciences and Humanities, Mahidol University, Nakorn Pathom, Thailand; John F. Kennedy School of Government, Harvard University, Cambridge, MA, USA.
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Giang HT, Duc NQ, Molès JP, Vinh VH, Nagot N, Thanh NTT, Huong DT, Oanh KTH, Khue PM, Mai LS, Trang NT, Ngoc PT, Quillet C, Feelemyer J, Vallo R, Michel L, Jarlais DD, Laureillard D, Rapoud D. "Maintaining HIV and HCV prevention and care for people who inject drugs despite COVID-19 in Hai Phong, Vietnam". THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103870. [PMID: 36244242 PMCID: PMC9489978 DOI: 10.1016/j.drugpo.2022.103870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/31/2022] [Accepted: 09/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND After the emergence of COVID-19, a one-month strict lockdown was imposed in April 2020 in Vietnam, followed by lighter social distancing restrictions over the year. We investigated whether those measures affected people who inject drugs (PWID) in terms of risk behaviors for HIV and HCV and access to prevention and care in the city of Haiphong, a historic hotspot for HIV and drug use. METHODOLOGY We carried out a 'before-after' study from 2019 to 2020 using respondent-driven sampling method to enroll PWID. They were interviewed on their socioeconomic situation, drug use and sexual behaviors, relations to care services and tested for drugs and methadone in the urine, for HIV, HCV, and HIV plasma viral load when HIV-positive. Changes following the restrictions were assessed by comparing 'before' to 'after' data. RESULTS 780 PWID were enrolled. Mean age was 44 years; 94% were male. All were actively injecting heroin 'before', versus 56% 'after'. Among those, frequency of consumption decreased from 24 to 17 days per month. No changes were observed in the frequency and practices of methamphetamine smoking. The proportion of PWID on MMT increased from 68.7% to 75.3%, and that of PWID engaging in risky behaviors related to drug injection decreased from 6.0% to 1.5%. No HIV seroconversions were observed; HCV incidence was 2.6/100 person-years (95% CI [0.7-6.7]). 9% of PWID reported a monthly income of less than 130USD 'before' versus 53% 'after'. CONCLUSION The case of Hai Phong shows that it is possible, during times of COVID-19 pandemic, to maintain access to harm reduction and care and to prevent HIV and HCV transmission among PWID in a resource-limited setting where severe social distancing restrictions are implemented. Further research is needed to assess the consequences of long-term economic difficulties and the impact of actual spread of SARS-Cov2 that has since emerged in Haiphong.
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Affiliation(s)
- Hoang Thi Giang
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam,Corresponding author
| | - Nguyen Quang Duc
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Jean-Pierre Molès
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Établissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Vu Hai Vinh
- Infectious and Tropical Diseases Department, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Établissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | | | - Duong Thi Huong
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Pham Minh Khue
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Le Sao Mai
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Pham Thi Ngoc
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Catherine Quillet
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Établissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | | | - Roselyne Vallo
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Établissement Français du Sang, University of Antilles-Guyane, Montpellier, France
| | - Laurent Michel
- CESP Inserm UMRS 1018, Paris Saclay University, Pierre Nicole Center, French Red Cross, Paris, France
| | - Don Des Jarlais
- New York University School of Global Public Health, New York, USA
| | - Didier Laureillard
- Infectious Diseases Department, Caremeau University Hospital, Nimes, France
| | - Delphine Rapoud
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Établissement Français du Sang, University of Antilles-Guyane, Montpellier, France
