How research can both provide evidence of burden of disease and facilitate access to services

Integrated respondent-driven sampling and peer support for persons who inject drugs in Haiphong, Vietnam: a case study with implications for interventions.

Des Jarlais D, Duong HT, Pham Minh K, Khuat OH, Nham TT, Arasteh K, Feelemyer J, Heckathorn DD, Peries M, Moles JP, Laureillard D, Nagot N. AIDS Care. 2016 May 13:1-4. [Epub ahead of print]

Combined prevention for HIV among persons who inject drugs (PWID) has led to greatly reduced HIV transmission among PWID in many high-income settings, but these successes have not yet been replicated in resource-limited settings. Haiphong, Vietnam experienced a large HIV epidemic among PWID, with 68% prevalence in 2006. Haiphong has implemented needle/syringe programs, methadone maintenance treatment (MMT), and anti-retroviral treatment (ART), but there is an urgent need to identify high-risk PWID and link them to services. We examined integration of respondent-driven sampling (RDS) and strong peer support groups as a mechanism for identifying high-risk PWID and linking them to services. The peer support staff performed the key tasks that required building and maintaining trust with the participants, including recruiting the RDS seeds, greeting and registering participants at the research site, taking electronic copies of participant fingerprints (to prevent multiple participation in the study), and conducting urinalyses. A 6-month cohort study with 250 participants followed the RDS cross-sectional study. The peer support staff maintained contact with these participants, tracking them if they missed appointments, and providing assistance in accessing methadone and ART. The RDS recruitment was quite rapid, with 603 participants recruited in three weeks. HIV prevalence was 25%, Hepatitis C (HCV) prevalence 67%, and participants reported an average of 2.7 heroin injections per day. Retention in the cohort study was high, with 86% of participants re-interviewed at 6-month follow-up. Assistance in accessing services led to half of the participants in need of methadone enrolled in methadone clinics, and half of HIV-positive participants in need of ART enrolled in HIV clinics by the 6-month follow-up. This study suggests that integrating large-scale RDS and strong peer support may provide a method for rapidly linking high-risk PWID to combined prevention and care, and greatly reducing HIV transmission among PWID in resource-limited settings.

Abstract access [1]

Editor’s notes: This paper highlights that evidence on the effectiveness of harm reduction programmes including opioid substitution therapy, needle-syringe programmes and antiretroviral therapy, alone, and in combination have been shown to be effective in reducing incidence of HIV and hepatitis C in Europe, northern America and Australia. But evidence is lacking in countries with the largest or growing populations of people who inject drugs and high prevalence of HIV and hepatitis C. This is particularly true in low-income settings including South-East Asia and East Africa. But this is also true in high income countries such as the Russian Federation which has the fastest growing epidemic of HIV in the world, primarily among people who inject drugs. But opioid substitution therapy is prohibited. The paper is methodologically interesting. It demonstrates the feasibility of following-up a cohort of people who inject drugs over six months. More importantly, it illustrates how research can be used to link the most vulnerable members of the population, including people who inject frequently and people living with HIV who are not on treatment, into opioid substitution therapy and HIV treatment services. As well as demonstrating the practical use of research in increasing access to services, the research is also important for advocacy purposes. The authors illustrate the burden of HIV and hepatitis C among the population, further highlighting the need for harm reduction services and HIV/hepatitis C treatment. 

Asia [6]
Viet Nam [7]
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