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Pachuau LN, Tannous C, Chawngthu RL, Agho KE. Mortality among HIV-Positive and HIV-Negative People Who Inject Drugs in Mizoram, Northeast India: A Repeated Cross-Sectional Study (2007-2021). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:874. [PMID: 39063451 PMCID: PMC11276842 DOI: 10.3390/ijerph21070874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/13/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024]
Abstract
Background: HIV and drug overdose continue to be the leading causes of death among people who inject drugs (PWID). Mizoram, a small state in the northeast of India, has the highest prevalence of HIV in India and a high HIV prevalence among PWID. Objective: To estimate the mortality among HIV-positive and HIV-negative PWID and to describe its associated factors. Methods: Cross-sectional datasets from the 2007-2021 Mizoram State AIDS Control Society (MSACS) data comprising 14626 PWID were analyzed. Logistic regression analysis was conducted to examine the factors associated with mortality among HIV-negative and HIV-positive PWID after adjusting for potential confounding factors. Results: Mortality among HIV-negative PWID declined by 59% between 2007 and 2021. The mortality rate among HIV-positive PWID also declined by 41% between 2007 and 2021. The multiple logistic regression analysis revealed that being divorced/separated/widowed (AOR = 1.41, 95% CI 1.03-1.94) remained positively associated with mortality among HIV-positive PWID. Mortality among HIV-negative PWID remained positively associated with ages of 24-34 years (AOR = 1.54, 95% CI 1.29-1.84) and above 35 years (AOR = 2.08, 95% CI 1.52-2.86), being divorced/separated/widowed (AOR = 1.28, 95% CI 1.02-1.61), and the sharing of needles/syringes (AOR = 1.28, 95% CI 1.34-2.00). Mortality among HIV-negative PWID was negatively associated with being married (AOR = 0.72, 95% CI 0.57-0.90), being employed (AOR = 0.77, 95% CI 0.64-0.94), and having a monthly income. Conclusions: The mortality rate among HIV-negative and HIV-positive PWID declined significantly between 2007 and 2021 in Mizoram. To further reduce mortality among PWID, interventions should target those sharing needles/syringes, those above 24 years of age, and unmarried participants.
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Affiliation(s)
- Lucy Ngaihbanglovi Pachuau
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia; (C.T.); (K.E.A.)
| | - Caterina Tannous
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia; (C.T.); (K.E.A.)
| | | | - Kingsley Emwinyore Agho
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia; (C.T.); (K.E.A.)
- Translational Health Research Institute (THRI), Western Sydney University, Campbelltown, NSW 2560, Australia
- African Vision Research Institute (AVRI), Westville Campus, University of KwaZulu-Natal, Durban 3629, South Africa
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Roussos S, Angelopoulos T, Cholongitas E, Savvanis S, Papadopoulos N, Kapatais A, Chounta A, Ioannidou P, Deutsch M, Manolakopoulos S, Sevastianos V, Papageorgiou MV, Vlachogiannakos I, Mela M, Elefsiniotis I, Vrakas S, Karagiannakis D, Pliarchopoulou F, Chaikalis S, Tsirogianni E, Psichogiou M, Kalamitsis G, Leobilla F, Paraskevis D, Malliori M, Goulis I, Papatheodoridis G, Hatzakis A, Sypsa V. High levels of all-cause mortality among people who inject drugs from 2018 to 2022. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104356. [PMID: 38394950 DOI: 10.1016/j.drugpo.2024.104356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Mortality among people who inject drugs (PWID) is high, with overdose and HIV infection being the main causes of death. In Greece, there have been no data on mortality, and two HIV outbreaks have been recorded in this population in the past decade. In this study, we aim to estimate the all-cause crude mortality rate and the standardised mortality ratio in this population during 2018-2022. METHODS PWID recruited from two community-based programs in Athens and Thessaloniki during 2018-2021 were interviewed and tested for HIV/HCV. Data on vital status (deceased/alive) and date of death were obtained from death registries through December 31, 2022. All-cause crude mortality rates (CMR) and standardised mortality ratios (SMR) were estimated. Determinants of mortality were assessed using Cox proportional-hazards model. RESULTS Of 2,530 participants, 301 died over 8,543 person-years (PYs) of follow-up. The CMR (95 % CI) was 3.52 (3.15-3.94) deaths per 100 PYs; 3.10 per 100 PYs (2.68-3.58) in Athens and 4.48 per 100 PYs (3.74-5.37) in Thessaloniki. An increasing trend in CMR was identified over 2018-2022 in Athens (from 2.90 to 4.11 per 100 PYs, 41.5 % increase, p = 0.018). The pooled SMR (95 % CI) was 15.86 (14.17-17.76) for both cities and was particularly increased in younger individuals, females, those injecting daily, not enrolled to opioid agonist treatment and HIV-infected individuals. Older age, living in Thessaloniki, Greek origin, homelessness, history of injection in the past 12 months, and HIV infection were independently associated with higher risk of death. CONCLUSION Mortality among PWID in the two largest cities (Athens and Thessaloniki) in Greece in 2018-2022 was high, with the population in Thessaloniki being particularly affected. The increasing trend in mortality in Athens may reflect the long-term impact of the COVID-19 pandemic. Preventive programs such as take-home naloxone, screening and treatment for HIV, are urgently needed.
