title: Prospects for ending the HIV epidemic among persons who inject drugs in Haiphong, Vietnam.
abstract: To examine the prospects for "ending the HIV epidemic" among persons who inject drugs (PWID) in Haiphong, Vietnam. Reaching an incidence of <0.5/100 person-years at risk (PY) was used as an operational definition for "ending the epidemic."
  
  
  
  A respondent driven sampling study of 603 PWID was conducted from September to October 2014. Current heroin use (verified with urine testing and marks of injection) was an eligibility requirement. A structured questionnaire was administered by trained interviewers to obtain demographic, drug use, and risk behavior data; HIV counseling and testing and HCV testing was also conducted. Two methods (by assuming all new injectors were HIV negative at first injection and by slope of prevalence by years injecting) were used for estimating HIV among persons injecting for <5 years ("new injectors"). Comparisons were made to the HIV epidemic among PWID in New York City and modeling of the HIV epidemic in Can Tho province.
  
  
  
  HIV prevalence was 25% in 2014, down from 68% in 2006 and 48% in 2009; overall HCV prevalence in the study was 67%. Among HIV seropositive PWID, 33% reported receiving antiretroviral treatment. The great majority (83%) of subjects reported pharmacies as their primary source of needles and syringes and self-reported receptive and distributive syringe sharing were quite low (<6%). Estimating HIV incidence among non-MSM male new injectors with the assumption that all were HIV negative at first injection gave a rate of 1.2/100 person-years (95% CI -0.24, 3.4). Estimating HIV incidence by the slope of prevalence by years injecting gave a rate of 0.8/100 person-years at risk (95% CI -0.9, 2.5).
  
  
  
  The current HIV epidemic among PWID in Haiphong is in a declining phase, but estimated incidence among non-MSM new injectors is approximately 1/100 person-years and there is a substantial gap in provision of ART for HIV seropositives. Scaling up interventions, particularly HIV counseling and testing and antiretroviral treatment for all seropositive PWID, should accelerate the decline. Ending the epidemic is an attainable public health goal.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York City, USA. Electronic address: ddesjarlais@chpnet.org.
authors.forename: Don C
authors.initials: DC
authors.lastname: Des Jarlais
authors.affiliation: Hai Phong University of Medicine and Pharmacy, Hai Phong, Viet Nam.
authors.forename: Duong
authors.initials: D
authors.lastname: Thi Huong
authors.affiliation: Supporting Community Development Initiatives, Hanoi, Viet Nam.
authors.forename: Khuat
authors.initials: K
authors.lastname: Thi Hai Oanh
authors.affiliation: Hai Phong University of Medicine and Pharmacy, Hai Phong, Viet Nam.
authors.forename: Minh
authors.initials: M
authors.lastname: Khuê Pham
authors.affiliation: Hai Phong University of Medicine and Pharmacy, Hai Phong, Viet Nam.
authors.forename: Hoang
authors.initials: H
authors.lastname: Thi Giang
authors.affiliation: Supporting Community Development Initiatives, Hanoi, Viet Nam.
authors.forename: Nham
authors.initials: N
authors.lastname: Thi Tuyet Thanh
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York City, USA.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Arasteh
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York City, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Feelemyer
authors.affiliation: Abt Associates, Cambridge, MA, USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Hammett
authors.affiliation: Inserm U1058, Etablissement Français du Sang, University of Montpellier, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: Peries
authors.affiliation: Pierre Nicole Center, Red Cross, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Michel
authors.affiliation: Infectious Diseases Department, Viet Tiep Hospital, Hai Phong, Viet Nam.
authors.forename: Vinh
authors.initials: V
authors.lastname: Vu Hai
authors.affiliation: Inserm, Paris, France.
authors.forename: Marie Jauffret
authors.initials: MJ
authors.lastname: Roustide
authors.affiliation: Inserm U1058, Etablissement Français du Sang, University of Montpellier, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Moles
authors.affiliation: Inserm U1058, Etablissement Français du Sang, University of Montpellier, France; Infectious Diseases Department, Caremeau University Hospital, Nîmes, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Laureillard
authors.affiliation: Inserm U1058, Etablissement Français du Sang, University of Montpellier, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Nagot
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D003376:Counseling / Q000379:methods; D058872:Epidemics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D006679:HIV Seropositivity / Q000188:drug therapy; D006556:Heroin Dependence / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing / Q000706:statistics & numerical data; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D012309:Risk-Taking; D012494:Sampling Studies; D000072339:Sexual and Gender Minorities / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014744:Vietnam / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; Men who have sex with men (MSM); Persons who inject drugs (PWID); Respondent driven sampling (RDS); Sex workers; Vietnam