Could the CARE-SHAKTI intervention for injecting drug users be maintaining the low HIV prevalence in Dhaka, Bangladesh?
OBJECTIVE
To explore whether the low HIV prevalence observed in Bangladesh results from prevention activities, this study uses mathematical modelling to estimate the impact of a needle/syringe exchange intervention for injecting drug users (IDUs) in Dhaka, Bangladesh.


METHODS
Epidemiological, behavioural and intervention monitoring data were used to parameterize a dynamic mathematical model, and fit it to National HIV Sero-surveillance data among IDUs (2000-02). The model was used to estimate the impact of the intervention on HIV transmission among IDUs and their sexual partners.


METHODS
Dhaka, Bangladesh, where the HIV prevalence has remained low despite high-risk sexual and injecting behaviours, and growing HIV epidemics in neighbouring countries.


RESULTS
The model predicts that the intervention may have reduced the incidence of HIV among IDUs by 90% (95% CI 74-94%), resulting in an IDU HIV prevalence of 10% (95% CI 4-19%) after 8 years of intervention activity instead of 42% (95% CI 30-47%) if the intervention had not occurred.


CONCLUSIONS
The analysis highlights the potential for rapid HIV spread among IDUs in Dhaka, and suggests that the intervention may have substantially reduced IDU HIV transmission. However, there is no room for complacency. Sustained and expanded funding for interventions in Dhaka and other regions of Bangladesh are crucial to maintaining the low HIV prevalence.
Foss
Anna M
AM
HIV Tools Research Group, Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine (LSHTM), UK. anna.foss@lshtm.ac.uk
Watts
Charlotte H
CH
Vickerman
Peter
P
Azim
Tasnim
T
Guinness
Lorna
L
Ahmed
Munir
M
Rodericks
Andrea
A
Jana
Smarajit
S
D001459:Bangladesh / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D040261:Harm Reduction; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D018671:Needle-Exchange Programs / Q000706:statistics & numerical data*; D015995:Prevalence; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000517:prevention & control*; D013594:Syringes / Q000706:statistics & numerical data*