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Affiliation(s)
- Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Angelopoulos
- Gastroenterology Resident, Gastroenterology Department, G.H.A. Korgialeneio Mpenakeio Hellenic Red Cross, Athens, Greece
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Savvanis
- Department of Internal Medicine, General Hospital of Athens "Elpis", Athens, Greece
| | - Nikolaos Papadopoulos
- 2nd Department of Internal Medicine, 401 General Army Hospital of Athens, Athens, Greece
| | - Andreas Kapatais
- 1st Department of Internal Medicine, Western Attica General Hospital "Agia Varvara", Athens, Greece
| | - Athina Chounta
- 4th Department of Internal Medicine, General University Hospital "Attikon", Athens, Greece
| | - Panagiota Ioannidou
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Melani Deutsch
- 2nd Academic Department of Internal Medicine, Hippokration General Hospital, Athens, Greece
| | - Spilios Manolakopoulos
- 2nd Academic Department of Internal Medicine, Hippokration General Hospital, Athens, Greece
| | | | - Maria-Vasiliki Papageorgiou
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Ioannis Vlachogiannakos
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Maria Mela
- Department of Gastroenterology, Evangelismos General Hospital, Athens, Greece
| | - Ioannis Elefsiniotis
- Department of Internal Medicine-Hepatogastroenterology, "Agioi Anargyroi" General and Oncology Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Vrakas
- Department of Gastroenterology, Tzaneion General Hospital of Piraeus, Piraeus, Greece
| | - Dimitrios Karagiannakis
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Fani Pliarchopoulou
- 4th Department of Internal Medicine, General University Hospital "Attikon", Athens, Greece
| | - Savvas Chaikalis
- Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted and Emerging Diseases, Athens, Greece
| | - Effrosyni Tsirogianni
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mina Psichogiou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Dimitrios Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Meni Malliori
- Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Goulis
- Fourth Department of Internal Medicine, Hippokratio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papatheodoridis
- Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", Athens, Greece
| | - Angelos Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Hellenic Scientific Society for the Study of AIDS, Sexually Transmitted and Emerging Diseases, Athens, Greece
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Dumchev K, Guo X, Ha TV, Djoerban Z, Zeziulin O, Go VF, Sarasvita R, Metzger DS, Latkin CA, Rose SM, Piwowar-Manning E, Richardson P, Hanscom B, Lancaster KE, Miller WC, Hoffman IF. Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial. BMC Infect Dis 2023; 23:319. [PMID: 37170118 PMCID: PMC10173611 DOI: 10.1186/s12879-023-08201-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 03/27/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION The HIV Prevention Trials Network (HPTN) 074 study demonstrated a positive effect of an integrated systems navigation and psychosocial counseling intervention on HIV treatment initiation, viral suppression, medication assisted treatment (MAT) enrollment, and risk of death among people who inject drugs (PWID). In this sub-study, we analyzed the incidence, causes, and predictors of death among HIV-infected and uninfected participants. METHODS The HPTN 074 randomized clinical trial was conducted in Indonesia, Ukraine, and Vietnam. HIV-infected PWID with unsuppressed viral load (indexes) were recruited together with at least one of their HIV-negative injection partners. Indexes were randomized in a 1:3 ratio to the intervention or standard of care. RESULTS The trial enrolled 502 index and 806 partner participants. Overall, 13% (66/502) of indexes and 3% (19/806) of partners died during follow-up (crude mortality rates 10.4 [95% CI 8.1-13.3] and 2.1 [1.3-3.3], respectively). These mortality rates were for indexes nearly 30 times and for partners 6 times higher than expected in a population of the same country, age, and gender (standardized mortality ratios 30.7 [23.7-39.0] and 5.8 [3.5-9.1], respectively). HIV-related causes, including a recent CD4 < 200 cells/μL, accounted for 50% of deaths among indexes. Among partners, medical conditions were the most common cause of death (47%). In the multivariable Cox model, the mortality among indexes was associated with sex (male versus female aHR = 4.2 [1.5-17.9]), CD4 count (≥ 200 versus < 200 cells/μL aHR = 0.3 [0.2-0.5]), depression (moderate-to-severe versus no/mild aHR = 2.6 [1.2-5.0]) and study arm (intervention versus control aHR = 0.4 [0.2-0.9]). Among partners, the study arm of the index remained the only significant predictor (intervention versus control aHR = 0.2 [0.0-0.9]) while controlling for the effect of MAT (never versus ever receiving MAT aHR = 2.4 [0.9-7.4]). CONCLUSIONS The results confirm that both HIV-infected and uninfected PWID remain at a starkly elevated risk of death compared to general population. Mortality related to HIV and other causes can be significantly reduced by scaling-up ART and MAT. Access to these life-saving treatments can be effectively improved by flexible integrated interventions, such as the one developed and tested in HPTN 074.
