HIV control programs reduce HIV incidence but not HCV incidence among people who inject drugs in HaiPhong, Vietnam

Jean-Pierre Molès,Roselyne Vallo,Nham Thi Tuyet Thanh,Laurent Michel,Vu Hai Vinh,Didier Laureillard,Duong Thi Huong,Khuat Thi Hai Oanh,Don Des Jarlais,Hoang Thi Giang,Nguyen Thi Thoa,Tuyet Anh Bui Thi,Nicolas Nagot,Marianne Peries,Jonathan Feelemyer,Kamyar Arasteh,Catherine Quillet,Pham Minh Khue

doi:10.1038/s41598-020-63990-w

Abstract

In Vietnam, harm reduction programs to control HIV among people who inject drugs (PWID) were implemented approximately 10 years ago. Since then, the HIV prevalence has declined in this population, however, the impact of these programs on the rate of new HIV and Hepatitis C (HCV) infections remains unknown as high mortality can exceed the rate of new infections. We evaluated HIV and HCV incidences in a cohort of active PWID in HaiPhong in 2014, who were recruited from a community-based respondent driven sampling (RDS) survey and followed for 1 year. Only HIV-negative or HCV-negative participants not on medication assisted treatment (MAT) were eligible. HIV/HCV serology was tested at enrollment and at 32- and 64-week follow-up visits. Among 603 RDS participants, 250 were enrolled in the cohort, including 199 HIV seronegative and 99 HCV seronegative PWID. No HIV seroconversion was reported during the 206 person-years (PY) of follow-up (HIV incidence of 0/100PY, one-sided 97.5%CI:0-1.8/100 PY). Eighteen HCV seroconversions were reported for an incidence of 19.4/100 PY (95%CI;11.5-30.7). In multivariate analysis, “Injecting more than twice daily” was associated with HCV seroconversion with an adjusted odds ratio of 5.8 (95%CI;1.8–18.1). In Hai Phong, in a context that demonstrates the effectiveness of HIV control programs, the HCV incidence remains high. New strategies such as mass access to HCV treatment should be evaluated in order to tackle HCV transmission among PWID.

Highlights

People who inject drugs (PWID) are at increased risk of blood borne infections
Out of the 603 respondent driven sampling (RDS) participants who reported using injection drugs, had recent skin marks of injection and had an injectable drug detected in urine, 384 met the cohort inclusion criteria and 250 were recruited (Fig. 1)
There was a relatively high odd ratio for “Having been arrested during the at-risk period” with HCV incidence in bivariate analysis (OR = 4.6). This association was not significant in either univariate or multivariable analysis but the power was low due to small numbers (n = 6 subjects arrested). This observational cohort study provides an in-depth studies of HIV and HCV incidence rates among active PWID in Hai Phong, Vietnam

Summary

Introduction

People who inject drugs (PWID) are at increased risk of blood borne infections. Among these infections, HIV and Hepatitis C (HCV) infections remain highly endemic in this high-risk group. Beginning in 2015, the country modified its legal and policy framework with support from international agencies (Global Fund to fight AIDS, tuberculosis and Malaria, President’s Emergency Plan for AIDS Relief) toward more evidence-based programs, including harm reduction through widespread needle and syringe provision (NSP), medication assisted treatment (MAT) and an increasing number of outpatient clinics for HIV care[3]. Both large scale access to sterile needles and syringes[4,5] and MAT6–8 have proved efficacious in reducing. Hai Phong was chosen as a model city to evaluate whether programmatic interventions which proved successful for eliminating HIV transmission among PWID in high income countries could be adapted to low/middle income countries

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