1. The 6 th National Scientific Conference on HIV/AIDS BASIC INTERVENTION PACKAGE FOR PEOPLE WHO INJECT DRUG: COVERAGE AND IMPACT ON RISK BEHAVIORSCOVERAGE AND IMPACT ON RISK BEHAVIORS Pham Duc Manh, Tran Dai Quang, Le Anh Tuan, Nguyen Anh Tuan THE 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS

2. The 6 th National Scientific Conference on HIV/AIDS INTRODUCTION o HAARP has been implemented in 5 Asian countries: Vietnam, Laos, Cambodia, Myanmar, and China; 4 years: 2010-2013 o Aims to reduce HIV transmission in relation to drug use in 3 provinces of Vietnam (Bac Kan, Hoa Binh, Tuyen Quang) through providing HR services for IDUs o Baseline survey in 2009/2010 among IDU group: high HIV prevalence; high risk behaviors (syringes and needle sharing, consistent use of condom…) o Upon 4 year implementation: 1.HIV prevalence among IDUs in the community changes between 2009 and 2013? What are the factors related to change? 2.Accessibility to interventions impacts on HIV transmission risk behaviors among IDUs in the community?

3. The 6 th National Scientific Conference on HIV/AIDS STUDY OBJECTIVES 1.To measure HIV prevalence among IDUs in community in 3 project provinces Bac Kan, Hoa Binh, Tuyen Quang in 2013, compared to 2009 2.To determine some main risk behaviors related to HIV transmission among IDUs in the 3 project provinces 3.To evaluate coverage of activities in community of the Asia Regional HIV/AIDS Program in Vietnam

4. The 6 th National Scientific Conference on HIV/AIDS METHODOLOGY  Study population 18+; Injected in last 1 month; Voluntarily participation  Time: 11/2013 – 3/2014  Location: o Bac Kan: Bac Kan town, Cho Moi district o Hoa Binh: Hoa Binh city, Mai Châu district o Tuyen Quang: Tuyen Quang city, Son Duong district  Design: Cross-sectional  Sample size: BK 201, HB 200, TQ 200  Sampling method: TLS, based on mapped results of IDU hotspots  Used CEM to analyze cross-sectional data for project evaluation

5. The 6 th National Scientific Conference on HIV/AIDS RESULTS: HIV prevalence: 2013 vs. 2009

6. The 6 th National Scientific Conference on HIV/AIDS HIV prevalence by project sites (district level) ProvinceBac KanHoa BinhTuyen Quang District Bac Kan town Cho Moi district Hoa Binh city Mai Chau district Tuyen Quang city Son Duong district 200939,045,117,538,321,617,5 201328,222,011,713,811,126,1

7. The 6 th National Scientific Conference on HIV/AIDS HIV prevalence by injecting time and age

8. The 6 th National Scientific Conference on HIV/AIDS IndicatorsBKHBTQAll 201200 601 Duration of injecting drug (year)8.0 7.17.7 Drug injecting time per day (time)1.92.12.22.1 >= 2 times of injecting drug per day (%)62.268.561.364.0 Cost paid for 1 time injecting drug (‘000d)189193292225 >= 200k for 1 time injecting drug (%)46.546.985.059.6 Injecting drug history

9. The 6 th National Scientific Conference on HIV/AIDS Correlation between injecting behavior and HIV prevalence OR [95% CI]p value Sharing needles, drugs or injecting equipment in last 6 months 2,11 [1,39 – 3,21]0,000 Sharing needle in last 1 month 1,93 [1,22 – 3,08]0,005 (OR = Odds Ratio; CI = Confidence Interval)

10. The 6 th National Scientific Conference on HIV/AIDS Received needles, condoms and discussion with PEs

11. The 6 th National Scientific Conference on HIV/AIDS Cascade model for VCT services

12. The 6 th National Scientific Conference on HIV/AIDS Cascade model for MMT program

13. The 6 th National Scientific Conference on HIV/AIDS Cascade model for basic services package

14. The 6 th National Scientific Conference on HIV/AIDS Cascade model for HIV testing and ARV treatment

15. The 6 th National Scientific Conference on HIV/AIDS Sharing needles and syringes in the last month Matched sample (n=552) UnivariateMultivariate OR [95% CI]p valueAOR [95% CI]p value Received information on safe injection in last 6m 0,77 [0,31 – 1,87] 0,562 Received free needles and syringes in last 6 month 0,46 [1,15 – 1,42] 0,178 HIV tested and known result in last 6 month 0,36 [0,23 – 0,56] 0,000 0,41 [0,26 – 0,65] 0,000 On MMT program 0,42 [0,24 – 0,73] 0,002 0,54 [0,31 – 0,95] 0,033 Association between kind of services received and injecting behaviors (OR = Odds Ratio; AOR = Adjusted Odds Ratio; CI = Confidence Interval)

16. The 6 th National Scientific Conference on HIV/AIDS Sharing needles and syringes in the last month Matched sample (n=552) UnivariateMultivariate OR [95% CI]p valueAOR [95% CI]p value Received 3 services 1,19 [0,73 – 1,95] 0,487 Received 5 services 0,60 [0,40 – 0,90] 0,015 0,79 [0,51 – 1,22] 0,284 Received all basic services 0,30 [0,14 – 0,61] 0,001 0,34 [0,16 – 0,72] 0,005 (OR = Odds Ratio; AOR = Adjusted Odds Ratio; CI = Confidence Interval) Association between level of services received and injecting behaviors

17. The 6 th National Scientific Conference on HIV/AIDS LIMITATIONS Sampling frame  Sample representativeness o Mapping results covered only project sites Sample size  not enough for some analysis o Calculated based on HIV prevalence; % sharing syringe&needle) o Coarsened Exact Matching o Limited budget Evaluating effectiveness – causal inference o Cross-sectional o Lack of qualitative information

18. The 6 th National Scientific Conference on HIV/AIDS CONCLUSIONS & RECOMMENDATIONS 1.HIV prevalence reduced considerably compared to baseline (except Son Duong). High S&N sharing rate; 2.Coverage of intervention activities: high of each single HR service, but low coverage of full basic package 3.Efficient services: VCT, MMT services, full basic package For intervention program in 3 provinces: increase coverage of full basic package, 2 efficient services (VCT; MMT) Develop intervention model for Son Duong For study methods: apply CEM in cross-sectional surveys for project evaluation

19. The 6 th National Scientific Conference on HIV/AIDS THANK YOU!