title: Increased Survival Among HIV-Infected PWID Receiving a Multi-Level HIV Risk and Stigma Reduction Intervention: Results From a Randomized Controlled Trial.
abstract: OBJECTIVE
  In Vietnam, where 58% of prevalent HIV cases are attributed to people who inject drugs, we evaluated whether a multi-level intervention could improve care outcomes and increase survival.
  
  
  METHODS
  We enrolled 455 HIV-infected males who inject drugs from 32 communes in Thai Nguyen Province. Communes were randomized to a community stigma reduction intervention or standard of care and then within each commune, to an individual enhanced counseling intervention or standard of care, resulting into 4 arms: Arm 1 (standard of care); Arm 2 (community intervention alone); Arm 3 (individual intervention alone); and Arm 4 (community + individual interventions). Follow-up was conducted at 6, 12, 18, and 24 months to assess survival.
  
  
  RESULTS
  Overall mortality was 23% (n = 103/455) more than 2 years. There were no losses to follow-up for the mortality endpoint. Survival at 24 months was different across arms: Arm 4 (87%) vs Arm 1 (82%) vs Arm 2 (68%) vs Arm 3 (73%); log-rank test for comparison among arms: P = 0.001. Among those with CD4 cell count <200 cells/mm and not on antiretroviral therapy at baseline (n = 162), survival at 24 months was higher in Arm 4 (84%) compared with other arms (Arm 1: 61%; Arm 2: 50%; Arm 3: 53%; P-value = 0.002). Overall, Arm 4 (community + individual interventions) had increased uptake of antiretroviral therapy compared with Arms 1, 2, and 3.
  
  
  CONCLUSIONS
  This multi-level behavioral intervention seemed to increase survival of HIV-infected participants more than a 2-year period. Relative to the standard of care, the greatest intervention effect was among those with lower CD4 cell counts.
authors.affiliation: *Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; †Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ‡Centre for Preventive Medicine of Thai Nguyen, Thai Nguyen, Vietnam; §University of North Carolina, UNC-Project Vietnam, Hanoi, Vietnam; ‖Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and ¶Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Vivian F
authors.initials: VF
authors.lastname: Go
authors.forename: Constantine
authors.initials: C
authors.lastname: Frangakis
authors.forename: Nguyen
authors.initials: N
authors.lastname: Le Minh
authors.forename: Tran Viet
authors.initials: TV
authors.lastname: Ha
authors.forename: Carl A
authors.initials: CA
authors.lastname: Latkin
authors.forename: Teerada
authors.initials: T
authors.lastname: Sripaipan
authors.forename: Carla E
authors.initials: CE
authors.lastname: Zelaya
authors.forename: Wendy W
authors.initials: WW
authors.lastname: Davis
authors.forename: David D
authors.initials: DD
authors.lastname: Celentano
authors.forename: Vu Minh
authors.initials: VM
authors.lastname: Quan
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality* / Q000523:psychology; D006801:Humans; D008297:Male; D040242:Risk Reduction Behavior; D057545:Social Stigma; D015819:Substance Abuse, Intravenous / Q000150:complications*; D016019:Survival Analysis; D014744:Vietnam