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Background: High HIV prevalence among injecting drug users (IDUs) remains a cause of concern and are considered key drivers of concentrated epidemic in India. The present paper aims to assess the effectiveness of the targeted intervention (TI) program on the risk behaviors among IDUs across regions of India. Materials and Methods: This paper used the data from the integrated biological and behavioral surveillance 2014–2015 among the IDUs in India. Descriptive statistics and propensity score matching analysis was carried out to understand the effectiveness of the TI program on the new needle/syringe used and needle/syringe shared in the last injecting episode by accounting for the covariates. Results: The matched samples estimate, i.e., average treatment effect on treated of new needles/syringe used and shared in the last injecting episode by those who received needles/syringes from peer educator or outreach workers (PE/ORWs) and those who did not receive was 2.8% (confidence interval [CI]: 0.05–5.6) increase in the use of new needles/syringes and 6.5% (CI: −9.7–−3.3) decrease in the needles/syringes shared in last injecting episode indicating that IDUs who received new needles/syringes from PE/ORWs are more likely to use new needle/syringe and less likely to share needle/syringes to those who did not receive needles/syringes. The results vary across the different regions of India. Conclusion: TI program proves to be an effective initiative in the behavior change among IDUs as substantiated by use of new needles/syringes and decreased sharing of needles/syringes. TI program coverage varies from region to region and may further be expanded to accelerate the program services to prevent HIV/AIDS.
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Objective@#To understand the mortality and influencing factors on injecting drug users (IDUs) with HIV/AIDS, in Guizhou province, 1996-2015.@*Methods@#A retrospective cohort study was conducted on IDUs with HIV/AIDS that were reported through national comprehensive HIV/AIDS information system, in Guizhou province during 1996-2015. Cox proportional hazard regression model was used to analyze the influencing factors on the mortality of HIV/AIDS.@*Results@#A total of 3 958 cases of IDUs with HIV/AIDS were recruited in this study, with all-cause mortality rate of 44.01% (1 742/3 958) and total mortality rate of 7.80/100 person-years, respectively. The median survival time between diagnosis and death was 8.08 years. Mortality rate was 3.57/100 person-years in the group receiving antiretroviral therapy (ART). The mortality appeared to be 4.08/100 person-years in the group who were on methadone maintenance treatment (MMT). Data from the multiple regression analysis indicated that factors of gender, ethnicity, age when HIV/AIDS diagnosis was made, CD4+T lymphocyte (CD4) count at the first testing, ART and MMT were significantly associated with deaths among these people. The risk of death in females was 0.82 times (95%CI: 0.69-0.98) higher than that in males. The risk of deaths among the ethnic minority subjects was 1.39 times (95%CI: 1.21-1.60) higher than that of the Hans. The risk of death appeared to be 2.44 times higher (95%CI: 1.07-5.56) in the over-50-year of age group than in the <20 year-old group, when HIV/AIDS was diagnosed for the first time. The risk of death in CD4 ≥500/μl group in the first time was 0.27 times (95%CI: 0.22-0.32) more than CD4 <200/μl group in the firs time. The risk of death in cases who were treated with ART or MMT was 2.83 times (95%CI: 2.45-3.26) and 1.35 times (95%CI: 1.15-1.59) higher than those who did not receive any treatment, respectively.@*Conclusion@#Higher risks on death seemed to be related to the following factors: being male, older age at the time of diagnosis, lower CD4 at diagnosis, not on ART or MMT among the IDUs with HIV/AIDS in Guizhou province, between 1996-2015.
