1. Prospect ENDING HIV EPIDEMIC AMONG PEOPLE WHO INJECTION DRUGS IN HAI PHONG VIETNAM NIDA RO1 DA / ANRS 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

2. “No conflict of interest to declare”
CONFLICTS OF INTEREST
“No conflict of interest to declare”

3. Background
Initial spread of HIV among persons who inject drugs (PWID) occurred in 1990s in Hai Phong

4. 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

5. 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
 1st RDS completed in Jan 2017, with N = 1385 enrolled

6. 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%)
Self Report Sharing Syringes
5.5% ?
Currently on ART
59 (39%)
282 (68%)

7. HIV incidence & population viral load
2017 RDS: Undetectable viral load (1000 copies/mL): 303/400 (76%) Undetectable viral load (50 copies/mL): 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)

8. DRIVE Cohort CBO Support for ART & MMT initiation
Number of follow-up participants
860
727 (84.5%)
ART
282
311 (82.2%)
MMT
303
436 (50.6%)
Health Insurance
445 (51.7%)

9. 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

10. 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:
Maintain very low HIV incidence
Reduce HCV incidence

11. Acknowledgements France USA Vietnam HaNoi medical University
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
HaNoi medical University
Le Minh Giang
Nguyen Thu Trang
Community Base Organisation