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Affiliation(s)
- Kostyantyn Dumchev
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, Kyiv, 04050, Ukraine.
| | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tran Viet Ha
- Dept. of Health Behavior, Gilings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zubairi Djoerban
- Depts. of Hematology, Medical Oncology, and Medicine, Univ. of Indonesia/ Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Oleksandr Zeziulin
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, Kyiv, 04050, Ukraine
| | - Vivian F Go
- Dept. of Health Behavior, Gilings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - David S Metzger
- HIV Prevention Research Division, Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carl A Latkin
- Dept. of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Scott M Rose
- Science Facilitation Department, Durham, North Carolina, FHI 360, USA
| | | | - Paul Richardson
- Dept. of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Brett Hanscom
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Kathryn E Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - William C Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Irving F Hoffman
- Dept. of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 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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Giang HT, Duc NQ, Khue PM, Quillet C, Oanh KTH, Thanh NTT, Vallo R, Feelemyer J, Vinh VH, Rapoud D, Michel L, Laureillard D, Moles JP, Jarlais DD, Nagot N, Huong DT. Gender Differences in HIV, HCV risk and Prevention Needs Among People who Inject drug in Vietnam. AIDS Behav 2022; 27:1989-1997. [PMID: 36441408 PMCID: PMC10149475 DOI: 10.1007/s10461-022-03932-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 11/30/2022]
Abstract
We examined gender differences among people who inject drug (PWID) in Hai Phong, Vietnam in term of blood-borne infections, risk behaviors, and access to care. Using respondent-driven-sampling surveys, we recruited 3146 PWID from 2016 to 2018. Inclusion criteria included a positive urine test for heroin and recent injection marks. There were 155 female PWID (4,9%), including 82 at RDS-2016, 32 at RDS-2017 and 38 at RDS-2018. The age mean was 36.3 ± 7.2 years. The majority of female PWID had less than high school education (90.9%) and were unemployed (51.3%). There was no difference in the proportion of HIV and HCV positive by gender. However, women had several significant differences in risk behaviors than men in multivariable logistic regression. Being a woman was independently associated with being unemployed, being a sex worker, having unstable housing, having uses drugs for less than 5 years, more use of methamphetamine, having a partner who ever injected drugs, and less access to methadone treatment. Interventions targeting female PWID are needed, possibly through community organizations and peer educators.
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Affiliation(s)
- Hoang Thi Giang
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam.
