The effect of a multi-level intervention on the initiation of antiretroviral therapy (ART) among HIV-infected men who inject drugs and were diagnosed late in Thai Nguyen, Vietnam

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

Research output: Contribution to journalArticle

Abstract

Background In Vietnam, an estimated 256,000 people are living with HIV, and 58% of HIV-infections reported are among people who inject drugs (PWID). While antiretroviral therapy (ART) is widely available in Vietnam, marginalized hard-to-reach male PWID, demonstrate significantly reduced and delayed access to ART. Methods We investigated the effect of a randomized four-arm multi-level intervention trial on ART initiation among male PWID. Our analysis was conducted among a subset of trial participants (n = 136), who were newly diagnosed as HIV-infected, treatment naïve, and eligible for ART (baseline late diagnosis). The trial arms included: 1, standard of care (HIV testing and counseling); 2, structural-level intervention (door-to-door communications and community video screenings); 3, individual-level intervention (counseling plus group support); and 4, individual-level plus structural-level intervention. In a time-to-event analysis, we used a nonparametric approach for competing risks to estimate cumulative incidence function (CIF) for ART initiation (event of interest) by arm and the difference in CIF for each trial arm as compared to Arm 1. Follow-up was conducted at 6, 12, 18 and 24 months. Data collection occurred from 2009 to 2013. Findings By 24-months, 61.0% initiated ART, and 30.9%had died prior to ART initiation. In the first 6 months, participants in arm 4 (individual plus community intervention) had a 28% (95% confidence interval (CI): 6-50%) increased probability of initiating ART. Despite increasing coverage of ART in all arms throughout follow-up, participants in arm 4 retained a 31% (95% CI: 5-56%) increased probability of initiating ART. The individual and community components of the intervention were only effective when delivered together. Conclusions Marginalized, hard-to-reach men, who do not routinely engage in HIV services, and therefore come into care late, may benefit significantly from both individual counseling and group support, in combination with community-focused stigma reduction, when being referred and attempting to initiate urgently needed ART.

Original languageEnglish (US)
Article numbere0161718
JournalPLoS One
Volume11
Issue number8
DOIs
StatePublished - Aug 1 2016

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Vietnam
HIV
drugs
therapeutics
Pharmaceutical Preparations
counseling
Screening
Therapeutics
Counseling
Communication
Testing
confidence interval
Confidence Intervals
incidence
HIV infections
Delayed Diagnosis
communication (human)
Incidence
stigma
Standard of Care

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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The effect of a multi-level intervention on the initiation of antiretroviral therapy (ART) among HIV-infected men who inject drugs and were diagnosed late in Thai Nguyen, Vietnam. / Zelaya, Carla E.; Le Minh, Nguyen; Lau, Bryan M; Latkin, Carl A; Viet Ha, Tran; Quan, Vu Minh; Mo, Thi Tran; Sripaipan, Teerada; Davis, Wendy W.; Celentano, David D; Frangakis, Constantine; Go, Vivian F.

In: PLoS One, Vol. 11, No. 8, e0161718, 01.08.2016.

Research output: Contribution to journalArticle

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abstract = "Background In Vietnam, an estimated 256,000 people are living with HIV, and 58{\%} of HIV-infections reported are among people who inject drugs (PWID). While antiretroviral therapy (ART) is widely available in Vietnam, marginalized hard-to-reach male PWID, demonstrate significantly reduced and delayed access to ART. Methods We investigated the effect of a randomized four-arm multi-level intervention trial on ART initiation among male PWID. Our analysis was conducted among a subset of trial participants (n = 136), who were newly diagnosed as HIV-infected, treatment na{\"i}ve, and eligible for ART (baseline late diagnosis). The trial arms included: 1, standard of care (HIV testing and counseling); 2, structural-level intervention (door-to-door communications and community video screenings); 3, individual-level intervention (counseling plus group support); and 4, individual-level plus structural-level intervention. In a time-to-event analysis, we used a nonparametric approach for competing risks to estimate cumulative incidence function (CIF) for ART initiation (event of interest) by arm and the difference in CIF for each trial arm as compared to Arm 1. Follow-up was conducted at 6, 12, 18 and 24 months. Data collection occurred from 2009 to 2013. Findings By 24-months, 61.0{\%} initiated ART, and 30.9{\%}had died prior to ART initiation. In the first 6 months, participants in arm 4 (individual plus community intervention) had a 28{\%} (95{\%} confidence interval (CI): 6-50{\%}) increased probability of initiating ART. Despite increasing coverage of ART in all arms throughout follow-up, participants in arm 4 retained a 31{\%} (95{\%} CI: 5-56{\%}) increased probability of initiating ART. The individual and community components of the intervention were only effective when delivered together. Conclusions Marginalized, hard-to-reach men, who do not routinely engage in HIV services, and therefore come into care late, may benefit significantly from both individual counseling and group support, in combination with community-focused stigma reduction, when being referred and attempting to initiate urgently needed ART.",
author = "Zelaya, {Carla E.} and {Le Minh}, Nguyen and Lau, {Bryan M} and Latkin, {Carl A} and {Viet Ha}, Tran and Quan, {Vu Minh} and Mo, {Thi Tran} and Teerada Sripaipan and Davis, {Wendy W.} and Celentano, {David D} and Constantine Frangakis and Go, {Vivian F.}",
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T1 - The effect of a multi-level intervention on the initiation of antiretroviral therapy (ART) among HIV-infected men who inject drugs and were diagnosed late in Thai Nguyen, Vietnam

