HIV care continuum characteristics among people with opioid use disorder and HIV in Vietnam: baseline results from the BRAVO study

Abstract

Background: Little is known about patient characteristics that contribute to initiating antiretroviral therapy (ART) and achieving viral suppression among HIV people with opioid use disorder in Vietnam. The primary objective of this analysis was to evaluate associations between participant characteristics and the critical steps in the HIV care continuum of ART initiation and HIV viral suppression among people with opioid use disorder and HIV in Vietnam. Methods: We assessed baseline participant characteristics, ART status, and HIV viral suppression (HIV RNA PCR < 200 copies/mL) enrolled in a clinical trial of HIV clinic-based buprenorphine versus referral for methadone among people with opioid use disorder in Vietnam. We developed logistic regression models to identify characteristics associated with ART status and HIV viral suppression. Results: Among 283 study participants, 191 (67.5%) were prescribed ART at baseline, and 168 of those on ART (90%) were virally suppressed. Years since HIV diagnosis (aOR = 1.12, 95% CI 1.06, 1.19) and being married (aOR = 2.83, 95% CI 1.51, 5.34) were associated with an increased likelihood of current prescription for ART at baseline. Greater depression symptoms were negatively associated with receipt of ART (aOR = 0.97, 95% CI = (0.94, 0.9963)). In the HIV suppression model, once adjusting for all included covariates, only receipt of ART was associated with viral suppression (aOR = 25.9, 95% CI = (12.5, 53.8). In bivariate analyses, methamphetamine was negatively correlated with ART prescription (p = 0.07) and viral suppression (p = 0.08). Conclusion: While fewer than 90% of participants had received ART, 90% of those on ART had achieved HIV viral suppression at baseline, suggesting that interventions to improve uptake of ART in Vietnam are essential for achieving UNAIDS 90-90-90 goals in people who use heroin in Vietnam. Social determinants of health associated with ART and HIV viral suppression suggest that social support may be a key to facilitating both of these steps in the HIV care continuum.

The longitudinal association between depression, anxiety symptoms and HIV outcomes, and the modifying effect of alcohol dependence among ART clients with hazardous alcohol use in Vietnam

“…While mental health symptoms are independently associated with poorer HIV outcomes, alcohol use can also accelerate HIV progression through a number of mechanisms. High levels of alcohol use do not only negatively impact ART adherence and response to medication but can also lead to compromised liver function and liver diseases [35][36][37][38][39][40][41][42]. Therefore, mental health symptoms and high levels of alcohol use can substantially increase the risk of treatment failure among PWH [43].…”

Association between recent methamphetamine use, antiretroviral therapy and HIV viral load; a mediation analysis from a cohort of HIV positive persons who inject drugs in Hai Phong, Vietnam

“…We then divided adherence scores into two categories; imperfect adherence (defined as scores 1–8) and perfect/high adherence (defined as scores 9–10), similar to previous studies categorization of HIV viral load, including the BRAVO trial conducted in Vietnam. 19 ART adherence measurements were based on self-report (note that previous studies have highlighted the reliability of self-reported ART adherence measurements, 20 and our community based organization members (CBOs) worked with our participants to ensure accurate ART adherence reporting).…”

Facing drug addiction: Vietnam’s struggle with opioids

“…They were: low levels of education, the requirement to have an identity card, treatment schedules that conflict with work schedules, and the policy of subsidizing the cost of running the clinics. A recent report assessing associations between participant characteristics and critical steps in the HIV care continuum of the BRAVO (Buprenorphine to Improve HIV Care Engagement and Outcomes) study suggested the need for an intervention such as integrating opioid use disorder treatment in HIV treatment settings, and at the same time highlighted the essential of family and social relationships in HIV viral suppression (King et al, 2020). Korthuis et al (2021) pointed out improved HIV viral suppression in participants at HIV clinics that integrated either buprenorphine plus naloxone or methadone maintenance therapy, and that the retention in either antiretroviral treatment or opioid use disorder medications of participants could influent the appearance of serious adverse events and deaths.…”