Essentiality of HIV testing and education for effective HIV control in the national pilot harm reduction program: The Taiwan experience

Abstract

In 2005, a national pilot harm reduction program (PHRP), which mainly included a methadone maintenance treatment program (MMTP) and a needle/syringe exchange program (NSP), was implemented in Taiwan. We conducted this study to evaluate the effectiveness of harm reduction measures on HIV control among injecting drug users (IDUs) between PHRP and nonPHRP. The data on HIV, collected from incumbent Taiwanese authorities, were analyzed for their associations, risk and protective factors with PHRP measures. While the monthly HIV incidences did not show significant differences before and after PHRP in the four areas with PHRP (Taipei City, Taipei County, Taoyuan County and Tainan County), a significant increase in the HIV incidence was found in the 21 areas without PHRP. Hence, the implementation of the PHRP did result in a significant difference in the monthly HIV incidence between areas with and without the PHRP. Mandatory HIV testing was significantly associated with the HIV incidence according to the generalized estimation equations (GEE) model. With adjustments of time period and area with PHRP, and urban area, protective factors associated with HIV incidence were: educational materials, condoms, dilution water, and alcohol sponges/swabs. MMTP contributed to a higher HIV incidence, probably due to the concurrent HIV testing upon admission. Since HIV testing was not required in the NSP, the HIV testing-dependent MMTP may explain the association of the PHRP intervention and an increased HIV incidence. In summary, HIV testing and education were essential for effective HIV control upon implementing the PHRP.

Moving toward Personalized Medicine in the Methadone Maintenance Treatment Program: A Pilot Study on the Evaluation of Treatment Responses in Taiwan

“…Many Taiwan IDUs had an experience of sharing needles or dilution water, and the HIV prevalence among IDUs reached a peak in 2005 [35, 36]. However, many antiretroviral agents [18, 19] have been investigated as CYP3A4, 2B6, or 2D6 strong inducers or inhibitors.…”

“…In Taiwan, to encounter the escalating IDUs and HIV infections through needle sharing, the first MMTPs were implemented in July 2006 [35, 36]. However, a thorough evaluation on the treatment responses of a MMTP has not yet been conducted.…”

Survey of methadone-drug interactions among patients of methadone maintenance treatment program in Taiwan

“…To address the escalating IDU and HIV infections through needle-sharing, the first MMTPs were implemented in July 2006 [38,39]. Because of this new measure, it is especially important for medical professionals to understand the comprehensive effects of MDIs among MMTP patients to inform treatment planning and care management.…”

HIV risk and the association with accessibility coverage to medical facilities and socioeconomic status among heroin users in Kaohsiung, Taiwan (2011‐2015): A GIS approach

“…In Taiwan, heroin and methamphetamine have been the predominant illicit drugs since 1990s, with an increasing trend of illegal ketamine use . Since 2005, due to the escalating HIV incidences among the injection drug users, the national harm reduction program (HRP) was implemented . The measures of HRP mainly included methadone maintenance treatment program (MMTP) and needle exchange program (NEP) .…”

“…The measures of HRP mainly included methadone maintenance treatment program (MMTP) and needle exchange program (NEP) . We have previously shown that education and HIV testing were essential for the effective HIV control among injecting heroin users . However, the factors contributing to such outcomes other than education remain to be scrutinized, especially at the local levels .…”