AU - Zelaya, Carla E.

AU - Le Minh, Nguyen

AU - Lau, Bryan M

AU - Latkin, Carl A

AU - Viet Ha, Tran

AU - Quan, Vu Minh

AU - Mo, Thi Tran

AU - Sripaipan, Teerada

AU - Davis, Wendy W.

AU - Celentano, David D

AU - Frangakis, Constantine

AU - Go, Vivian F.

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N2 - Background In Vietnam, an estimated 256,000 people are living with HIV, and 58% of HIV-infections reported are among people who inject drugs (PWID). While antiretroviral therapy (ART) is widely available in Vietnam, marginalized hard-to-reach male PWID, demonstrate significantly reduced and delayed access to ART. Methods We investigated the effect of a randomized four-arm multi-level intervention trial on ART initiation among male PWID. Our analysis was conducted among a subset of trial participants (n = 136), who were newly diagnosed as HIV-infected, treatment naïve, and eligible for ART (baseline late diagnosis). The trial arms included: 1, standard of care (HIV testing and counseling); 2, structural-level intervention (door-to-door communications and community video screenings); 3, individual-level intervention (counseling plus group support); and 4, individual-level plus structural-level intervention. In a time-to-event analysis, we used a nonparametric approach for competing risks to estimate cumulative incidence function (CIF) for ART initiation (event of interest) by arm and the difference in CIF for each trial arm as compared to Arm 1. Follow-up was conducted at 6, 12, 18 and 24 months. Data collection occurred from 2009 to 2013. Findings By 24-months, 61.0% initiated ART, and 30.9%had died prior to ART initiation. In the first 6 months, participants in arm 4 (individual plus community intervention) had a 28% (95% confidence interval (CI): 6-50%) increased probability of initiating ART. Despite increasing coverage of ART in all arms throughout follow-up, participants in arm 4 retained a 31% (95% CI: 5-56%) increased probability of initiating ART. The individual and community components of the intervention were only effective when delivered together. Conclusions Marginalized, hard-to-reach men, who do not routinely engage in HIV services, and therefore come into care late, may benefit significantly from both individual counseling and group support, in combination with community-focused stigma reduction, when being referred and attempting to initiate urgently needed ART.

AB - Background In Vietnam, an estimated 256,000 people are living with HIV, and 58% of HIV-infections reported are among people who inject drugs (PWID). While antiretroviral therapy (ART) is widely available in Vietnam, marginalized hard-to-reach male PWID, demonstrate significantly reduced and delayed access to ART. Methods We investigated the effect of a randomized four-arm multi-level intervention trial on ART initiation among male PWID. Our analysis was conducted among a subset of trial participants (n = 136), who were newly diagnosed as HIV-infected, treatment naïve, and eligible for ART (baseline late diagnosis). The trial arms included: 1, standard of care (HIV testing and counseling); 2, structural-level intervention (door-to-door communications and community video screenings); 3, individual-level intervention (counseling plus group support); and 4, individual-level plus structural-level intervention. In a time-to-event analysis, we used a nonparametric approach for competing risks to estimate cumulative incidence function (CIF) for ART initiation (event of interest) by arm and the difference in CIF for each trial arm as compared to Arm 1. Follow-up was conducted at 6, 12, 18 and 24 months. Data collection occurred from 2009 to 2013. Findings By 24-months, 61.0% initiated ART, and 30.9%had died prior to ART initiation. In the first 6 months, participants in arm 4 (individual plus community intervention) had a 28% (95% confidence interval (CI): 6-50%) increased probability of initiating ART. Despite increasing coverage of ART in all arms throughout follow-up, participants in arm 4 retained a 31% (95% CI: 5-56%) increased probability of initiating ART. The individual and community components of the intervention were only effective when delivered together. Conclusions Marginalized, hard-to-reach men, who do not routinely engage in HIV services, and therefore come into care late, may benefit significantly from both individual counseling and group support, in combination with community-focused stigma reduction, when being referred and attempting to initiate urgently needed ART.

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