A prospective “test‐and‐treat” demonstration project among people who inject drugs in Vietnam

• Published in: Journal of the International AIDS Society Vol. 21; no. 7; pp. e25151 - n/a
• Main Authors: Nguyen, Hai H, Bui, Duong D, Dinh, Thuy TT, Pham, Loc Q, Nguyen, Van TT, Tran, Tram H, Pham, Thang H, Nguyen, Sang M, Suthar, Amitabh B, Do, Nhan T, Ford, Nathan, Lo, Ying‐Ru, Nguyen, Long Hoang, Giang, Le M, Kato, Masaya
• Format: Journal Article
• Language: English
• Published: Switzerland International AIDS Society 01-07-2018; John Wiley & Sons, Inc; John Wiley and Sons Inc
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Antiretroviral agents; Antiretroviral drugs; antiretroviral therapy; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Cohort Studies; Control; Disease transmission; Dosage and administration; Drug therapy; Drug use; Female; HIV; HIV infections; HIV Infections - drug therapy; HIV Infections - etiology; Human immunodeficiency virus; Humans; Infections; Male; Medical personnel; Medical tests; Opiate Substitution Treatment; Outpatient care facilities; people who inject drugs; Prevalence; Prevention; Prospective Studies; Provinces; Retention; Retrospective Studies; risk behaviour; Risk factors; Risk-Taking; Studies; Substance Abuse, Intravenous - complications; Surveillance; test‐and‐treat; Vietnam; Vietnam - epidemiology; viral suppression; Vietnam; test-and-treat; Vietnam; antiretroviral therapy; people who inject drugs; risk behaviour; viral suppression; retention
• DOI: 10.1002/jia2.25151
• EISSN: 1758-2652

Introduction
Modelling suggests that early diagnosis and immediate antiretroviral therapy (ART) among key populations would have a substantial impact in reducing HIV transmission and mortality in Vietnam. An implementation research project of “test‐and‐treat” among people who inject drugs (PWID) was developed to inform effective roll‐out of such interventions.
Methods
“Test‐and‐treat” was offered to PWID in two high burden provinces, Thai Nguyen and Thanh Hoa. The interventions comprised the offer of biannual HIV testing and immediate ART, irrespective of CD4 count. PWID were enrolled between April 2014 and July 2015 and followed up for 12 months, and retention, HIV viral load (VL) and risk behaviours were assessed. Retention in care of this prospective cohort was compared with the retention among men enrolled in care in the preceding period (April 2012 to March 2013) at the same clinics when ART was initiated at CD4 cell count ≤350 cells/mm3.
Results
In total, 287 HIV positive PWID started immediate ART. The majority (98%) were men; median age was 34; and median (interquartile range) CD4 count was 199 (50 to 402) cells/mm3. After 12 months, 238 participants (83%) were retained on ART, and 205 achieved viral suppression (<1000 copies/mL) (92% among those in whom VL was measured, 71% overall). Baseline CD4 count ≤100 cells/mm3 and history of imprisonment were associated with lower retention and viral suppression, while engagement in methadone maintenance was associated with higher retention. Retention in care was higher in the “test‐and‐treat” cohort (83%) compared with men enrolled in care in the preceding period (78%), primarily because lost‐to‐follow‐up during pre‐ART care was eliminated. No decline in consistent condom use and clean needle use was observed.
Conclusions
Early ART initiation resulted in successful treatment outcomes among PWID, with no observed increase in self‐reported risk behaviours, suggesting feasibility and potential effectiveness of “test‐and‐treat” approach. The results also call for differentiated care for PWID, including promoting early diagnosis and engagement in methadone maintenance therapy while enhancing care for those with advanced HIV disease and history of imprisonment.