| | - Nguyen Quang Duc
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam
| | - Pham Minh Khue
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam
| | - Catherine Quillet
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | | | | | - Roselyne Vallo
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | | | - Vu Hai Vinh
- Dept of Infectious and Tropical Diseases, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Delphine Rapoud
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | - Laurent Michel
- Pierre Nicole Center, CESP/Inserm 1018, French Red Cross, Paris, France
| | - Didier Laureillard
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Nîmes, France
| | - Jean Pierre Moles
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | | | - Nicolas Nagot
- Pathogenesis and control of chronic & emerging infections, Etablissement Français du Sang, University of Montpellier, INSERM, University of Antilles, Montpellier, France
| | - Duong Thi Huong
- Faculty of Public Health, Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen district, Haiphong city, Vietnam
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6
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Duong HT, Moles JP, Pham KM, Vallo R, Hoang GT, Vu VH, Khuat OTH, Nham TTT, Nguyen DQ, Quillet C, Rapoud D, Van de Perre P, Castellani J, Feelemyer J, Michel L, Laureillard D, Jarlais DD, Nagot N. A community-based intervention to decrease the prevalence of HIV viremia among people who inject drugs in Vietnam. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 27:100538. [PMID: 35856068 PMCID: PMC9287471 DOI: 10.1016/j.lanwpc.2022.100538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND In most low-to-middle-income countries, HIV control at the population level among people who inject drugs (PWID) remains a major challenge. We aimed to demonstrate that an innovative intervention can identify HIV-positive PWID in the community who are not treated efficiently, and get them treated efficiently. METHODS Between 2016 and 2020, we implemented an intervention consisting of mass HIV screening of PWID using three annual respondent-driven sampling surveys (RDSS) and a post-intervention evaluation RDSS in community-based organisation (CBO) sites, coupled with peer support to facilitate/improve access to antiretroviral and methadone therapy in Haiphong, Vietnam. The primary outcome was the proportion of identified uncontrolled HIV-positive PWID who achieved viral control. We also estimated the potential effect of the intervention on the proportion of PWID with HIV RNA >1000 copies/mL among all PWID during the study period. FINDINGS Over the three RDSS, 3150 different PWID were screened, i.e. two-thirds of the estimated population size. They all injected heroin, their median age was of 39 years, 95% were male, 26.5% were HIV-infected, and 78.6% of the latter had HIV RNA ≤1000 copies/mL. Among the 177 PWID identified with an unsuppressed viral load, 73 (41.2%) achieved viral suppression at the final visit. HIV viremia decreased from 7.2% at baseline to 2.9% at the final RDSS (p<0.001). Up to 42% of this observed reduction may be explained by the intervention, in the absence of any external intervention targeting PWID during the study period. INTERPRETATION Mass community-based screening using RDSS coupled with CBO support is a powerful tool to rapidly identify untreated HIV-positive PWID and (re)link them to care. FUNDING NIDA (USA) and ANRS (France).
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Affiliation(s)
- Huong Thi Duong
- Department of Public Health, Haiphong University of Medicine and Pharmacy, Số 72A Nguyễn Bỉnh Khiêm, Ngô Quyền, Haiphong, Vietnam
| | - Jean-Pierre Moles
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France
| | - Khue Minh Pham
- Department of Public Health, Haiphong University of Medicine and Pharmacy, Số 72A Nguyễn Bỉnh Khiêm, Ngô Quyền, Haiphong, Vietnam
| | - Roselyne Vallo
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France
| | - Giang Thi Hoang
- Department of Public Health, Haiphong University of Medicine and Pharmacy, Số 72A Nguyễn Bỉnh Khiêm, Ngô Quyền, Haiphong, Vietnam
| | - Vinh Hai Vu
- Infectious and Tropical Diseases Department, Viet Tiep Hospital, 1 Nha Thuong Street, Le Chan Dis, Hai Phong City, Haiphong, Vietnam
| | - Oanh Thi Hai Khuat
- Supporting Community Development Initiatives, No.9 165/30 Alley, Thai Ha Street, Lang Ha Ward, Dong Da District, Hanoi, Vietnam
| | - Thanh Tuyet Thi Nham
- Supporting Community Development Initiatives, No.9 165/30 Alley, Thai Ha Street, Lang Ha Ward, Dong Da District, Hanoi, Vietnam
| | - Duc Quang Nguyen
- Department of Public Health, Haiphong University of Medicine and Pharmacy, Số 72A Nguyễn Bỉnh Khiêm, Ngô Quyền, Haiphong, Vietnam
| | - Catherine Quillet
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France
| | - Delphine Rapoud
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France
| | - Joëlle Castellani
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France
| | - Jonathan Feelemyer
- School of Global Public Health, New York University, 708 Broadway, New York, NY 10003, USA
| | - Laurent Michel
- Paris Saclay University, Pierre Nicole Center, French Red Cross, CESP Inserm UMRS 1018, Paris, France
| | - Didier Laureillard
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France
- Infectious Diseases Department, Caremeau University Hospital, Place du Professeur Robert Debré, 30029 Nîmes, France
| | - Don Des Jarlais
- School of Global Public Health, New York University, 708 Broadway, New York, NY 10003, USA
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic & Emerging Infections, University of Montpellier, INSERM, Etablissement Français du Sang, University of Antilles, Montpellier, 60 Rue de Navacelles, 34394 Montpellier, France
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Nguyen TT, Hoang GT, Nguyen DQ, Nguyen AH, Luong NA, Laureillard D, Nagot N, Des Jarlais D, Duong HT, Nham TTT, Khuat OTH, Pham KM, Le MS, Michel L, Rapoud D, Le GM. How has the COVID-19 epidemic affected the risk behaviors of people who inject drugs in a city with high harm reduction service coverage in Vietnam? A qualitative investigation. Harm Reduct J 2022; 19:6. [PMID: 35090482 PMCID: PMC8799429 DOI: 10.1186/s12954-021-00586-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
The COVID-19 outbreak disproportionally affects vulnerable populations including people who inject drugs (PWID). Social distancing and stay-at-home orders might result in a lack of access to medical and social services, poorer mental health, and financial precariousness, and thus, increases in HIV and HCV risk behaviors. This article explores how the HIV/HCV risk behaviors of PWID in Haiphong, a city with high harm reduction service coverage in Vietnam, changed during the early phase of the COVID-19 pandemic, and what shaped such changes, using the risk environment framework.