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Nguyen Quoc G, Nguyen Le Thao M, Bao A, Nguyen Anh N, Vu Thi Tuong V, Nguyen Thi Ngoc D, Phan L, Phan Minh T, Lam Ngoc T, Nguyen Thanh A, Nguyen Anh T, Nguyen Nguyen Nhu T, Nguyen Thi L, Nguyen Thuy Thanh V, Nguyen Minh H, Nguyen Minh T, Do Thuy An M, Nguyen Tri T, Tran Thi P, Pham Hong S, Tran Thi N, Hoang Thai A, Duong Thi My H, Cooke GS, Chambers M, Van Nuil JI. Mapping for Engagement: Setting up a Community Based Participatory Research Project to Reach Underserved Communities at Risk for Hepatitis C in Ho Chi Minh City, Vietnam. Front Public Health 2022; 10:795470. [PMID: 35223733 PMCID: PMC8863677 DOI: 10.3389/fpubh.2022.795470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Approximately 1. 07 million people in Vietnam are infected with hepatitis C virus (HCV). To address this epidemic, the South East Asian Research Collaborative in Hepatitis (SEARCH) launched a 600-patient cohort study and two clinical trials, both investigating shortened treatment strategies for chronic HCV infection with direct-acting antiviral drugs. We conducted ethnographic research with a subset of trial participants and found that the majority were aware of HCV infection and its implications and were motivated to seek treatment. However, people who inject drugs (PWID), and other groups at risk for HCV were under-represented, although injecting drug use is associated with high rates of HCV. MATERIAL AND METHODS We designed a community-based participatory research (CBPR) study to engage in dialogues surrounding HCV and other community-prioritized health issues with underserved groups at risk for HCV in Ho Chi Minh City. The project consists of three phases: situation analysis, CBPR implementation, and dissemination. In this paper, we describe the results of the first phase (i.e., the situation analysis) in which we conducted desk research and organized stakeholder mapping meetings with representatives from local non-government and community-based organizations where we used participatory research methods to identify and analyze key stakeholders working with underserved populations. RESULTS Twenty six institutions or groups working with the key underserved populations were identified. Insights about the challenges and dynamics of underserved communities were also gathered. Two working groups made up of representatives from the NGO and CBO level were formed. DISCUSSION Using the information provided by local key stakeholders to shape the project has helped us to build solid relationships, give the groups a sense of ownership from the early stages, and made the project more context specific. These steps are not only important preliminary steps for participatory studies but also for other research that takes place within the communities.
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Affiliation(s)
| | | | - An Bao
- CBPR Stakeholder Working Group, Ho Chi Minh City, Vietnam
| | | | | | | | - Loc Phan
- CBPR Stakeholder Working Group, Ho Chi Minh City, Vietnam
| | - Thai Phan Minh
- CBPR Stakeholder Working Group, Ho Chi Minh City, Vietnam
| | - Thuy Lam Ngoc
- CBPR Stakeholder Working Group, Ho Chi Minh City, Vietnam
| | | | | | | | - Lan Nguyen Thi
- CBPR Stakeholder Working Group, Ho Chi Minh City, Vietnam
| | | | | | | | - My Do Thuy An
- CBPR Community Advisory Group, Ho Chi Minh City, Vietnam
| | | | - Phung Tran Thi
- CBPR Community Advisory Group, Ho Chi Minh City, Vietnam
| | - Son Pham Hong
- CBPR Community Advisory Group, Ho Chi Minh City, Vietnam
| | - Ngoc Tran Thi
- CBPR Community Advisory Group, Ho Chi Minh City, Vietnam
| | - Anh Hoang Thai
- CBPR Community Advisory Group, Ho Chi Minh City, Vietnam
| | | | - Graham S. Cooke
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Mary Chambers
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam,Centre for Topical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam,Centre for Topical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom,*Correspondence: Jennifer Ilo Van Nuil
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Dumchev K. Challenges of sexually transmitted infections and sexual health among people who inject drugs. Curr Opin Infect Dis 2022; 35:55-60. [PMID: 34799511 DOI: 10.1097/qco.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review provides a summary of recently published research on sexually transmitted infections (STI) and related behaviors among people who inject drugs (PWID), covering three major areas: sexual behavior and its role in STI transmission among PWID, multilevel factors associated with STI risk, and strategies addressing sexual health of PWID. This review is timely given the growing priority of combination prevention approaches and integrated care for PWID. RECENT FINDINGS Modern research improves the understanding that PWID have an increased risk of STI, which varies by gender, setting, type of substance used, and presence of mental disorders. Major socioeconomic and structural factors, specific and nonspecific to PWID, facilitate inequality and sexual risk behavior. Sexual transmission continues to contribute substantially to the spread of bloodborne infections among PWID, accounting for at least 10% of new HIV cases according to epidemiological modeling. Despite the substantial evidence that behavioral interventions can improve sexual health and reduce sex-related risks among PWID, there is a research-practice gap, reflected in the scarcity of implementation studies published recently. SUMMARY Integration of sexual health into prevention programs for PWID is essential to curb transmission of STI, including HIV, among PWID and their sexual partners.
