title: The Effect of a Multi-Level Intervention on the Initiation of Antiretroviral Therapy (ART) among HIV-Infected Men Who Inject Drugs and Were Diagnosed Late in Thai Nguyen, Vietnam.
abstract: BACKGROUND
  In Vietnam, an estimated 256,000 people are living with HIV, and 58% of HIV-infections reported are among people who inject drugs (PWID). While antiretroviral therapy (ART) is widely available in Vietnam, marginalized hard-to-reach male PWID, demonstrate significantly reduced and delayed access to ART.
  
  
  METHODS
  We investigated the effect of a randomized four-arm multi-level intervention trial on ART initiation among male PWID. Our analysis was conducted among a subset of trial participants (n = 136), who were newly diagnosed as HIV-infected, treatment naïve, and eligible for ART (baseline late diagnosis). The trial arms included: 1, standard of care (HIV testing and counseling); 2, structural-level intervention (door-to-door communications and community video screenings); 3, individual-level intervention (counseling plus group support); and 4, individual-level plus structural-level intervention. In a time-to-event analysis, we used a non-parametric approach for competing risks to estimate cumulative incidence function (CIF) for ART initiation (event of interest) by arm and the difference in CIF for each trial arm as compared to Arm 1. Follow-up was conducted at 6, 12, 18 and 24 months. Data collection occurred from 2009 to 2013.
  
  
  RESULTS
  By 24-months, 61.0% initiated ART, and 30.9% had died prior to ART initiation. In the first 6 months, participants in arm 4 (individual plus community intervention) had a 28% (95% confidence interval (CI): 6-50%) increased probability of initiating ART. Despite increasing coverage of ART in all arms throughout follow-up, participants in arm 4 retained a 31% (95% CI: 5-56%) increased probability of initiating ART. The individual and community components of the intervention were only effective when delivered together.
  
  
  CONCLUSIONS
  Marginalized, hard-to-reach men, who do not routinely engage in HIV services, and therefore come into care late, may benefit significantly from both individual counseling and group support, in combination with community-focused stigma reduction, when being referred and attempting to initiate urgently needed ART.
authors: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, Maryland 21205, United States of America.
authors: Carla E
authors: CE
authors: Zelaya
authors: Centre for Preventive Medicine of Thai Nguyen, 971 Duong Tu Minh Road, Thai Nguyen City, Vietnam.
authors: Nguyen
authors: N
authors: Le Minh
authors: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, Maryland 21205, United States of America.
authors: Bryan
authors: B
authors: Lau
authors: Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, 624 N. Broadway, Hampton House 737, Baltimore, Maryland 21205, United States of America.
authors: Carl A
authors: CA
authors: Latkin
authors: University of North Carolina, No 6, Lane 76, Linh Lang Street, Hanoi, Vietnam.
authors: Tran
authors: T
authors: Viet Ha
authors: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, Maryland 21205, United States of America.
authors: Vu
authors: V
authors: Minh Quan
authors: University of North Carolina, No 6, Lane 76, Linh Lang Street, Hanoi, Vietnam.
authors: Thi Tran
authors: TT
authors: Mo
authors: University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 361 Rosenau Hall, Campus Box 7440, Chapel Hill, NC 27599, United States of America.
authors: Teerada
authors: T
authors: Sripaipan
authors: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, Maryland 21205, United States of America.
authors: Wendy W
authors: WW
authors: Davis
authors: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, Maryland 21205, United States of America.
authors: David D
authors: DD
authors: Celentano
authors: Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, 615 N. Wolfe Street, Room E3642, Baltimore, Maryland 21205, United States of America.
authors: Constantine
authors: C
authors: Frangakis
authors: University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior, 361 Rosenau Hall, Campus Box 7440, Chapel Hill, NC 27599, United States of America.
authors: Vivian F
authors: VF
authors: Go
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014744:Vietnam / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents