TRENDS OF HIV PREVALENCE, NEEDLE SHARING, AND EXPOSURE TO HIV/AIDS

INTERVENTION AMONG PWID IN VIETNAM: IBBS RESULTS

Nguyen Anh Tuan

NATIONAL INSTITUTE OF HYGIENE AND EPIDEMIOLOGY

VIETNAM

Introduction• It was estimated 255,000 PLWAs in Vietnam in 2015 with 14,000 new

infections and 12,000 HIV/AIDS related deaths. More than 80% of PLWA was related to drug use and PWID

• Estimated number of PWID in 2015 is about 210,000

• HIV epidemic in Viet Nam comprises many sub-epidemics across the country and remains concentrated among people who inject drugs (PWID), men who have sex with men (MSM) and female sex workers (FSW)

• The complexity of Vietnam’s HIV/AIDS epidemic need the data for routine, high-quality sero-prevalence and behavioral data related to:

– Distribution, burden (e.g. incidence, prevalence), and changes in the epidemic and associated behaviors

– Estimation of program ‘coverage’ and service uptake– Impact of key HIV/AIDS intervention programs on risk factors,

transmission, and morbidity

HIV Surveillance System

• The first case HIV positive was detected in 1991.

• System of HIV/AIDS case reporting (1992): HIV/AIDS cases were reported from hospitals, clinics, provincial HIV/AIDS center, center for preventive medicine, ... in all 63 provinces.

• System of HIV sentinel surveillance - HSS (1994) (now reaches 40 provinces) in People who inject Drug (PWID), Female Sex Worker (FSW), and Men who have Sex with Men (MSM)

• Behavioral Surveillance Surveys – BSS (in 2000 and 2001) in PWID, FSW, and mobile groups

• Integrated Behavioral-Biological Survey (IBBS) was implementing 3 rounds (2005, 2009, 2013) among PWID, FSW, and MSM in 12 provinces of the most serious epidemic in Vietnam

HIV Surveillance System

• System of HIV sentinel surveillance integrated with behavioral indicators (HSS+) was implemented in 2010

• HIV incidence among the 6 sentinel groups were started in 2000.

• STI sentinel surveillance was starting in 2003 in 10 provinces

• HIV drug resistance surveillance was started in 2006

Estimated number of PLHIV in Vietnam, 1990 – 2020

19901992

19941996

19982000

20022004

20062008

20102012

20142016

20182020

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

Low scenario Medium scenario High scenario

Integrated Behavioral Biological Survey

• IBBSs were conducted 3 rounds in Vietnam (2005, 2009, 2013)

• Provided data to key stakeholders such as policy-makers, program managers, monitoring and evaluation officers, members of civil society, and development partners.

• Provided main data source in HIV/AIDS estimation and projection

• Primary objectives of IBBS are:

– To provide representative provincial-level estimates of HIV prevalence (current and trends over time) in PWID, FSW, and MSM

– To measure risk and preventive behaviors including sexual and drug-used behaviors as well as exposure to HIV/AIDS intervention programs

IBBS provinces

150 km

100 mi © d

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ap

s.c

om

Organizational Involvement

- Vietnam IBBS is a collaborative effort:• Vietnam Authority for HIV/AIDS Control (VAAC)• National Institute of Hygiene and Epidemiology (NIHE)• Pasteur Institutes• US Centers for Disease Control and Prevention (CDC)• FHI360• Selected Provincial AIDS Centers.

- Technical assistance by FHI, CDC, and USAID- Funding by PEPFAR

• Cross-sectional surveys were conducted in 2005, 2009 and 2013 among male PWID across 09 provinces of Vietnam

• Biologic and behavioral data were collected to obtain– HIV/STI prevalence, – CD4 count, viral load– HBV, HCV prevalence– Risk and preventive behaviors on sexual and drug-used behaviors– Exposure to HIV/AIDS intervention programs

Study Design

Collected Sample Size

Province 2005 2009 2013 Sampling Method

An Giang 300 300 375 RDS

Can Tho 299 277 515 RDS

Dien Bien NA 300 500 TLS

Ha Noi 296 300 500 RDS

Hai Phong 301 300 400 TLS

Ho Chi Minh City 296 310 500 RDS

Nghe An NA 300 400 TLS

Quang Ninh 266 300 420 TLS

Yen Bai NA 360 400 TLS

TOTAL 1,758 2,747 2,300 6,805

Sampling Method

Is target population hidden and invisible?

YES

RDS

NO

Is estimated population size less than/or about equal to required sample size?

YES

Take-all method

NO

Is estimated population size about double the required sample size?