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Vinh VH, Vallo R, Giang HT, Huong DT, Oanh KTH, Khue PM, Thanh NTT, Quillet C, Rapoud D, Michel L, de Perre PV, Feelemyer J, Moles JP, Cournil A, Jarlais DD, Laureillard D, Nagot N. A cohort study revealed high mortality among people who inject drugs in Hai Phong, Vietnam. J Clin Epidemiol 2021; 139:38-48. [PMID: 34280476 PMCID: PMC10116693 DOI: 10.1016/j.jclinepi.2021.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/28/2021] [Accepted: 07/12/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To estimate the residual mortality rate among people who inject drugs (PWID) in a Low-Middle Income Countries context where the HIV epidemic has been controlled and methadone coverage is high. STUDY DESIGN AND SETTING PWID from Haiphong, Vietnam, were recruited through three annual respondent-driven sampling surveys that fueled two cohorts of PWID with HIV (n = 761) and without HIV (n = 897), with bi-annual follow-up. Presumed causes of death were ascertained from medical records and/or interviews of participants family. RESULTS Among the 1658 participants with a median follow-up of 2 years, 67 and 36 died in the HIV-positive and HIV-negative cohort, respectively, yielding crude mortality rates of 4.3 (95% Confidence interval (CI): 3.3-5.4) per 100 person-years of follow-up (PYFU) and 1.9 (CI: 1.4-2.6) per 100 PYFU. In the HIV-positive cohort, in which 81% of participants had undetectable viral load, the two main causes of death were tuberculosis and HIV-related diseases. In the HIV-negative cohort, the two main causes of death were liver-related diseases and overdose. In a time-dependent multivariable model, "unsuppressed viral load" was associated with increased risk of mortality, whereas "being on methadone" or "being employed" was associated with a lower risk. CONCLUSION Despite a very successful HIV and methadone program, the mortality remains high among PWID in Vietnam, largely due to curable infectious diseases such as tuberculosis and viral hepatitis.
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Affiliation(s)
- Vu Hai Vinh
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Roselyne Vallo
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France
| | - Hoang Thi Giang
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Duong Thi Huong
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Pham Minh Khue
- Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Catherine Quillet
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France
| | - Delphine Rapoud
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France
| | - Laurent Michel
- Pierre Nicole Centre, French Red Cross, CESP/Inserm 1018, Paris, France
| | - Philippe Van de Perre
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France
| | | | - Jean Pierre Moles
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France.
| | - Amandine Cournil
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France
| | | | - Didier Laureillard
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France; Department of Infectious Diseases, Caremeau University Hospital, Nîmes, France
| | - Nicolas Nagot
- Pathogenesis and control of chronic infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, France.