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Objective To understand the demographic characteristics of HIV infected injecting drug users (IDUs) with access to antiretroviral therapy (ART) and to identify the factors influencing their access to methadone maintenance treatment (MMT).Methods Outpatients infected with HIV through injecting drug use were selected from the ART clinics in 2 counties in Yunnan province.They were divided into 2 groups,MMT group and non MMT group.Descriptive epidemiologic analysis was conducted on their demographic characteristics,disease history and high risk behaviors and logistic regression analysis was done to identify the factors associated with the access to MMT.Results Among 635 IDUs (536 males,99 females) surveyed,247 received MMT (38.9％),388 received no MMT(61.1％).The median age was 40.33 years and the median diagnosed HIV infection time was 6.08 years.Multivariate logistic regression indicated that being female (OR=2.40,95％CI:1.00-5.74),educational level of junior high school (OR =3.28,95％CI:1.75-6.14),educational level of senior high school or above (OR =7.10,95 ％CI:1.90-26.62),more than 6 years of diagnosed HIV infection history (OR=3.84,95％CI:2.11-6.98) and HCV positive (OR=6.21,95％CI:3.06-12.58) were the positive factors influencing IDUs' access to MMT.However,being married (OR=0.38,95％CI:0.20-0.72) or being employed (OR=0.01,95％CI:0.00-0.02) were the negative factors influencing IDUs' access to MMT.Conclusion The proportion of HIV infected IDUs who received MMT in ART clinics was still very low in the two counties,targeted intervention measures should be taken to increase the MMT coverage,especially among those who are married or employed.
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Objective To explore the comprehensive intervention methods among people with high-risk of AIDS ,and to evaluate the effects of the intervention to provide reference basis for the scientific prevention of AIDS .Methods The 1-year comprehensive intervention including the health education ,psychological and medical consultation ,and condom promotion was conducted among the commercial sex workers(CSW) and the injecting drug users(IDU) in the Xunyang district .The questionnaire survey was performed before and after the intervention ,and then the effects of intervention were evaluated .Results Through the comprehensive interven-tion ,the total awareness rate of the AIDS knowledge among CSW was increased from 70 .75% to 84 .75% (χ2 =22 .66 ,P<0 .01) while which among IDU was increased from 77 .25% to 88 .50% (χ2 =17 .84 ,P<0 .01) .The frequencies of using condoms with cli-ents ,spouse or boyfriend in recently one month were significantly increased (Z= -2 .73 ,P<0 .01 ,Z= -2 .02 ,P=0 .04) .The fre-quency of sharing needle in recently six months among IDU was significantly decreased (Z= -3 .67 ,P<0 .01) and the frequency of using condoms in recently one year among IDU was significantly increased (Z= -2 .96 ,P<0 .01) .Conclusion The comprehensive intervention may effectively increase the awareness rate of the AIDS knowledge among CSW and IDU and change their dangerous behaviors possibly leading to AIDS transmission .
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Hepatitis C virus (HCV) is the major infectious disease agent among injecting drug users (IDUs), with seroprevalence ranging from 50-90 percent. In this paper, serological and virological parameters were investigated among 194 IDUs, 94 ex-IDUs and 95 non-IDUs that were sampled by the "snowball" technique in three localities renowned for both intense drug use and trafficking activities in Salvador, Brazil. The majority of the participants were male, but sex and mean age differed significantly between IDUs/ex-IDUs and non-IDUs (p < 0.05). Anti-HCV screening revealed that 35.6 percent, 29.8 percent and 5.3 percent of samples from IDUs, ex-IDUs and non-IDUs, respectively, were seropositive. HCV-RNA detection confirmed that the prevalence of infection was 29.4 percent, 21.3 percent and 5.3 percent for IDUs, ex-IDUs and non-IDUs, respectively. Genotyping analysis among IDUs/ex-IDUs determined that 76.9 percent were infected with genotype 1, 18.5 percent with genotype 3 and 4.6 percent with a mixed genotype; this result differed significantly from non-IDUs, where genotype 3 was the most frequent (60 percent), followed by genotype 1 (20 percent) and a mixed genotype (20 percent). We report a significantly higher prevalence of HCV infection in IDUs/ex-IDUs compared to the control group (p < 0.001). Although the sample size of our study was small, the differences in HCV genotype distribution reported herein for IDUs/ex-IDUs and non-IDUs warrant further investigation.
