The Association Between Access to Opioid Substitution Therapy and HIV Incidence Among People Who Inject Drugs (PWID) in Kachin, Myanmar, 2008-2020

Author: Anna McNaughton Jack Stone KT Oo M Taw MT Aung Am Min Ernst Wisse Peter Vickerman

Theme: Epidemiology & Public Health Research Year: 2022

Background: Kachin in Myanmar has a large population of people who inject drugs (PWID) with a
very high prevalence of HIV (>40%). We used routine HIV testing data to assess associations with HIV
incidence among PWID attending harm reduction drop-in centres (DICs) in Kachin.
Methods: Data relating to HIV testing and drug use behaviours was collected from three Médecins
du Monde DICs offering HIV testing over 2008-2020. HIV prevalence was assessed using testing data
from first-time DIC visits. HIV incidence was estimated by linking subsequent test records. Cox
regression was used to examine associations with HIV incidence, including the impact of opioid
substitution therapy (OST).
Results: First test results were available for 13,056 PWID. Overall, HIV prevalence was 52.0% (95%CI
51.2-52.9%), which peaked in 2017 (69.7%; 95%CI 67.2-72.1%) and then declined to 39.5% (95%CI
36.9-42.2%) by 2020. Data on follow-up HIV testing was available for 37.4% (2,343/6,268) of PWID
initially testing HIV-negative, with 5988.6 person-years (py) of follow-up and 466 incident HIV
infections over 2009-2020. Overall HIV incidence was 7.8 per 100py (95%CI 7.1-8.5), which
decreased from 23.9 (95%CI 16.9-33.8) in 2008-11 to 5.5 per 100py (95%CI 4.9-6.3) by 2017-20. Two
DICs provided OST from 2008, with 65.4% of their clients followed on OST for on average 2.5yrs.
Among PWID at these DIC, currently being on OST during follow-up was associated with reduced HIV
incidence (aHR 0.38, 95%CI 0.28-0.51; p<0.001), following adjustment for DIC location and year of
testing. Recent (≤6weeks) needle sharing was associated with higher incidence (aHR 2.23, 95%CI
1.86-2.97; p<0.001).
Conclusion: Although HIV incidence is high among PWID in Kachin, data suggests it has decreased
over recent years and is lower if on OST. It is important to determine whether increases in harm
reduction access contributed to observed decreases in incidence.
Disclosure of Interest Statement: Peter Vickerman has received unrestricted research funding off
Gilead Sciences not linked to this work. No pharmaceutical grants were received in the development
of this study.

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