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Jin F, Dore GJ, Matthews G, Luhmann N, Macdonald V, Bajis S, Baggaley R, Mathers B, Verster A, Grulich AE. Prevalence and incidence of hepatitis C virus infection in men who have sex with men: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 6:39-56. [PMID: 33217341 DOI: 10.1016/s2468-1253(20)30303-4] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/07/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND WHO has set targets for hepatitis C virus (HCV) elimination by 2030. We did a global systematic review of HCV prevalence and incidence in men who have sex with men (MSM) to provide updated estimates that can guide community education and public health policy. METHODS We did a systematic review and meta-analysis of studies published and listed on MEDLINE or Embase between Jan 1, 2000, and Oct 31, 2019, including conference proceedings. Studies were eligible if they reported measures of HCV prevalence or HCV incidence (or both) among MSM. Studies that relied on participants' self-reported HCV status with no laboratory confirmation were excluded. Pooled HCV estimates in MSM were stratified by HIV status and by injecting drug use, then by WHO region and by income level. Random-effects meta-analysis was done to account for between-study heterogeneity and examined using the I2 statistic. Pooled HCV prevalence was also compared with HCV estimates in the general population and presented as prevalence ratios (PRs). In HIV-negative MSM, incidence estimates were stratified by use of HIV pre-exposure prophylaxis (PrEP). The systematic review was registered with PROSPERO, number CRD42020156262. FINDINGS Of 1221 publications identified, 194 were deemed to be eligible and included in the systematic review and meta-analysis. Overall, the pooled HCV prevalence in MSM was 3·4% (95% CI 2·8-4·0; I2=98·0%) and was highest in Africa (5·8%, 2·5-10·4) and South-East Asia (5·0%, 0·0-16·6). Globally, HCV prevalence was 1·5% (1·0-2·1) in HIV-negative MSM and 6·3% (5·3-7·5) in HIV-positive MSM. Compared with the general population, HCV prevalence was slightly higher in HIV-negative MSM (PR 1·58, 95% CI 1·14-2·01) and markedly higher (6·22, 5·14-7·29) in HIV-positive MSM. Pooled HCV prevalence was substantially higher in MSM who had ever injected drugs (30·2%, 22·0-39·0) or currently injected drugs (45·6%, 21·6-70·7) than in those who never injected drugs (2·7%, 2·0-3·6). In HIV-negative MSM, the pooled HCV incidence was 0·12 per 1000 person-years (95% CI 0·00-0·72) in individuals not on PrEP and 14·80 per 1000 person-years (9·65-20·95) in individuals on PrEP. HCV incidence in HIV-positive MSM was 8·46 per 1000 person-years (6·78-10·32). INTERPRETATION HIV-positive MSM are at substantially increased risk of HCV. Overall, HIV-negative MSM had a slightly higher prevalence of HCV than the general population but had a lower prevalence than HIV-positive MSM. High HCV incidence in more recent PrEP studies suggests that as PrEP use increases, greater HCV transmission might occur. HCV burden in MSM varies considerably by region, which is likely to be associated with variation in the prevalence of injecting drug use and HIV. FUNDING World Health Organization.
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Affiliation(s)
- Fengyi Jin
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Niklas Luhmann
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Virginia Macdonald
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Sahar Bajis
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Rachel Baggaley
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Bradley Mathers
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Annette Verster
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Andrew E Grulich
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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Rashti R, Sharafi H, Alavian SM, Moradi Y, Mohamadi Bolbanabad A, Moradi G. Systematic Review and Meta-Analysis of Global Prevalence of HBsAg and HIV and HCV Antibodies among People Who Inject Drugs and Female Sex Workers. Pathogens 2020; 9:pathogens9060432. [PMID: 32486342 PMCID: PMC7350380 DOI: 10.3390/pathogens9060432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/01/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
The main objective of this study was to evaluate the prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), hepatitis C virus (HCV) and hepatitis B virus (HBV) and their co-infections among people who inject drugs (PWID) and female sex workers (FSWs). Data sources were searched from January 2008 to October 2018 in different databases. Data were analyzed in Stata 16 software using the Metaprop command. The results showed that the prevalence of HIV, HCV and HBV among PWID was 15%, 60% and 6%, respectively. The prevalence of HIV, HCV and HBV among FSWs was 5%, 1% and 3%, respectively. The prevalence of HIV/HCV, HIV/HBV, HCV/HBV and HIV/HCV/HBV co-infections among PWID was 13%, 2%, 3% and 2%, respectively. The prevalence of HIV/HCV and HIV/HBV co-infections among FSWs was 3% and 1%, respectively. The results show that the prevalence of HCV and HIV infections in PWID and the prevalence of HIV in FSWs is higher than their prevalence in the general population. Interventions for the prevention of HIV and HCV in PWID appear to be poor, and may not be sufficient to effectively prevent HIV and HCV transmission.
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Affiliation(s)
- Roya Rashti
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
| | - Heidar Sharafi
- Middle East Liver Diseases Center, Tehran 1598976513, Iran;
| | - Seyed Moayed Alavian
- Professor of Gastroenterology and Hepatology, Middle East Liver Disease Center, Tehran 1598976513, Iran;
| | - Yousef Moradi
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran 1449614535, Iran;
| | - Amjad Mohamadi Bolbanabad
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
| | - Ghobad Moradi
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj 6617713446, Iran; (R.R.); (A.M.B.)
