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      What are the factors associated with HIV testing among male injecting and non-injecting drug users in Lashio, Myanmar: a cross-sectional study

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          Abstract

          Objectives

          HIV testing is an effective intervention for reducing HIV risk and providing information on HIV status. However, uptake of HIV testing is a major challenge within the drug-using population due to the stigma and discrimination associated with their illegal drug use behaviours. This study thus aimed to identify factors associated with HIV testing among injecting drug users (IDUs) and non-injecting drug users (NIDUs) in Lashio, Myanmar.

          Design

          A cross-sectional study was conducted from January 2010 to February 2010.

          Setting

          This study was carried out in Lashio city, Northern Shan State, Myanmar.

          Participants

          In total, 158 male IDUs and 210 male NIDUs were recruited using a respondent-driven sampling method.

          Primary outcome measures

          Proportion of both drug users who were ever tested for HIV and factors associated with HIV testing.

          Results

          Approximately 77% of IDUs and 46% of NIDUs were ever tested for HIV. The multivariate analysis revealed that having ever received drug treatment was positively associated with HIV testing among both IDUs (adjusted OR (AOR) 13.07; 95% CI 3.38 to 50.53) and NIDUs (AOR 3.58; 95% CI 1.38 to 9.24). IDUs who were married (AOR 0.24; 95% CI 0.06 to 0.94) and who injected at least twice daily (AOR 0.30; 95% CI 0.09 to 0.97) were less likely to undergo HIV testing. Among NIDUs, those who belonged to Shan (AOR 0.30; 95% CI 0.11 to 0.84) or Kachin (AOR 0.30; 95% CI 0.10 to 0.87) ethnicities were less likely to test for HIV.

          Conclusions

          IDUs and NIDUs who have received drug treatment are more likely to test for HIV. Integrating HIV testing into drug treatment programmes alongside general expansion of HIV testing services may be effective in increasing HIV testing uptake among both IDUs and NIDUs in the Northern Shan State of Myanmar.

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          Most cited references23

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          Cost-effectiveness of voluntary HIV-1 counselling and testing in reducing sexual transmission of HIV-1 in Kenya and Tanzania.

          Access to HIV-1 voluntary counselling and testing (VCT) is severely limited in less-developed countries. We undertook a multisite trial of HIV-1 VCT to assess its impact, cost, and cost-effectiveness in less-developed country settings. The cost-effectiveness of HIV-1 VCT was estimated for a hypothetical cohort of 10000 people seeking VCT in urban east Africa. Outcomes were modelled based on results from a randomised controlled trial of HIV-1 VCT in Tanzania and Kenya. Our main outcome measures included programme cost, number of HIV-1 infections averted, cost per HIV-1 infection averted, and cost per disability-adjusted life-year (DALY) saved. We also modelled the impact of targeting VCT by HIV-1 prevalence of the client population, and the proportion of clients who receive VCT as a couple compared with as individuals. Sensitivity analysis was done on all model parameters. HIV-1 VCT was estimated to avert 1104 HIV-1 infections in Kenya and 895 in Tanzania during the subsequent year. The cost per HIV-1 infection averted was US$249 and $346, respectively, and the cost per DALY saved was $12.77 and $17.78. The intervention was most cost-effective for HIV-1-infected people and those who received VCT as a couple. The cost-effectiveness of VCT was robust, with a range for the average cost per DALY saved of $5.16-27.36 in Kenya, and $6.58-45.03 in Tanzania. Analysis of targeting showed that increasing the proportion of couples to 70% reduces the cost per DALY saved to $10.71 in Kenya and $13.39 in Tanzania, and that targeting a population with HIV-1 prevalence of 45% decreased the cost per DALY saved to $8.36 in Kenya and $11.74 in Tanzania. HIV-1 VCT is highly cost-effective in urban east African settings, but slightly less so than interventions such as improvement of sexually transmitted disease services and universal provision of nevirapine to pregnant women in high-prevalence settings. With the targeting of VCT to populations with high HIV-1 prevalence and couples the cost-effectiveness of VCT is improved significantly.
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            Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT Study Group.