Method
We conducted three focus group discussions with peer outreach workers in May 2020 at the very end of the first lockdown, and 30 in-depth interviews with PWID between September and October 2020, after the second wave of infection in Vietnam. Discussions and interviews centered on the impact of the COVID-19 pandemic on their lives, and how their drug use and sexual behaviors changed as a result of the pandemic.
Results
The national shutdown of nonessential businesses due to the COVID-19 epidemic caused substantial economic challenges to participants, who mostly were in a precarious financial situation before the start of the epidemic. Unsafe injection is no longer an issue among our sample of PWID in Haiphong thanks to a combination of different factors, including high awareness of injection-related HIV/HCV risk and the availability of methadone treatment. However, group methamphetamine use as a means to cope with the boredom and stress related to COVID-19 was common during the lockdown. Sharing of smoking equipment was a standard practice. Female sex workers, especially those who were active heroin users, suffered most from COVID-related financial pressure and may have engaged in unsafe sex.
Conclusion
While unsafe drug injection might no longer be an issue, group methamphetamine use and unsafe sex were the two most worrisome HIV/HCV risk behaviors of PWID in Haiphong during the social distancing and lockdown periods. These elevated risks could continue beyond the enforced lockdown periods, given PWID in general, and PWID who are also sex workers in particular, have been disproportionately affected during the global crisis.
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Assessment of a psychiatric intervention at community level for people who inject drugs in a low-middle income country: the DRIVE-Mind cohort study in Hai Phong, Viet Nam. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 18:100337. [PMID: 35024661 PMCID: PMC8669310 DOI: 10.1016/j.lanwpc.2021.100337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Access to psychiatric care for people who inject drugs (PWID) is limited/absent and stigmatized in most low-middle-income countries (LMICs). Innovative interventions are needed. We aimed to describe and assess the impact of a community-based psychiatric intervention among PWID in Hai Phong, Vietnam Methods In a cohort study with one year psychiatric follow-up, PWID diagnosed with a psychotic disorder, a major depressive episode, or suicide risk, were recruited from the wider Drug-Related Infections in ViEtnam (DRIVE) project in the city of Hai Phong. The community-based psychiatric intervention included specialized follow-up (free consultations with psychiatrists, free medication, referral to mental health department for hospitalization when necessary) and support from community-based organisations (case management, harm reduction, administrative support, linkage to HIV care, methadone maintenance treatment and mental health support). The main outcome was reduction/remission of symptoms. Access to and retention in psychiatric care, quality-of-life and stigmatization were also measured pre and post-intervention. Findings Among the 1212 participants screened from March to May 2019, 271 met the inclusion criteria, 233 (86.3%) accepted the intervention and 170 completed the follow-up (72.9%). At inclusion, 80.6% were diagnosed with current depression, 44.7% with psychotic disorder and 42.4% with suicide risk. After a one-year follow-up, these proportions dropped to 15.9%, 21.8%, and 22.9% respectively. Quality-of-life and perceived stigma related to mental health were also significantly improved, while drug use decreased only marginally. Interpretation Community-based psychiatric interventions are both feasible and efficient in the Vietnamese context. Similar interventions should be implemented and evaluated in other, different LMICs. Funding : This work was supported by grants from NIDA (US) (#DA041978) and ANRS (France) (#13353). The funding agencies had no role in designing the research, data analyses, or preparation of the report.
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Key Words
- ANRS, French Agency for Research on AIDS and Viral Hepatitis
- CBO, community-based organization
- CGI, clinical global impression scale
- DRIVE, Drug-Related Infections in ViEtnam
- EQ5D5L, 5 levels/5 dimensions EuroQol instrument
- HIV, human immunodeficiency virus
- LMICs, low-middle income countries
- MINI, MINI international neuropsychiatric interview
- MMT, methadone maintenance treatment
- NIDA, National Institute on Drug Abuse
- PHQ, patient health questionnaire
- PWID, people who inject drugs
- RDS, respondent driven sampling
- SCDI, Supporting Community Development Initiatives
- VND, Vietnamese dong
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