YES

Systematic Random Sampling

NO

Time location with two- stage cluster sampling or Venue-day time sampling

Laboratory Testing

• Strategy III of WHO was used for HIV positive confirmation

• Plasma samples were tested using an EIA test Genscreen Ultra HIV

Ag/Ab (Biorad, US) for screening of HIV infection and confirmed by a

rapid test [Determine HIV-1/2 (Alere, Japan)] and EIA test Murex HIV

Ag/Ab Combination (DiaSorin, UK).

Statistical Analysis• STATA 12 was used to obtain point estimates and 95% confident intervals

for sample populations obtained through the TLS and take-all methods

• For TLS, sampling weights were calculated and applied to adjust for different sampling probabilities among participants.

• RDS Analyst 9.0 with successive sampling estimator (Gile’s estimator) was applied to all three rounds.

• In 2013, RDS Analyst was used for data analysis among PWID in only Ha Noi, Can Tho, HCMC, AnGiang. Point estimates and 95% confident intervals were calculated for the population estimates.

• Regression analysis and the Cochran-Armitage test were applied to test for statistical significance in trend among TLS and RDS samples, respectively, across 2005, 2009 and 2013.

Socio-Demographic Characteristics of PWID, 2013

Characteristic An Giang Can Tho HCMC Ha Noi Hai Phong

Nghe An Quang Ninh

Yen Bai Dien Bien

Age, years (n) 374 427 530 500 400 400 420 399 500Mean 27.1 31.7 31.8 35.0 34.9 30.8 34.8 37.4 33.7

Age group, years (n) 374 427 530 500 400 400 420 399 500< 20 11.7 8.9 2.0 2.7 1.4 5.2 1.8 0.2 2.9

20 to<25 34.3 19.0 8.6 13.3 8.0 21.8 6.7 7.3 12.625 to<30 25.2 22.9 26.4 15.0 17.8 23.2 18.2 13.1 24.5

>=30 28.8 49.2 63.0 69.0 72.8 49.8 73.3 79.4 60.0Monthly income, million VND (n)

372 427 530 500 400 389 419 390 500

Mean 3.2 4.2 5.0 3.9 8.0 3.5 3.2 3.2 3.3Age at first drug use, years (n) 374 427 530 500 400 386 419 372 496

Mean 20.8 22.4 20.5 24.0 23.7 22.5 24.7 26.3 23.1Duration of drug use, years (n) 374 426 508 473 400 386 419 372 496

Mean 6.2 8.7 11.0 11.0 11.3 8.3 10.1 10.7 10.5Duration of injection drug use, years (n)

374 426 530 500 400 389 418 376 496

Mean 5.7 7.0 8.2 7.9 7.7 6.5 7.8 7.7 5.6

Used Substance, 2013

Data source: IBBS 2013

0.0

20.0

40.0

60.0

80.0

100.099.5

26.9 24.7 24.019.0

14.9

4.1 2.7 2.2 0.7 0.4

HIV Prevalence Trends, 2005-2013

HIV prevalence, 2013

An Gi-

ang*

Can Tho*

HCMC* Hanoi* Hai Phong

Nghe An

Quang Ninh

Yen Bai Dien Bien

0

20

40

60

80

100

10.318.8

37.1

25.9

43.5

16.625.0 25.9

30.9

Trends in Needle Sharing in past 6 months, 2005-2013

Sex with Different Partners in Past 12 Months, 2013

Consistent Condom Use with Different Sex Partners in Past 12 months, 2013

HIV Testing and Received Results in Past Year, 2005-2013

Receiving Free Clean Syringes/Needles in Past Month, 2013

National HIV prevalence among MARP, Vietnam 1990 – 2020

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 20200.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

IDU FSW MSM

Distribution of New HIV Infections in Vietnam 2005 – 2020: Medium scenario

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 20200

5,000

10,000

15,000

20,000

25,000

MSM Low Risk Male Low Risk Female Male client of FSW FSW IDU

Summary

In general:• Overall trend of HIV prevalence were decreasing overtime, but still in

high prevalence (10.3-43.5%)• Overall trend of sharing needles and syringes in the past six months

were decreasing• Overall trend ever voluntarily tested for HIV over time were

increasing• Overall trend having HIV voluntarily testing and receiving results in

the past year were increasing in 4 (HN, QN, HCMC, CT), decreasing in 2 (HP, DB), and did not find difference in 3 (NA, YB, AG)

• Success in controlling the HIV epidemic among PWID will depend on their continued assess to clean needles/syringes and voluntary HIV testing.

Thank you!