HIV, HBV and HCV in people who inject drugs and are placed on methadone maintenance therapy, Yangon, Myanmar

Abstract

Two drug treatment centres (DTCs) for people who inject drugs (PWID) and are enrolled in methadone maintenance therapy (MMT), Yangon, Myanmar. Objectives: To determine, in PWID enrolled for MMT from 2015 to 2017, 1) testing uptake and results for human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV); 2) risk factors for infection; and 3) retention in care and risk factors for loss to follow-up (LTFU). Design: Cohort study using secondary data. Results: Of 642 PWID, 578 (90.0%) were tested for HIV, HBV and/or HCV. Overall, 404 (69.9%) were infected: 316 (78.2%) had one infection and the remainder had dual/triple infections. Testing uptake was generally better in 2015 and 2016 than in 2017. Prevalence of HIV infection was 15-17%, for HBV it was 4-7%, and for HCV it was 68-76%. Age 30 years, being single and duration of drug use were independent risk factors for infection. Retention in MMT at 6 months was 76% and declined thereafter. Experimental use of drugs and needle sharing were independent risk factors for LTFU. Conclusion: PWID enrolled in MMT in Yangon had high rates of HIV, HBV and HCV, and retention in care declined with time. Ways to improve individual tracing, programmatic retention and linkage to care are needed.

Hepatitis C elimination in Myanmar: Modelling the impact, cost, cost-effectiveness and economic benefits

“…Co-infection with HIV was not included explicitly, but rates of disease progression were calibrated to account for the fact that among people with HCV, approximately 50% are coinfected with HIV [22 , 26] and approximately 20% are coinfected with HBV [26] , and that those with coinfections could be expected to develop liver disease at increased rates [23] .…”

Treatment outcomes and costs of a simplified antiviral treatment strategy for hepatitis C among monoinfected and HIV and/or hepatitis B virus‐co‐infected patients in Myanmar

“…5,10,11 HCV/HIV co-infection rates vary, with estimates ranging from 5% to 22.8% and high risk among PWID. 10,[12][13][14] Mynamar has a national treatment and testing strategy for the elimination of HCV. Availability and access to HCV testing and treatment, fear of prosecution for drug use, and high stigma for key populations, results in most presenting for HCV and HIV treatment are already well advanced in their illness.…”

Public health interventions for reducing HIV, hepatitis B and hepatitis C infections in people who inject drugs

“…2 PWID are subject to marginalisation and stigmatisation, which creates social and economic barriers to access to public health interventions. [1][2][3][4][5] Between 1990 and 2013, there was a four-fold increase in disability-adjusted life-years (DA-LYs) attributable to PWID for HIV, HBV and HCV (10.08 million DALYs attributable to HIV, HBV and HCV in 2013 alone). 1 Successful public health intervention programmes for PWID rely on a combination of peer education programmes, safe-injecting practice support, accessible, clean-injecting equipment, opiate substitution therapy and proactive testing and treatment of BBV.…”

“…4 In this edition of the journal, researchers from Myanmar present data on the uptake of BBV testing from two methadone replacement programmes demonstrating high rates of testing (78-90%) and expected prevalence rates of HIV (15-17%), HBV (4-7%) and HCV (53%). 5 Importantly, they have documented retention in care rates from enrolment, showing that 76% were accessing care at 6 months, 65% at 1 year and 53% at 2 years. 5 As global politics evolve and public health resources are threatened, the tide is against this highly marginalised group.…”

“…5 Importantly, they have documented retention in care rates from enrolment, showing that 76% were accessing care at 6 months, 65% at 1 year and 53% at 2 years. 5 As global politics evolve and public health resources are threatened, the tide is against this highly marginalised group. Not only are PWID at risk of general poor health outcomes, they are also at very high risk of HIV, HBV and HCV.…”