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. 2019 Apr 1:9:44-51.
doi: 10.1016/j.eclinm.2019.03.012. eCollection 2019 Mar.

HIV Incidence and Risk Behaviours of People Who Inject Drugs in Bangkok, 1995-2012

Michael Martin  1   2 , Suphak Vanichseni  3 , Udomsak Sangkum  3 , Philip A Mock  2 , Manoj Leethochawalit  4 , Sithisat Chiamwongpaet  4 , Punnee Pitisuttithum  5 , Jaranit Kaewkungwal  5 , Frits van Griensven  1   6   7 , Janet M McNicholl  1 , Jordan W Tappero  1   8 , Timothy D Mastro  1   9 , Somyot Kittimunkong  10 , Kachit Choopanya  3
Affiliations

HIV Incidence and Risk Behaviours of People Who Inject Drugs in Bangkok, 1995-2012

Michael Martin et al. EClinicalMedicine. .

Abstract

Background: Three consecutive prospective studies were conducted among people who inject drugs (PWID) from May 1995 through June 2012 in Bangkok, Thailand. We examined data from these studies to evaluate HIV incidence and explore trends in risk behaviours.

Methods: We used data from a 1995-1998 cohort study, a 1999-2004 HIV vaccine trial, and a 2005-2012 HIV pre-exposure prophylaxis (PrEP) study to examine per-quarter trends in HIV incidence, using a restricted cubic spline function for time in a Poisson regression. We also examined temporal trends in HIV-associated risk behaviours.

Findings: HIV incidence declined from 5.7 per 100 person-years during the cohort study, to 2.7 per 100 person-years in the vaccine trial, to 0.7 per 100 person-years among PrEP study placebo recipients. Incidence peaked at 12.1 per 100 person-years in 1996 and declined to < 1 per 100 person-years during 2005-2012. Reports of injecting drugs and sharing needles also declined from the cohort study to the PrEP study (p < 0.0001). Heroin was the most common drug injected during the cohort study and the vaccine trial, but stimulants (e.g., methamphetamine) and sedatives (e.g., midazolam) were injected more often during the PrEP study.

Interpretation: HIV incidence among PWID declined during 2005-2012. Several factors likely contributed to the decline, including decreases in the frequency of injecting and sharing, improved access to HIV testing and antiretroviral therapy, and the use of PrEP. Expanding access to effective HIV prevention tools can hasten control of the HIV epidemic among PWID.

Funding: The Bangkok Metropolitan Administration and U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention.

Keywords: HIV; HIV pre-exposure prophylaxis; People who inject drugs; Tenofovir; Thailand.

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Figures

Fig. 1
Fig. 1
HIV incidence density curve by quarter among people who inject drugs in three consecutive prospective studies in Bangkok, Thailand, 1995–2012. Cohort study 1995–1998; vaccine trial 1999–2004; PrEP study 2005–2012.
Fig. 2
Fig. 2
Per cent of participants injecting drugs and sharing needles by quarter in three consecutive prospective studies among people who inject drugs in Bangkok, Thailand, 1995–2012.
Fig. 3
Fig. 3
Per cent of participants incarcerated by quarter in three consecutive prospective studies among people who inject drugs in Bangkok, Thailand, 1995–2012.
Fig. 4
Fig. 4
Per cent of participants who injected heroin, stimulants, or sedatives by quarter in three consecutive prospective studies in Bangkok, 1995–2012.
See this image and copyright information in PMC

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