IAS 2017 IASconference PROSPECT ENDING HIV EPIDEMIC AMONG

#IAS 2017 | @IAS_conference PROSPECT ENDING HIV EPIDEMIC AMONG PEOPLE WHO INJECTION DRUGS IN HAI PHONG VIETNAM NIDA RO 1 DA 041978 / ANRS 12353 DRIVE STUDY Duong Thi Huong, , Nicolas Nagot, Pham Minh Khue, Hoang Thi Giang, Nham Thi Tuyet Thanh, Khuat Thi Hai Oanh, Kamyar Arasteh, Jean Pierre Moles, Vu Hai Vinh, Roselyne Vallo, Catherine Quillet, Delphine Rapoud, Laurent Michel, Ted Hammett, Didier Laureillard, Nicolas Nagot, Jonathan Feelemyer and Don Des Jarlais, for the DRIVE STUDY TEAM

#IAS 2017 | @IAS_conference CONFLICTS OF INTEREST “No conflict of interest to declare”

#IAS 2017 | @IAS_conference Background Initial spread of HIV among persons who inject drugs (PWID) occurred in 1990 s in Hai Phong

#IAS 2017 | @IAS_conference Background Early national response relied on compulsory ‘rehabilitation centers’ Not Effective Interventions implemented targeting PWID: • Needle/syringe exchange program started in 2007 • Methadone maintenance started in 2008, with increased coverage in 2017 • Antiretroviral therapy (ART) for HIV seropositive started in 2005, with increased coverage in 2015

#IAS 2017 | @IAS_conference Methods DRIVE initiation phase (DRIVE-IN): • Community-based RDS recruiting 603 ‘active PWID’ • 199 HIV-negatives: 1 year follow-up • 51 HIV-positives: feasibility of peer support for access to ART & MMT DRIVE project RDS implemented to address HIV: • increase HIV screening coverage through 4 annual large RDS • improve access to MMT and ART through peer support 1 st RDS completed in Jan 2017, with N = 1385 enrolled

#IAS 2017 | @IAS_conference HIV/HCV testing & ART 2014 RDS (N=603) 2017 RDS (N=1385) HIV positive 152 (25. 2%) 412 (29. 8%) HCV positive 403 (66. 8%) 973 (70. 5%) 5. 5% ? 59 (39%) 282 (68%) Self Report Sharing Syringes Currently on ART

#IAS 2017 | @IAS_conference HIV incidence & population viral load 2017 RDS: Undetectable viral load (1000 copies/m. L): 303/400 (76%) Undetectable viral load (50 copies/m. L): 271/400 (68%) => PWID viremia prevalence = 7% (15% in DRIVE-IN) No HIV seroconversion in DRIVE-IN and between 2 RDS (>200 PY of follow-up) HCV prevalence = 70% HCV seroconversion approximately 21/100 (PY)

#IAS 2017 | @IAS_conference DRIVE Cohort CBO Support for ART & MMT initiation M 0 M 9 860 727 (84. 5%) ART 282 311 (82. 2%) MMT 303 436 (50. 6%) Number of follow-up participants Health Insurance 445 (51. 7%)

#IAS 2017 | @IAS_conference The challenges to ART access • Proportion of HIV testing for new/unknown HIV infection in the city remains low • Delay in ART access because many PWID have no ID card which prevents from getting health insurance • Likelihood of increasing lost to follow-up of patients on ART who have to disclose their HIV status if they use health insurance for HIV care

#IAS 2017 | @IAS_conference Next steps • Further testing of the intervention • Use of very large sequential RDS as a testing tool to cover the majority of PWID • Peer groups • To support PWID to MMT and ART DRIVE goals for next 4 years: Ø Maintain very low HIV incidence Ø Reduce HCV incidence

#IAS 2017 | @IAS_conference France Acknowledgements University of Montpellier Nicolas Nagot Didier Laureillard Jean-Pierre Moles Marianne Peries Roselyne Vallo Catherine Quillet Delphine Rapoud Centre Pierre Nicole, French Red Cross, Paris Laurent Michel UMR 988, Université Paris Descartes, Paris Marie Jauffret-Roustide Hôpital Européen Georges Pompidou, Paris Laurence Weiss USA Beth Israel Medical Center, New York Don Des Jarlais Vietnam Center for Supporting Community Development Initiatives (SCDI), Hanoi Khuat Thi Hai Oanh Nguyen Hoai Huong Nham Thi Tuyet Thanh Hai Phong University of Medicine & Pharmacy, Hai Phong Duong Thi Huong Pham Minh Khue Hoang Thi Giang Laboratory of the Provincial HIV/AIDS Center, Hai Phong Nguyen Thi Thoa Viettiep Hospital, Hai Phong Vu Hai Vinh Hai Phong Health Services, Hai Phong Vu Van Cong Ha. Noi medical University Le Minh Giang Nguyen Thu Trang Community Base Organisation