- Correspondence:
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Le LVN, O’Connor S, Tran TH, Maher L, Kaldor J, Sabin K, Tran HV, Tran QD, Ho VAT, Nguyen TA. High hepatitis C virus infection among female sex workers in Viet Nam: strong correlation with HIV and injection drug use. Western Pac Surveill Response J 2019; 10:9-18. [PMID: 32110460 PMCID: PMC7024697 DOI: 10.5365/wpsar.2019.10.1.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The World Health Organization's guidelines on viral hepatitis testing and treatment recommend prioritizing high prevalence groups. Hepatitis C virus (HCV) infection disproportionately affects people who inject drugs and men who have sex with men, but data on female sex workers (FSW) are limited. The study aimed to determine active HCV infection and risk factors associated with HCV exposure among Vietnamese FSW. METHODS We surveyed 1886 women aged ≥ 18 years from Haiphong, Hanoi and Ho Chi Minh City who had sold sex in the last month. We tested for HCV antibody and HCV core antigen as markers for exposure to HCV and active infection, respectively. RESULTS Across these provinces, high prevalence of HCV exposure (8.8-30.4%) and active infection (3.6-22.1%) were observed. Significant associations with HCV exposure were HIV infection (aOR = 23.7; 95% CI: 14.8-37.9), injection drug use (aOR = 23.3; 95% CI: 13.1-41.4), history of compulsory detention (aOR = 2.5; 95% CI: 1.4-4.2) and having more than 10 sex clients in the last month (aOR = 1.9; 95% CI: 1.2-3.2). Among FSW who reported never injecting drugs, HIV infection (aOR = 24.2; 95% CI: 14.8-39.4), a history of non-injection drug use (aOR = 3.3, CI: 1.8-5.7), compulsory detention (aOR = 2.2; 95% CI: 1.2-4.0) and having over 10 sex clients in the last month (aOR = 2.2, 95% CI: 1.3-3.7) were independently associated with HCV exposure. DISCUSSION FSW have elevated HCV risks through sex- and drug-related pathways. These findings highlight the need to offer FSW-targeted HCV interventions and ensure their access to HIV prevention and treatment.
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Affiliation(s)
- Linh-Vi N Le
- Kirby Institute for Infection and Immunity, UNSW Sydney, Australia
| | - Siobhan O’Connor
- United States Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Tram Hong Tran
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
| | - Lisa Maher
- Kirby Institute for Infection and Immunity, UNSW Sydney, Australia
| | - John Kaldor
- Kirby Institute for Infection and Immunity, UNSW Sydney, Australia
| | | | | | - Quang Dai Tran
- General Department of Preventive Medicine, Ministry of Health, Hanoi, Viet Nam
| | - Van Anh Thi Ho
- United States Centers for Disease Control and Prevention, Hanoi, Viet Nam
| | - Tuan Anh Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam
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10
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Nguyen TT, Lemee V, Bollore K, Vu HV, Lacombe K, Thi XLT, Luong QA, Dubos C, Plantier JC, Thi HD, Laureillard D, Lemoine M, Tuaillon E. Confirmation of HCV viremia using HCV RNA and core antigen testing on dried blood spot in HIV infected peoples who inject drugs in Vietnam. BMC Infect Dis 2018; 18:622. [PMID: 30514229 PMCID: PMC6280470 DOI: 10.1186/s12879-018-3529-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/19/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Nucleic acid tests performed on blood samples collected on Dried Blood Spot (DBS) and detection of HCV core antigen (HCVcAg) are two approaches that may facilitate access to HCV diagnosis in low and middle incomes countries. In this study we evaluate HCV RNA and HCV antigen testing on DBS in HIV/HCV co-infected peoples who inject drugs in Vietnam. METHOD One hundred and four HIV/HCV seropositive patients managed in outpatient care at the Haiphong Viet Tiep hospital were included in this study from February to March, 2014 (ANRS 12262 study). RESULTS Eighty-six subjects were tested positive for HCV RNA in serum, median (IQR): 6.9 log10 IU/ml (5.6-7.4 log10 IU/ml). Genotypes consisted of 57 G1 (69%), 3 G3 (4%), and 22 G6 (27%). HCV RNA was detected on DBS specimens in 79 out 86 subjects with chronic hepatitis C (sensitivity 92.5%; 95% CI: 85.1-96.9%). HCV RNA level on DBS and serum was moderately correlated (r = 0.24; p = 0.05) suggesting a degradation of HCV RNA due to transportation and storage conditions. HCVcAg was detected in 75/86 dB specimens (sensitivity: 87.2%; 95% CI: 78.3-93.4%), with a strong positive relationship between DBS HCVcAg and serum HCV RNA levels (r = 0.80; P < 0.0001). CONCLUSIONS Quantification of HCVcAg on DBS appears to benefit from substantial stability under prolonged storage conditions but with a lower analytical sensitivity compared to DBS HCV RNA testing. Detection of HCV RNA on DBS is an interesting approach for confirming viral replication in HCV seropositive persons but the impact of pre-analytical conditions on the integrity of HCV RNA needs to be controlled.
