In Vietnam, where 58% of prevalent HIV cases are attributed to PWID, we evaluated whether a multi-level intervention could improve care outcomes and increase survival.
We enrolled 455 HIV-infected male PWID from 32 communes in Thai Nguyen Province. Communes were randomized to a community stigma reduction intervention or standard of care and then within each commune, to an individual enhanced counseling intervention or standard of care, resulting in four arms: Arm 1 (standard of care); Arm 2 (community intervention alone); Arm 3 (individual intervention alone); and Arm 4 (community + individual interventions). Follow-up was conducted at 6, 12, 18, and 24 months to assess survival.
Overall mortality was 23% (n = 103/455) over two years. There were no losses to follow-up for the mortality endpoint. Survival at 24-months was different across arms: Arm 4 (87%) vs Arm 1 (82%) vs Arm 2 (68%) vs Arm 3 (73%); log-rank test for comparison among arms: p=0.001. Among those with CD4 cell count <200 cells/mm3 and not on antiretroviral therapy (ART) at baseline (n=162), survival at 24 months was higher in Arm 4 (84%) compared to other arms (Arm 1: 61%; Arm 2: 50%; Arm 3: 53%; p-value=0.002). Overall, Arm 4 (community + individual interventions), increased uptake of ART compared to Arms 1, 2, and 3.