Controlling HIV epidemics among injection drug users: eight years of Cross-Border HIV prevention interventions in Vietnam and China.

Theodore M Hammett,Ryan Kling,Tho Huu Nguyen,Wei Liu,Yi Chen,Punneeporn Wasinrapee,Janet M Mcnicholl,J Stephen Mcdougal,Binh Thanh Kieu,Tren Van Hoang,Donghua Meng,Don C Des Jarlais,Ngu Doan,Quyen Ngoc Hoang,Sten H Vermund

doi:10.1371/journal.pone.0043141

Abstract

IntroductionHIV in Vietnam and Southern China is driven by injection drug use. We have implemented HIV prevention interventions for IDUs since 2002–2003 in Lang Son and Ha Giang Provinces, Vietnam and Ning Ming County (Guangxi), China.MethodsInterventions provide peer education and needle/syringe distribution. Evaluation employed serial cross-sectional surveys of IDUs 26 waves from 2002 to 2011, including interviews and HIV testing. Outcomes were HIV risk behaviors, HIV prevalence and incidence. HIV incidence estimation used two methods: 1) among new injectors from prevalence data; and 2) a capture enzyme immunoassay (BED testing) on all HIV+ samples.ResultsWe found significant declines in drug-related risk behaviors and sharp reductions in HIV prevalence among IDUs (Lang Son from 46% to 23% [p<0.001], Ning Ming: from 17% to 11% [p = 0.003], and Ha Giang: from 51% to 18% [p<0.001]), reductions not experienced in other provinces without such interventions. There were significant declines in HIV incidence to low levels among new injectors through 36–48 months, then some rebound, particularly in Ning Ming, but BED-based estimates revealed significant reductions in incidence through 96 months.DiscussionThis is one of the longest studies of HIV prevention among IDUs in Asia. The rebound in incidence among new injectors may reflect sexual transmission. BED-based estimates may overstate incidence (because of false-recent results in patients with long-term infection or on ARV treatment) but adjustment for false-recent results and survey responses on duration of infection generally confirm BED-based incidence trends. Combined trends from the two estimation methods show sharp declines in incidence to low levels. The significant downward trends in all primary outcome measures indicate that the Cross-Border interventions played an important role in bringing HIV epidemics among IDUs under control. The Cross-Border project offers a model of HIV prevention for IDUs that should be considered for large-scale replication.

Highlights

HIV in Vietnam and Southern China is driven by injection drug use
There are more than 200,000 injection drug users (IDUs) in Vietnam, with an overall HIV prevalence of 30%; approximately 60% of all reported HIV cases have been among IDUs [3] (National Institute of Hygiene and Epidemiology and FHI360, unpublished data, 2009)
This paper presents a long-term evaluation of the CrossBorder HIV Prevention Project for IDUs in Southern China and Northern Vietnam

Summary

Introduction

HIV in Vietnam and Southern China is driven by injection drug use. HIV prevalence among the 16 million injection drug users (IDUs) worldwide is estimated at 19% [1]. Injection drug use is driving HIV epidemics in many countries in Asia, the Middle East, and Eastern Europe [1]. This is true in southern China and all of Vietnam. In China, there are between 1.8 and 3 million IDUs (0.4%–0.6% of the male population aged 15– 64), with national HIV prevalence estimated at 8%–19% [1]. Prevalence is higher than 50% in several provinces and about 32% of HIV infections are attributed to injection drug use [4]

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