Subject(s)
Adult , Female , Humans , Male , Hepacivirus/genetics , Hepatitis C Antibodies/blood , Hepatitis C/epidemiology , RNA, Viral/blood , Substance Abuse, Intravenous/epidemiology , Brazil/epidemiology , Case-Control Studies , Genotype , Hepacivirus/immunology , Hepatitis C/virology , Prevalence , RNA, Viral/genetics , Seroepidemiologic Studies , Substance Abuse, Intravenous/complicationsABSTRACT
Objective To study the natural history of HIV-1 infection among intravenous drug users (IDUs) detected in late 1989 in the study area and the factors related to survival of these IDUs infected with HIV. Methods 196 injecting drug users first detected during August and December, 1989 were observed in Ruili county, Yunnan province. Data gathered from the 20-year follow-up program was collected and analyzed retrospectively. Results After 20 years' follow-up period, 90.3% of the 196 IDUs with HIV infection died, 5.1% of them were still alive, and 4.6% were lost. The crude pre-AIDS mortality rate was 98.1/1000 person-years, and the AIDS mortality rate was 54.9/1000 person-years. Malaria, septicemia were the main causes of death among the natural diseases whereas overdose and accidental causes were the principal causes related to those non-disease deaths.The median survival time from sero-conversion to death was 8.6 years (95%CI: 7.6-9.7). The median survival time from sero-conversion to death due to AIDS was 11.3 years (95%CI: 10.3-12.8) with the incubation time as around 10.3 years. People older than 30 years at seroconversion and length of drug usage were associated with shorter survival time, with hazards ratios as 1.9 and 0.7, respectively.Conclusion A high pre-AIDS mortality was observed among IDUs. Both the median survival time from sero-conversion to death and the HIV incubation period were shorter than that observed in the developed countries. Age of HIV infection seemed to have a strong effect on survival.
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Objective To study the prevalent status of human immunodeficiency virus-1 (HIV-1) subtypes in IDU (injecting drug users) population in Shenzhen and to study their source of infection in order to predict the epidemic trend and evolution. Methods 166 HIV-1 positive plasma from the IDUs was collected from 1996 to 2008. HIV-1 env genes were amplified by nested-PCR from RNA. The C2-V3 regions (450 bp) of HIV-1 env were sequenced for analyses. Phylogenetic analyses were performed on the nucleotide sequence data. Results Among 166 samples, there were 6 HIV-1 strains including CRF01_AE, CRF08_BC, CRF07_BC 3 circulating recombinant forms (CRFs) and B',C, A1 3 subtypes. Data from the genotype analyses showed that 65.06% (108/166) were CRF01_AE, 19.88% (33/166) were CRF07 BC_6.02% (10/166) were CRF08_BC, 7.23%(9/166) were subtype B', 0.60% (1/166) were subtype C and 1.20% (2/166) were subtype A1. Phylogenetic tree analysis showed that some of HIV-1 clusters defined in CRF01_AE, CRF07_BC and subtype B' in different time groups. Significant increase of gene distance in CRF01_AE and CRF07_BC strains in the three different periods. Conclusion CRF01_AE and CRF07_BC were the major epidemic CRF strains among the IDU population in Shenzhen while the subtype B', C, A1 and CRF08_BC were also circulating in IDU population in this region. The variation of all different subtypes was increasing through these years.
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Background: Lai Chau is one of northwestern provinces of Vietnam, where there was a drug vice and high prevalence of drug users. It is necessary to evaluate the situation of HIV infection in this group. Objectives: A study on HIV prevalence and factors relating to the behaviors of HIV Infection among Injecting Drug Users (IDUs) in various districts of Lai Chau province. Subjects and method: A quantitative, cross-sectional study was carried out on 330 IDUs in Lai Chau town and 3 districts of Lai Chau province from January to December 2007. Results: 40.30% of the IDUs tested positive for HIV, nearly 2 times higher than the prevalence in 2006 (23.2%). 87.27% of the IDUs never re-used their syringes and needles. However, 12.4% still sometimes re-used their syringes and needles. Of 43 IDUs (12.73%) who re-used their syringes and needles, only 27.91% always cleaned their syringes and needles, 23.26% cleaned their syringes and needles most of the time after using them and up to 27.91% only sometimes cleaned their syringes and needles. Most IDUs use heroin (97.88%). Percentage of IDUs sharing syringes and needles accounts for 12.42%. 10% of the IDUs had sexual intercourses with commercial sex workers within the last month. There is a relationship between the time of using drugs and the HIV prevalence rate. There is a double risk of HIV infection for the IDUs injecting drugs for 5 years and upwards compared to those injecting drugs less than 5 years. (p <0.05, OR = 2). Conclusion: It is required to develop communications in order to change the behaviors of HIV infection among IDUs in Lai Chau province.