HIV care continuum characteristics among people with opioid use disorder and HIV in Vietnam: baseline results from the BRAVO study

Caroline King,P Todd Korthuis,Gavin Bart,Lynn Kunkel,Le Minh Giang

doi:10.1186/s12889-020-08538-3

Abstract

BackgroundLittle is known about patient characteristics that contribute to initiating antiretroviral therapy (ART) and achieving viral suppression among HIV people with opioid use disorder in Vietnam. The primary objective of this analysis was to evaluate associations between participant characteristics and the critical steps in the HIV care continuum of ART initiation and HIV viral suppression among people with opioid use disorder and HIV in Vietnam.MethodsWe assessed baseline participant characteristics, ART status, and HIV viral suppression (HIV RNA PCR < 200 copies/mL) enrolled in a clinical trial of HIV clinic-based buprenorphine versus referral for methadone among people with opioid use disorder in Vietnam. We developed logistic regression models to identify characteristics associated with ART status and HIV viral suppression.ResultsAmong 283 study participants, 191 (67.5%) were prescribed ART at baseline, and 168 of those on ART (90%) were virally suppressed. Years since HIV diagnosis (aOR = 1.12, 95% CI 1.06, 1.19) and being married (aOR = 2.83, 95% CI 1.51, 5.34) were associated with an increased likelihood of current prescription for ART at baseline. Greater depression symptoms were negatively associated with receipt of ART (aOR = 0.97, 95% CI = (0.94, 0.9963)). In the HIV suppression model, once adjusting for all included covariates, only receipt of ART was associated with viral suppression (aOR = 25.9, 95% CI = (12.5, 53.8). In bivariate analyses, methamphetamine was negatively correlated with ART prescription (p = 0.07) and viral suppression (p = 0.08).ConclusionWhile fewer than 90% of participants had received ART, 90% of those on ART had achieved HIV viral suppression at baseline, suggesting that interventions to improve uptake of ART in Vietnam are essential for achieving UNAIDS 90–90-90 goals in people who use heroin in Vietnam. Social determinants of health associated with ART and HIV viral suppression suggest that social support may be a key to facilitating both of these steps in the HIV care continuum.

Highlights

Little is known about patient characteristics that contribute to initiating antiretroviral therapy (ART) and achieving viral suppression among human immunodeficiency virus (HIV) people with opioid use disorder in Vietnam
Opioid use disorder (OUD) and human immunodeficiency virus (HIV) are intertwined epidemics worldwide; around one-third of all new HIV infections outside of sub-Saharan African occur among people who inject drugs [1, 2]
In the HIV viral suppression model, only current ART use Discussion Our study indicates that the majority (67.5%) of people with OUD and HIV enrolling in the BRAVO study had already initiated ART at baseline; of those, 90% were virally suppressed, suggesting that further progress toward achieving the The Joint United Nations Programme on HIV/AIDS (UNAIDS) goal of 90% with HIV viral suppression in Vietnam hinges on increasing the proportion of people receiving ART

Summary

Introduction

Little is known about patient characteristics that contribute to initiating antiretroviral therapy (ART) and achieving viral suppression among HIV people with opioid use disorder in Vietnam. In Vietnam, people who use drugs experience even higher rates of HIV infection, with an estimated 60% of new HIV cases occurring among people who inject drugs [3]. In Vietnam, research is needed to explore what factors may impact aspects of the HIV care continuum, including antiretroviral therapy (ART) initiation and viral suppression, among people with opioid use disorder and HIV. Recent literature highlights systems-level factors that impact this care continuum in Vietnam, including the cost of treatment [5], care coordination, chronic disease management, and peer networks [6].

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