THE DRIVE-IN PROJECT SUMMARY
Oct. 19, 2018
Tracing people who inject drugs (PWID) is extremely difficult, and the termination of the HIV epidemic among this group is still a big question. Therefore, "Ending HIV epidemics among PWID" project - DRIVE-IN stage was launched and deployed in Haiphong. After 20 months of implementation, DRIVE-IN has been managed to track 200 people, 80% of the total number of people involved in the project. This is an extremely impressive figure compared to the studies done on previous PWID groups. The final meeting of DRIVE-IN stage took place at Hanoi headquarters of the Center for Supporting Community Development Initiatives SCDI on 10th July 2016, did attract researchers and experts from relevant ministries and departments and created big resonance.
Ending HIV epidemic among PWID is achieved when no more than 1 new infection among 200 PWID in a year. This is happening in some cities like New York, Vancover, with commonality of implementing of combined intervention for PWID. Therefore, SCDI desires to implement combination intervention and achieve "ending HIV academic" in resource-constraint settings like Vietnam, in Hai Phong. It is known for the one with the highest number of people living with HIV in Vietnam (HIV prevalence among PWID was peaked at 60% in early 2000s), and also known for the comprehensive intervention program (needle and syringe, condom distribution, methadone maintenance and scaled-up ART).
FOR PWID =
| Distribution of clean needles and syringes
+ Oral substitution therapy for opiod dependence
|+ Facilitated HIV testing|
|+ Access to immediate ART for PWID who are HIV-infected|
Started during late 2014, the study included cross-sectional phase (RDS survey) on a total of 603 active injectors to learn about the evolution of HIV and the situation of treatment for PWID in Haiphong. Next, the results of cross-sectional phase provided information on the coverage of HIV, risky behaviors as well as HIV/HCV prevalence: HIV prevalence among PWID in Haiphong was still very high, 50 times of general population living in the same city. In addition, the prevalence of HCV was also worrisome, with 33% of new injecting infected with HCV, and high co-infection HIV/HCV prevalence (23%).
Longitudinal stage of the study involved long-term follow-up of 250 participants who were not in either methadone or HIV care at the time of the RDS survey, in order to determine the feasibility of implementing combined intervention on PWID who were hard to reach and have lower probability to be in services. In the longitudinal stage results, the factors that hinder the access to and use of treatment services in this sub-population were clarified. Other barriers, such as lack of motivation, registration costs of health insurance, lack of personal documents, methadone not desirable, and so on were also the main inhibiting factors for enrolment in HIV care. Therefore, in order to achieve the 90-90-90 targets set by UNAIDS, as well as the objectives of the National Strategy on HIV/AIDS, this sub-population should receive access and should be supported by many innovative intervention strategies.
Slide presentation about the longitudinal phase on 250 PWID. Photo credit: SCDI
|UNAIDS 90-90-90 objectives include:
- By 2020, 90% of all people living with HIV will know their HIV status.
- By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
- By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.
Research showed the probability of ending HIV epidemic with the promising indicators. After 6 months of combined intervention on more than 150 HIV-negative people, no conversion on HIV was recorded. Additionally, despite the challenges of participant drop-out or lost-to-follow-up, after 20 months, 200 on the total of 250 PWID of longitudinal study continue to be followed up, thanks to the strong cohesion with PWID communities through community-based organizations (CBOs). The CBOs played crucial roles in introducing, connecting PWID with treatment facilities, contributing to harm reduction, reintegrating PWID with their families.
However, big challenges were also set out for the study in the near future. Not only the very high HCV sero-conversion and co-infection HIV/HCV prevalence, but also mental health issues were taken into account. The field of mental health in PWID was underestimated and wasn’t focused on during this research, the rate of depression and suicide was high among participants (31%), they would also face risk of stigmatization in hospital, making high probability of abandoning treatment.
Epidemiologist Nicolas Nagot from Université de Montpellier, France presented DRIVE project design and 5-year plan.
Photo credit: SCDI
The summary seminar had shared research and experiences well as set out lessons to follow in the next 5 years. Dr. Hoang Dinh Canh - Deputy Director of Vietnam Administration of HIV/AIDS Control (VAAC) did appreciate the result and the quality of DRIVE-IN, pledged their support commitment to encourage other Departments and universities to participate further, and contributed to better focus-oriented research and policy advocacy, in line with the HIV/AIDS prevention recommended by the Ministry of Health.
|The DRIVE-IN project is to study the feasibility of DRIVE project (Drugs an Viral Infections in Vietnam) – an interventional research aiming at evaluating impacts of combined intervention on HIV incidence among PWID, towards the ending of HIV epidemic in Vietnam. The project was first implemented in Hai Phong, funded by the French Research Agency ANRS (France REcherche Nord&Sud Sida-HIV Hépatites) and NIDA (National Institute on Drug Abuse) in the United States.
This is the multinational, multi-agency study with many components, healthcare researchers and experts involved. Principal investigators include:
- Prof. Duong Thi Huong from Hai Phong Medical University
- Mr. Nicolas Nagot, Medical epidemiologist
- Dr. Khuat Thi Hai Oanh, Director of SCDI
- Dr. Don Des Jarlais
With the support and participation of other team members and participants, especially the very important contribution of 3 community-based organizations: Friendship Arms, Mimosa Flower and White Sand in Hai Phong.