Trends in HIV incidence following scale-up of harm reduction interventions among people who inject drugs in Kachin, Myanmar, 2008-2020: Analysis of a retrospective cohort dataset

Anna McNaughton, Jack Stone, Khine Thet Oo, Zaw Zen Let, Mar Taw, Minn Thit Aung, Aung Myo Min, Aaron G Lim, Ernst Wisse, Peter T Vickerman*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

3 Citations (Scopus)

Abstract

Background: People who inject drugs (PWID) in Kachin, Myanmar, have a high HIV prevalence (>40%), but there is no data on incidence. We used HIV testing data from three harm reduction drop-in centres (DIC) in Kachin (2008-2020) to determine HIV incidence trends among PWID and associations with intervention uptake.

Methods: Individuals were HIV-tested at first DIC visit and periodically thereafter, during which demographic and risk behaviour data were collected. Two DIC provided opioid agonist therapy (OAT) from 2008. Monthly DIC-level needle/syringe provision (NSP) data was available from 2012. Site-level 6-monthly NSP coverage was denoted low, high, or medium if it was below the lower quartile, above upper quartile, between these quartiles of provision levels over 2012-2020, respectively. HIV incidence was estimated by linking subsequent test records for those initially HIV-negative. Associations with HIV incidence were examined using Cox regression.

Findings: Follow-up HIV testing data was available for 33.6% (2,227) of PWID initially testing HIV-negative, with 444 incident HIV infections during 6,266.5 person-years (py) of follow-up. Overall HIV incidence was 7.1 per 100py (95% confidence interval 6.5-7.8), which decreased from 19.3 (13.3-28.2) in 2008-11 to 5.2 per 100py (4.6-5.9) in 2017-20. In the full PWID incidence dataset after adjustment for various factors, recent (≤6weeks) injecting (aHR 1.74, 1.35-2.25) and needle sharing (aHR 2.00, 1.48-2.70) were associated with higher incidence, while longer injection careers were associated with reduced incidence (aHR 0.54, 0.34-0.86, for 2-5yrs vs
Interpretation: Although HIV incidence is high among PWID in Kachin, data suggests it has decreased since the scale-up in harm reduction interventions.
Original languageEnglish
Article number100718
Number of pages12
JournalThe Lancet Regional Health - Western Pacific
Volume34
Early online date27 Feb 2023
DOIs
Publication statusE-pub ahead of print - 27 Feb 2023

Bibliographical note

Funding Information:
The study was funded Médecins du Monde . J.S., A.G.L. and P.V. acknowledge support from the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol . P.V. and J.S. acknowledge support from U.S. National Institute on Drug Abuse (NIDA grant numbers R01 AI147490 , R01 DA037773 , R21 DA046809 and R01 DA047952 and R01 DA033679 ). P.V. also acknowledges support from the Wellcome Trust . We would also like to acknowledge the contributions of the many people involved over the years in the harm reduction initiatives in Kachin, and we particularly thank the community of people who use drugs and the peer workers that are leading the Médecins du Monde prevention work in the region.

Funding Information:
US NIH, Médecins du Monde.The study was funded Médecins du Monde. J.S. A.G.L. and P.V. acknowledge support from the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at the University of Bristol. P.V. and J.S. acknowledge support from U.S. National Institute on Drug Abuse (NIDA grant numbers R01 AI147490, R01 DA037773, R21 DA046809 and R01 DA047952 and R01 DA033679). P.V. also acknowledges support from the Wellcome Trust. We would also like to acknowledge the contributions of the many people involved over the years in the harm reduction initiatives in Kachin, and we particularly thank the community of people who use drugs and the peer workers that are leading the Médecins du Monde prevention work in the region.

Publisher Copyright:
© 2023 The Authors

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