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Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Increased Survival Among HIV-Infected PWID Receiving a Multi-Level HIV Risk and Stigma Reduction Intervention: Results From a Randomized Controlled Trial

TitleIncreased Survival Among HIV-Infected PWID Receiving a Multi-Level HIV Risk and Stigma Reduction Intervention: Results From a Randomized Controlled Trial
Publication TypeJournal Article
Year of Publication2017
AuthorsGo, VF, Frangakis, C, Le Minh, N, Ha, TV, Latkin, CA, Sripaipan, T, Zelaya, CE, Davis, WW, Celentano, DD, Quan, VM
JournalJ Acquir Immune Defic Syndr
Volume74
Pagination166-174
Date PublishedFeb 01
ISBN Number1944-7884 (Electronic)1525-4135 (Linking)
Accession Number27861239
Keywords*Behavior Therapy, *Risk Reduction Behavior, *Social Stigma, Adult, Follow-Up Studies, HIV Infections/*drug therapy/*mortality/psychology, Humans, Male, Substance Abuse, Intravenous/*complications, Survival Analysis, Vietnam
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.