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Affiliation(s)
- Truong Tam Nguyen
- University of Medicine Pham Ngoc Thach, Ho Chi Minh City, Vietnam
- Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Véronique Lemee
- Normandie Univ., CHU Rouen, Laboratoire de Virologie, Rouen, France
| | - Karine Bollore
- Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Hai Vinh Vu
- Department of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Karine Lacombe
- Department of Infectious and Tropical Diseases, Saint-Antoine Hospital, AP-HP, Sorbonne Universités, Université Paris 06, INSERM S 1136, iPLESP, Paris, France
| | | | | | - Charline Dubos
- Normandie Univ., CHU Rouen, Laboratoire de Virologie, Rouen, France
| | | | - Huong Duong Thi
- Department of Public Health, University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Didier Laureillard
- Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, CHU Nîmes, Montpellier, France
| | - Maud Lemoine
- Department of Hepatology, St Mary’s Hospital, Imperial College, London, UK
| | - Edouard Tuaillon
- Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, CHU Montpellier, Montpellier, France
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11
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The Dark Side of Female HIV Patient Care: Sexual and Reproductive Health Risks in Pre- and Post-Clinical Treatments. J Clin Med 2018; 7:jcm7110402. [PMID: 30384413 PMCID: PMC6262424 DOI: 10.3390/jcm7110402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/26/2018] [Accepted: 10/28/2018] [Indexed: 12/22/2022] Open
Abstract
This study examines the pre- and post-clinical issues in human immunodeficiency virus (HIV) care and treatment for women and girls of high-risk population groups—namely sex workers, injecting drug users, women living with HIV, primary sexual partners of people living with HIV, adolescent girls who are children of these groups, and migrant young girls and women—in five provinces and cities in Vietnam. Through a sample of 241 surveyed participants and 48 respondents for in-depth interviews and 32 respondents in the focus group discussions, the study identifies multiple barriers that keep these groups from receiving the proper health care that is well within their human rights. Most respondents rated HIV testing as easily accessible, yet only 18.9% of the surveyed women living with HIV disclosed their infection status, while 37.8% gave no information at the most recent prenatal care visit. The level of knowledge and proper practices of sexual and reproductive health (SRH) care also remains limited. Meanwhile, modern birth control methods have yet to be widely adopted among these populations: only 30.7% of respondents reported using condoms when having sex with their husband. This increases the risks of unwanted pregnancy and abortion, as well as vulnerability to sexually transmitted infections (STIs) and HIV transmission. On the other hand, HIV-related stigma and discrimination at health care settings are still pervasive, which create significant barriers for patients to access proper care services. Based on these results, six recommendations to improve SRH status of women and girls of populations at high risk are put forward.
