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.
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 language | English |
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Article number | 100718 |
Number of pages | 12 |
Journal | The Lancet Regional Health - Western Pacific |
Volume | 34 |
Early online date | 27 Feb 2023 |
DOIs | |
Publication status | E-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