Diverse HIV epidemics among people who inject drugs in Thailand: Evidence from respondent-driven sampling surveys in Bangkok and Chiang Mai

Prybylski, Dimitri; Manopaiboon, Chomnad; Visavakum, Prin; Yongvanitjit, Kovit; Aramrattana, Apinun; Manomaipiboon, Parnrudee; Tanpradech, Suvimon; Suksripanich, Orapin; Pattanasin, Sarika; Wolfe, Mary E.; Whitehead, Sara J.

doi:10.1016/j.drugalcdep.2014.12.034

Cited by 11 publications

(9 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although HIV prevalence still remains high in some cities (23.6% in Bangkok, 10.9% in Chiang Mai), 175 the success of harm reduction programs has yielded a decreasing HIV incidence in PWID. 19,176 HIV vaccine efficacy trials in PWID are unlikely to proceed as illustrated in the HPTN 058 trial conducted in Xinjiang and Guangxi Provinces, China, and Chiang Mai, Thailand where only 7 of 1,157 HIV-uninfected PWID acquired HIV over a 2-year follow-up.…”

Section: Implications For Hiv Prevention Trialsmentioning

confidence: 99%

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Phanuphak

Shao³

et al. 2015

AIDS Research and Human Retroviruses

View full text Add to dashboard Cite

An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.

show abstract

Section: Implications For Hiv Prevention Trialsmentioning

confidence: 99%

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Phanuphak

Shao³

et al. 2015

AIDS Research and Human Retroviruses

View full text Add to dashboard Cite

show abstract

“…High prevalence of syringe lending has been documented in Bangkok and Chiang Mai [30,38,39]. However, needle sharing in Chiang Mai seems to be more frequent than in Bangkok where PWID are more exposed to harm reduction interventions [8].…”

Section: Discussionmentioning

confidence: 99%

“…This mountainous region is home to several "hill tribes", ethnic minorities living in isolated villages. Use of heroin and opium is more prevalent than in other Thai provinces where methamphetamine use is predominant [8].…”

Section: Introductionmentioning

confidence: 99%

Risky injection practices and HCV awareness in Chiang Mai Province, Thailand: a respondent-driven sampling study of people who inject drugs

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background People who inject drugs (PWID) are the most exposed to hepatitis C virus (HCV). In Thailand, drug use is highly criminalized, and harm reduction services are scarce. This study estimates risky injection practices and assesses the proportion of HCV awareness and screening in the PWID population in Northern Thailand. Methods We used respondent-driven sampling (RDS) to recruit PWID in Chiang Mai Province. Social and behavioural data were collected through face-to-face interviews at an addiction treatment facility. Weighted population estimates were calculated to limit biases related to the non-random sampling method. Univariate and multivariate analyses were performed to study factors associated with HCV awareness and screening. Results One hundred seventy-one PWID were recruited between April 2016 and January 2017. Median age was 33 (Interquartile range: 26–40) years, 12.2% were women, and 49.4% belonged to a minority ethnic group. Among participants, 76.8% injected heroin, 20.7% methadone, and 20.7% methamphetamine. We estimate that 22.1% [95% CI: 15.7–28.6] of the population had shared needles in the last 6 months and that 32.0% [95% CI: 23.6–40.4] had shared injection material. Only 26.6% [95% CI: 17.6–35.6] had heard of HCV. Factors independently associated with knowledge of HCV included belonging to a harm reduction organization (adjusted odds ratio (aOR) = 5.5 [95% CI: 2.0–15.3]) and voluntary participation in a drug rehabilitation programme (aOR = 4.3 [95% CI: 1.3–13.9]), while Lahu ethnicity was negatively associated (aOR = 0.3 [95% CI: 0.1–0.9]). We estimate that 5% of the PWID population were screened for HCV; the only factor independently associated with being screened was membership of a harm reduction organization (aOR = 5.7 [95% CI: 1.6–19.9]). Conclusion Our study reveals that the PWID population is poorly informed and rarely screened for HCV, despite widespread risky injection practices. A public health approach aimed at reducing the incidence of HCV should target the PWID population and combine harm reduction measures with information and destigmatization campaigns. Civil society organizations working with PWID are a major asset for the success of such an approach, based on their current positive interventions promoting awareness of and screening for HCV.

show abstract

“…It is thought that heroin use has decreased over time since the “war on drugs” campaign in 2003 because of its increased price and due to the greater availability and lower price of other drugs (van Griensvan et al, 2005; Vongchak et al, 2005). Reported midazolam injection prevalence has been consistently higher in Bangkok than in others areas of Thailand, including Songkhla, as this is where midazolam distribution is focused and it is a cheap and easily accessible substitute for heroin (Kerr et al, 2010; Prybylski et al, 2015). …”

Section: Discussionmentioning

confidence: 99%

“…This survey was effective at recruiting PWID who were not currently in drug treatment, and provided information about this sub-group which had not been previously available in Songkhla or Southern Thailand more generally. Given the increasing trend of poly-drug injecting use documented among both in- and out-of-treatment PWID, it is recommended a comprehensive and integrated combination intervention approach for both HIV services (i.e., prevention and linkages to care and treatment) and drug treatment is adopted (Prybylski et al, 2015). …”

Section: Discussionmentioning

confidence: 99%