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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
-m
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!