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12
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Psychiatric Comorbidities among People Who Inject Drugs in Hai Phong, Vietnam: The Need for Screening and Innovative Interventions. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8346195. [PMID: 30402495 PMCID: PMC6193349 DOI: 10.1155/2018/8346195] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/09/2018] [Indexed: 12/23/2022]
Abstract
The objective of this study is to describe psychiatric comorbidities, associated factors, and access to psychiatric assessment and care in a cohort of people who inject drugs (PWID) in Hai Phong, Vietnam. Mental health was assessed after 12 months' follow-up using the Mini International Neuropsychiatric Interview questionnaire (MINI 5.0.0). PWID medical history, drug use, and sociodemographic and clinical characteristics were also collected. Among 188 PWID who participated in the assessment, 48 (25.5%) had at least one psychiatric disorder and 19 (10.1%) had 2 or more psychiatric disorders. The most common current psychiatric disorders were major depressive episode (12.2%) and psychotic disorder (4.8%), reaching 10.1% for the latter when lifetime prevalence was considered. Females were more likely than males to have at least one psychiatric disorder, a major depressive disorder, or an anxiety disorder. Methamphetamine use was associated with an increased risk of presenting a lifetime psychotic syndrome. Problematic alcohol consumption was associated with an increased risk of having at least one psychiatric disorder. Psychiatric comorbidities are frequent among PWID in Vietnam. These results highlight the need for routine assessment and innovative interventions to address mental health needs among PWID. Community-based interventions targeting mental health prevention and care should be strongly supported.
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13
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Nghiem VT, Bui TC, Nadol PP, Phan SH, Kieu BT, Kling R, Hammett TM. Prevalence and correlates of HIV infection among men who inject drugs in a remote area of Vietnam. Harm Reduct J 2018; 15:8. [PMID: 29444685 PMCID: PMC5813411 DOI: 10.1186/s12954-018-0210-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/19/2018] [Indexed: 11/13/2022] Open
Abstract
Background Lack of information on the HIV epidemic among men who inject drugs (MWID) in northwestern Vietnam, a remote area, may hamper national efforts to control the disease. We examined HIV prevalence, needle–syringe sharing behaviors, and associated factors among MWID in three areas of northwestern Vietnam. Methods We used descriptive analysis to report the characteristics, frequency of risk behaviors, and of access to healthcare services among the MWID. Univariable logistic regression was used to assess the associations between the HIV infection, needle–syringe sharing behaviors, and their independent variables. We further explored these associations in multivariable analyses where we included independent variables based on a priori knowledge and their associations with the dependent variables determined in univariable analyses (p < 0.25). Results The HIV prevalence was 37.9, 16.9, and 18.5% for Tuan Giao, Bat Xat, and Lao Cai City, respectively, and 25.4% overall. MWID of Thai minority ethnicity were more likely to be HIV-positive (adjusted odds ratio (AOR) 3.55; 95% confidence interval (CI) 1.84–6.87). The rate of needle–syringe sharing in the previous 6 months was approximately 9% among the MWID in Tuan Giao and Lao Cai City, and 27.8% in Bat Xat. Two thirds of the participants never underwent HIV testing before this study. Ever having been tested for HIV before this study was not associated with any needle–syringe sharing behaviors. Among the HIV-positive MWID, those who received free clean needles and syringes were less likely to give used needles and syringes to peers (AOR 0.21; 95% CI 0.06–0.79). Going to a “hotspot” in the previous week was associated with increased odds of needle–syringe sharing in multiple subgroups. Conclusion Our findings on HIV prevalence and testing participation among a subset of MWID in the northwestern Vietnam were corroborated with trend analysis results from the most recent HIV/STI Integrated Biological and Behavioral Surveillance report (data last collected in 2013.) We provided important insights into these MWID’s risky injection behaviors. We suggest heightened emphasis on HIV testing and needle and syringe provision for this population. Also, policymakers and program implementers should target hotspots as a main venue to tackle HIV epidemics.
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Affiliation(s)
- Van T Nghiem
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, 77030, USA. .,Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
| | - Thanh C Bui
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Patrick P Nadol
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Hanoi, Vietnam
| | - Son H Phan
- International Health Division, Abt Associates, Bethesda, MD, 20814, USA
| | | | - Ryan Kling
- U.S. Health Division, Abt Associates, Cambridge, MA, 02138, USA
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