Increased survival among HIV-infected PWID receiving a multi-level HIV risk and stigma reduction intervention: results from a randomized controlled trial

Vivian F. Go, Constantine Frangakis, Nguyen Le Minh, Tran Viet Ha, Carl A Latkin, Teerada Sripaipan, Carla E. Zelaya, Wendy W. Davis, David D Celentano, Vu Minh Quan

Research output: Contribution to journalArticle

Abstract

OBJECTIVE:: In Vietnam, where 58% of prevalent HIV cases are attributed to PWID, we evaluated whether a multi-level intervention could improve care outcomes and increase survival. METHODS:: We enrolled 455 HIV-infected male PWID 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 in four 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) over two 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/mm3 and not on antiretroviral therapy (ART) at baseline (n=162), survival at 24 months was higher in Arm 4 (84%) compared to other arms (Arm 1: 61%; Arm 2: 50%; Arm 3: 53%; p-value=0.002). Overall, Arm 4 (community + individual interventions), increased uptake of ART compared to Arms 1, 2, and 3. CONCLUSION:: This multi-level behavioral intervention appeared to increase survival of HIV-infected participants over a two-year period. Relative to the standard of care, the greatest intervention effect was among those with lower CD4 cell counts.

Original languageEnglish (US)
JournalJournal of Acquired Immune Deficiency Syndromes
DOIs
StateAccepted/In press - Nov 14 2016

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases

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