            The efficacy of counseling to prevent infection with the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) has not been definitively shown. To compare the effects of 2 interactive HIV/STD counseling interventions with didactic prevention messages typical of current practice. Multicenter randomized controlled trial (Project RESPECT), with participants assigned to 1 of 3 individual face-to-face interventions. Five public STD clinics (Baltimore, Md; Denver, Colo; Long Beach, Calif; Newark, NJ; and San Francisco, Calif) between July 1993 and September 1996. A total of 5758 heterosexual, HIV-negative patients aged 14 years or older who came for STD examinations. Arm 1 received enhanced counseling, 4 interactive theory-based sessions. Arm 2 received brief counseling, 2 interactive risk-reduction sessions. Arms 3 and 4 each received 2 brief didactic messages typical of current care. Arms 1, 2, and 3 were actively followed up after enrollment with questionnaires at 3, 6, 9, and 12 months and STD tests at 6 and 12 months. An intent-to-treat analysis was used to compare interventions. Self-reported condom use and new diagnoses of STDs (gonorrhea, chlamydia, syphilis, HIV) defined by laboratory tests. At the 3- and 6-month follow-up visits, self-reported 100% condom use was higher (P<.05) in both the enhanced counseling and brief counseling arms compared with participants in the didactic messages arm. Through the 6-month interval, 30% fewer participants had new STDs in both the enhanced counseling (7.2%; P= .002) and brief counseling (7.3%; P= .005) arms compared with those in the didactic messages arm (10.4%). Through the 12-month study, 20% fewer participants in each counseling intervention had new STDs compared with those in the didactic messages arm (P = .008). Consistently at each of the 5 study sites, STD incidence was lower in the counseling intervention arms than in the didactic messages intervention arm. Reduction of STD was similar for men and women and greater for adolescents and persons with an STD diagnosed at enrollment. Short counseling interventions using personalized risk reduction plans can increase condom use and prevent new STDs. Effective counseling can be conducted even in busy public clinics.
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              Estimates of injecting drug users at the national and local level in developing and transitional countries, and gender and age distribution.

              To present and update available national and subnational estimates of injecting drug users (IDUs) in developing/transitional countries, and provide indicative estimates of gender and age distribution. Literature review of both grey and published literature including updates from previously reported estimates on estimates of IDU population and data sources giving age and gender breakdowns. The scope area was developing/transitional countries and the reference period was 1998-2005. Estimates of IDU numbers were available in 105 countries and 243 subnational areas. The largest IDU populations were reported from Brazil, China, India, and Russia (0.8 m, 1.9 m, 1.1 m, and 1.6 m respectively). Subnational areas with the largest IDU populations (35,000-79,000) are: Warsaw (Poland); Barnadul, Irtkustk, Nizhny-Novgorod, Penza, Voronez, St Petersburg, and Volgograd (Russia); New Delhi and Mumbai (India); Jakarta (Indonesia), and Bangkok (Thailand). By region, Eastern Europe and Central Asia have the largest IDU prevalence (median 0.65%) (min 0.3%; max 2.2%; Q1 0.39%; Q3 1.32%) [corrected] followed by Asia and Pacific: 0.24% (min 0.004%; max 1.47%; Q1 0.14%; Q3 1.47%) [corrected] In the Middle East and Africa the median value equals 0.2% (min 0.0003%; max 0.35%; Q1 0.11%; Q3 0.23%) [corrected] and in Latin America and the Caribbean: 0.12% (min 0.11%; max 0.69%; Q1 0.04%; Q3 0.13%) [corrected] Subnational areas with the highest IDU prevalence among adults (8-14.9%) were Shymkent (Kazakhstan), Balti (Moldova), Astrakhan, Barnadul, Irtkustk, Khabarovsk, Kaliningrad, Naberezhnyje Chelny, Penza, Togliatti, Volgograd, Voronez, and Yaroslavl (Russia), Dushanbe (Tajikistan), Ashgabad (Turkmenistan), Ivano-Frankivsk and Pavlograd (Ukraine) and Imphal, Manipur (India). 66% (297/447) of the IDU estimates were reported without technical information. Data on the IDU age/gender distributions are also scarce or unavailable for many countries. In 11 Eastern European and Central Asian countries the age group 50% of the total. The proportion of IDU men was 70%-90% in Eastern Europe and Central Asia, and there was a marked absence of data on women outside this region. Unfortunately data on IDU prevalence available to national and international policymakers is of an unknown and probably yet to be tested quality. This study provide baseline figures but steps need to be taken now to improve the reporting and assessment of these critical data.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2013
                6 June 2013
                : 3
                : 6
                : e002747
                Affiliations
                [1 ]Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
                [2 ]Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst , Amherst, Massachusetts, USA
                [3 ]Department of Preventive and Social Medicine, The University of Medicine 2 , Yangon, Myanmar
                Author notes
                [Correspondence to ] Dr Junko Yasuoka; jyasuoka@ 123456post.harvard.edu
                Article
                bmjopen-2013-002747
                10.1136/bmjopen-2013-002747
                3686230
                23794581
                174b2c5d-6356-4f81-a2cc-efcf4406b872
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode

                History
                : 2 May 2013
                : 11 April 2013
                : 7 May 2013
                Categories
                HIV/AIDS
                Research
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                Medicine
                health services administration & management
                Medicine
                health services administration & management

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