In Vietnam, where 58% of prevalent HIV cases are attributed to people who inject drugs, we evaluated whether a multi-level intervention could improve care outcomes and increase survival.
We enrolled 455 HIV-infected males who inject drugs from 32 communes in Thai Nguyen Province. Communes were randomized to a community stigma reduction intervention or standard of care and then within each commune, to an individual enhanced counseling intervention or standard of care, resulting into 4 arms: Arm 1 (standard of care); Arm 2 (community intervention alone); Arm 3 (individual intervention alone); and Arm 4 (community + individual interventions). Follow-up was conducted at 6, 12, 18, and 24 months to assess survival.
Overall mortality was 23% (n = 103/455) more than 2 years. There were no losses to follow-up for the mortality endpoint. Survival at 24 months was different across arms: Arm 4 (87%) vs Arm 1 (82%) vs Arm 2 (68%) vs Arm 3 (73%); log-rank test for comparison among arms: P = 0.001. Among those with CD4 cell count <200 cells/mm3 and not on antiretroviral therapy at baseline (n = 162), survival at 24 months was higher in Arm 4 (84%) compared with other arms (Arm 1: 61%; Arm 2: 50%; Arm 3: 53%; P-value = 0.002). Overall, Arm 4 (community + individual interventions) had increased uptake of antiretroviral therapy compared with Arms 1, 2, and 3.
This multi-level behavioral intervention seemed to increase survival of HIV-infected participants more than a 2-year period. Relative to the standard of care, the greatest intervention effect was among those with lower CD4 cell counts.
*Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC;
†Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
‡Centre for Preventive Medicine of Thai Nguyen, Thai Nguyen, Vietnam;
§University of North Carolina, UNC—Project Vietnam, Hanoi, Vietnam;
‖Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and
¶Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Correspondence to: Vivian F. Go, PhD, Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 (e-mail: email@example.com).
Supported by the National Institute on Drug Abuse (1R01-DA022962). C.Z. was partly supported by the Johns Hopkins University Center for AIDS Research (P30AI094189).
The authors have no conflicts of interest to disclose.
V.F.G. and C.F. prepared the first draft. V.F.G. finalized the draft based on comments from other authors. V.F.G., C.F., N.L.M., C.A.L., D.D.C. and V.M.Q. conceived of the study and provided overall guidance. C.F. and T.S. performed final statistical analyses. All other authors contributed to data collection, interpreted data, reviewed results, provided guidance on methodology, and reviewed the manuscript.
Received June 02, 2016
Accepted October 31, 2016