• Wisse, Ernst
• Lim, Aaron G.
• Taw, Mar
• Aung, Minn Thit
• Min, Aung Myo
• Stone, Jack
• Mcnaughton, Anna
• Vickerman, Peter
• Oo, Khine Thet
• Let, Zaw Zen

Abstract

Background: People who inject drugs (PWID) in Kachin, Myanmar, have a high HIV prevalence (&gt;40%), but there is no data on incidence. We used HIV testing data from three harm reduction drop-in centres (DIC) in Kachin (2008-2020) to determine HIV incidence trends among PWID and associations with intervention uptake.<br/><br/>Methods: Individuals were HIV-tested at first DIC visit and periodically thereafter, during which demographic and risk behaviour data were collected. Two DIC provided opioid agonist therapy (OAT) from 2008. Monthly DIC-level needle/syringe provision (NSP) data was available from 2012. Site-level 6-monthly NSP coverage was denoted low, high, or medium if it was below the lower quartile, above upper quartile, between these quartiles of provision levels over 2012-2020, respectively. HIV incidence was estimated by linking subsequent test records for those initially HIV-negative. Associations with HIV incidence were examined using Cox regression.<br/> <br/>Findings: Follow-up HIV testing data was available for 33.6% (2,227) of PWID initially testing HIV-negative, with 444 incident HIV infections during 6,266.5 person-years (py) of follow-up. Overall HIV incidence was 7.1 per 100py (95% confidence interval 6.5-7.8), which decreased from 19.3 (13.3-28.2) in 2008-11 to 5.2 per 100py (4.6-5.9) in 2017-20. In the full PWID incidence dataset after adjustment for various factors, recent (≤6weeks) injecting (aHR 1.74, 1.35-2.25) and needle sharing (aHR 2.00, 1.48-2.70) were associated with higher incidence, while longer injection careers were associated with reduced incidence (aHR 0.54, 0.34-0.86, for 2-5yrs vs <br/>Interpretation: Although HIV incidence is high among PWID in Kachin, data suggests it has decreased since the scale-up in harm reduction interventions. <br/>

Topics

• impedance spectroscopy