HIV-integrated approach to accelerate hepatitis testing and treatment among people who inject drugs in Vietnam.


Author: Bao Vu, Kim Do, An Tran, Long Tran, Kimberly Green, Khue Luong, Khoa Nguyen, Phuong Cao

Theme: Epidemiology & Public Health Research Year: 2023

Background
Vietnam estimates 8.8 million people living with hepatitis B (HBV) and hepatitis C (HCV); however, 80%-85% of infected people remain undiagnosed and 65%-70% of treatment-eligible people remain untreated. People who inject drugs (PWID) face a triple burden of HBV, HCV, and HIV. PATH, The Hepatitis Fund, and Vietnam’ Administration of Medical Services implemented a decentralized model of community-based and HIV-integrated HBV/HCV testing to boost testing uptake and linkage to care among PWID and other key populations (KP).

Methods
We engaged 9 KP-led community-based organizations (CBOs) and 18 clinics providing harm reduction, methadone maintenance treatment (MMT), HIV testing, pre-exposure prophylaxis, and antiretroviral therapy (ART) in Hanoi and Ho Chi Minh City. These sites offered HBV surface antigen (HBsAg) and HCV antibody (anti-HCV) testing and linkage to viraemia testing and treatment. PWID-led CBOs reached PWID through community outreach and the Zalo messaging platform.

Results
From April 2021—July 2022, we reached 8,403 PWID, of whom 88.4% accepted HBsAg testing, yielding a 10.5% positivity rate. Of 779 HBsAg+ PWID, 38.5% were evaluated for treatment eligibility and 70.0% of those eligible enrolled on treatment. HBV-HIV coinfection rate among PWID was 6.8%. HBV infection among all clients was significantly associated with being PWID (aOR=1.30 [1.06-1.61]) and on ART (aOR=1.84 [1.26-2.68]).

Among 8,403 PWID, 91.0% accepted anti-HCV testing, yielding a 19.7% positivity rate. Of 1,509 anti-HCV+ individuals, 46.9% received confirmatory testing and 83.0% of those diagnosed initiated treatment. HCV-HIV coinfection rate was exceptionally high (16.4%). HCV sero-positivity was significantly associated with being PWID (aOR=6.95 [5.91-8.17]), being coinfected with HIV (aOR=4.78 [3.80-6.01]), and using MMT (aOR=1.48 [1.17-1.86]).

Conclusion
Integrating viral hepatitis testing within existing harm reduction and HIV services is an effective approach to boost HBV/HCV service uptake among PWID. This model may be replicable in other resource-limited contexts to accelerate progress toward viral hepatitis elimination.

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