High rates of HIV can decrease with community-based support.
Connecting individuals who inject drugs with large-scale HIV screening and peer support was found to reduce uncontrolled HIV among users by over 40%, according to a new study from researchers in Haiphong, Vietnam.
Haiphong suffered both heroin injection and HIV epidemics in the early 2000s. A large, lower middle-income country, Vietnam put resources towards increasing HIV care, but prevention and treatment for this stigmatized community is a challenge. Treatment is barred by stigma, cost, unstable housing, confidentiality, imprisonment, incarceration, and lack of awareness regarding antiretroviral therapy.
Don Des Jarlais, PhD, co-author of this study, a professor of epidemiology, and associate director of the Center for Drug Use and HIV/HCV Research (CDUHR) at the NYU School of Global Public Health, created the DRIVE (DRug use and blood-borne Infections in ViEtnam) intervention with colleagues to identify and effectively treat HIV-positive individuals in Haiphong who use injection drugs.
“Innovative strategies are needed to overcome these obstacles and increase access to HIV diagnosis and treatment among people who inject drugs, particularly in low- and middle-income countries with fewer resources,” Des Jarlais said in a press release.
From 2016 to 2019, DRIVE enrolled 3,150 people who inject heroin into their program using 4 annual community surveys. The participants were mostly men, representing approximately two-thirds of Haiphong’s injection users.
DRIVE engaged community-based organizations to conduct interviews, provide drug and HIV screening, and give case management and peer support that connects participants with drug treatment and HIV care. These services were effective for building trust, reducing stigma, and removing structural, social, and logistical barrier to receiving care.
“Widespread screening coupled with support from community-based organizations is a powerful tool for rapidly identifying untreated HIV-positive people who inject drugs and linking or reconnecting them to care,” according to senior author Nicolas Nagot, MD, PhD.
Testing revealed that 833 participants were HIV-positive and 177 had unsuppressed viral loads that, left untreated, could be fatal. In 2020, the results of the community-based initiative revealed that over 40% of participants with originally unsuppressed viral loads ended the intervention with suppressed viral loads because of antiretrovirals or improved treatment adherence.
HIV transmission potential also dropped by 60% by the end of the study. Additionally, after measuring the community HIV viral load, unsuppressed viral load in patients was reduced from 7.2% to just 2.9%.
“The approach used in Haiphong of combining HIV screening, prevention, and care for people who inject drugs can serve as an example for other low- and middle-income countries and illustrates that it is possible to end HIV epidemics in these populations,” lead author Huong Duong said in the press release.
The Global Fund to Fight AIDS, Tuberculosis, and Malaria is also helping to replicate this strategy in other provinces in Vietnam, according to Oanh Khuat, the executive director of the Center for Supporting Community Development Initiatives, a local NGO working to stop the spread of HIV.
Mass screening, peer support, and treatment reduce HIV in people who inject drugs. EurekAlert. News Release. July 19, 2022. Accessed July 20, 2022.