Findings from Integrated Behavioral and Biologic Survey among Males Who Inject Drugs (MWID) — Vietnam, 2009–2010: Evidence of the Need for an Integrated Response to HIV, Hepatitis B Virus, and Hepatitis C Virus

<div><p>Introduction</p><p>Given the overlapping modes of transmission of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), understanding the burden and relationship of these infections is critical for an effective response. Representative data on these infections among males who inject drugs (MWID), the key high-risk population for HIV in Vietnam, are currently lacking.</p><p>Methods</p><p>Data and stored specimens from Vietnam’s 2009-2010 Integrated Biologic and Behavioral Survey, a cross-sectional study among high-risk populations, were used for this analysis. Plasma samples were tested for HIV, HBV, and HCV using commercial assays. A questionnaire was administered to provide demographic, behavior, and service-uptake information. Provincial-level analyses were conducted to profile MWID enrollees and to provide estimates on the prevalence of HIV, HBV, and HCV infection.</p><p>Results</p><p>Among 3010 MWID sampled across 10 provinces, the median (range) HIV prevalence was 28.1% (1.0%-55.5%). Median prevalence for current HBV infection (HBsAg+) was 14.1% (11.7%-28.0%), for previous exposure to HBV (total anti-HBc+) was 71.4% (49.9%-83.1%), and for current or past HCV infection (HCV Ag/Ab+) was 53.8% (10.9%-80.8%). In adjusted analysis, HBsAg+ (aOR: 2.09, 1.01-4.34) and HCV Ag/Ab+ (aOR: 19.58, 13.07-29.33) status were significantly associated with HIV infection; the association with total anti-HBc+ approached significance (aOR: 1.29, 0.99-1.68).</p><p>Conclusion</p><p>The prevalence and association between HIV, HBV, and HCV are high among MWID in Vietnam. These findings indicate the need for integrated policies and practice that for the surveillance, prevention, screening, and treatment of both HIV and viral hepatitis among MWID in Vietnam.</p></div

HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and co-infection prevalence.

<p>* indicate p-value <0.05</p><p>HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), and co-infection prevalence.</p

Provincial level correlation* of HIV to HBsAg, total anti-HBc, and HCV in the 2009 IBBS.

<p>Provincial level correlation* of HIV to HBsAg, total anti-HBc, and HCV in the 2009 IBBS.</p

Crude and Adjusted Associations between HIV prevalence (outcome) and select factors among MWID in Vietnam.

<p>Crude and Adjusted Associations between HIV prevalence (outcome) and select factors among MWID in Vietnam.</p

Costs associated with cryptococcal meningitis diagnosis, treatment and a cryptococcal screening program in Vietnam, in US dollars.

*<p>Inclusive of: CSF culture, cell count, glucose, protein, India Ink, and LFA.</p

Sensitivity analysis: variation in cost/LYG through screening by varied testing and drug costs, positive symptoms screen, LP rate, CM mortality rate and discount rate.

<p>Sensitivity analysis: variation in cost/LYG through screening by varied testing and drug costs, positive symptoms screen, LP rate, CM mortality rate and discount rate.</p

Cost-effectiveness of cryptococcal screening at a range of prevalences and cost scenarios.

<p>This graph has prevalence of asymptomatic cryptococcal antigenemia on the x-axis and incremental cost-effectiveness ratio (ICER) (increased cost per life-year gained [LYG] in US dollars) on the y-axis. The blue line represents the cost curve of full-cost fluconazole for one year of treatment. The red line represents the cost curve of full-cost fluconazole for ten weeks of treatment; the green line represents the cost curve of if fluconazole is obtained at no-cost. For Vietnam, the World Health Organization considers any intervention with an ICER under $6,948 to be ‘highly cost-effective’. This graph shows that cryptococcal screening, at any prevalence and under each of the three cost scenarios, should be considered a highly cost-effective intervention in Vietnam.</p

Number Needed to Screen (NNS), by prevalence of serum CrAg-positive persons in Vietnam.

<p>Number Needed to Screen (NNS), by prevalence of serum CrAg-positive persons in Vietnam.</p

Assumptions of a cost-effectiveness model for cryptococcal screening in Vietnam.

*<p>Dr. Cao Thuy, physician.</p>**<p>Assumed to be slightly lower than mortality among CM patients under existing standard of care, due to earlier diagnosis and treatment.</p>***<p>Assumed to be slightly higher than mortality among serum CrAg-negative patients under a screening scenario.</p

CrAg-positive prevalence by CD4 count and region of Vietnam.

<p>CrAg-positive prevalence by CD4 count and region of Vietnam.</p