TY - JOUR
T1 - Ending an HIV epidemic among persons who inject drugs in a middle-income country
T2 - Extremely low HIV incidence among persons who inject drugs in Hai Phong, Viet Nam
AU - des Jarlais, Don C.
AU - Huong, Duong Thi
AU - Oanh, Khuat Thi Hai
AU - Feelemyer, Jonathan P.
AU - Arasteh, Kamyar
AU - Khue, Pham Minh
AU - Giang, Hoang Thi
AU - Thanh, Nham Thi Tuyet
AU - Vinh, Vu Hai
AU - Le, Sao Mai
AU - Vallo, Roselyne
AU - Quillet, Catherine
AU - Rapoud, Delphine
AU - Michel, Laurent
AU - Laureillard, Didier
AU - Moles, Jean Pierre
AU - Nagot, Nicolas
N1 - Funding Information:
This work was supported by grants from NIDA (US) R01DA041978, R01DA003574, and ANRS (France) 12353. The funding agencies had no role in designing the research, data analyses, and preparation of the report.
Publisher Copyright:
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Objective: To determine whether it is possible to ‘end an HIV epidemic’ among persons who inject drugs (PWID) in a low/middle income country. Design: Serial cross-sectional surveys with a cohort of HIV seronegative participants with 6-month follow-up visits recruited from surveys. Methods: Surveys of PWID using respondent driven and snowball sampling were conducted in 2016, 2017, 2018, and 2019 (N ¼ 1383, 1451, 1444, and 1268). HIV recency testing was used to identify possible seroconversions in the window period prior to study entry. Structured interviews covering drug use histories, current drug use, and use of HIV-related services were administered by trained interviewers. Urinalysis was used to confirm current drug use. HIV and hepatitis C virus testing were conducted. Electronic fingerprint readers were used to avoid multiple participation in each survey and to link participants across surveys. A cohort of HIV seronegative participants with 6-month follow-up visits was recruited from the surveys, 480 from 2016, 233 from 2017, and 213 from 2018. Results: Participants were predominantly male (95%), mean age approximately 40, all reported injecting heroin, HIV prevalence ranged between 26 and 30%. We had three seroconversions in 1483 person-years at risk (PYAR) in the cohort study, and 0 in 696 PYAR among repeat survey participants, and 0 seroconversions in 1344 PYAR in recency testing. Overall HIV incidence was 0.085/100 PYAR, 95% confidence interval 0.02 – 0.25/100 PYAR. Conclusion: The data from Hai Phong clearly demonstrate that it is possible to achieve very low HIV incidence – ‘end an HIV epidemic’ – among PWID in a middle-income country.
AB - Objective: To determine whether it is possible to ‘end an HIV epidemic’ among persons who inject drugs (PWID) in a low/middle income country. Design: Serial cross-sectional surveys with a cohort of HIV seronegative participants with 6-month follow-up visits recruited from surveys. Methods: Surveys of PWID using respondent driven and snowball sampling were conducted in 2016, 2017, 2018, and 2019 (N ¼ 1383, 1451, 1444, and 1268). HIV recency testing was used to identify possible seroconversions in the window period prior to study entry. Structured interviews covering drug use histories, current drug use, and use of HIV-related services were administered by trained interviewers. Urinalysis was used to confirm current drug use. HIV and hepatitis C virus testing were conducted. Electronic fingerprint readers were used to avoid multiple participation in each survey and to link participants across surveys. A cohort of HIV seronegative participants with 6-month follow-up visits was recruited from the surveys, 480 from 2016, 233 from 2017, and 213 from 2018. Results: Participants were predominantly male (95%), mean age approximately 40, all reported injecting heroin, HIV prevalence ranged between 26 and 30%. We had three seroconversions in 1483 person-years at risk (PYAR) in the cohort study, and 0 in 696 PYAR among repeat survey participants, and 0 seroconversions in 1344 PYAR in recency testing. Overall HIV incidence was 0.085/100 PYAR, 95% confidence interval 0.02 – 0.25/100 PYAR. Conclusion: The data from Hai Phong clearly demonstrate that it is possible to achieve very low HIV incidence – ‘end an HIV epidemic’ – among PWID in a middle-income country.
KW - HIV
KW - Incidence
KW - Low/middle income countries
KW - Persons who inject drugs
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U2 - 10.1097/QAD.0000000000002712
DO - 10.1097/QAD.0000000000002712
M3 - Article
C2 - 33048884
AN - SCOPUS:85096347806
SN - 0269-9370
VL - 34
SP - 2305
EP - 2311
JO - AIDS
JF - AIDS
IS - 15
ER -