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Comparative Study
. 2021 Nov:139:38-48.
doi: 10.1016/j.jclinepi.2021.07.007. Epub 2021 Jul 16.

A cohort study revealed high mortality among people who inject drugs in Hai Phong, Vietnam

Vu Hai Vinh  1 , Roselyne Vallo  2 , Hoang Thi Giang  3 , Duong Thi Huong  3 , Khuat Thi Hai Oanh  4 , Pham Minh Khue  3 , Nham Thi Tuyet Thanh  4 , Catherine Quillet  2 , Delphine Rapoud  2 , Laurent Michel  5 , Philippe Van de Perre  2 , Jonathan Feelemyer  6 , Jean Pierre Moles  7 , Amandine Cournil  2 , Don Des Jarlais  6 , Didier Laureillard  8 , Nicolas Nagot  9
Affiliations
Comparative Study

A cohort study revealed high mortality among people who inject drugs in Hai Phong, Vietnam

Vu Hai Vinh et al. J Clin Epidemiol. 2021 Nov.

Abstract

Objective: To estimate the residual mortality rate among people who inject drugs (PWID) in a Low-Middle Income Countries context where the HIV epidemic has been controlled and methadone coverage is high.

Study design and setting: PWID from Haiphong, Vietnam, were recruited through three annual respondent-driven sampling surveys that fueled two cohorts of PWID with HIV (n = 761) and without HIV (n = 897), with bi-annual follow-up. Presumed causes of death were ascertained from medical records and/or interviews of participants family.

Results: Among the 1658 participants with a median follow-up of 2 years, 67 and 36 died in the HIV-positive and HIV-negative cohort, respectively, yielding crude mortality rates of 4.3 (95% Confidence interval (CI): 3.3-5.4) per 100 person-years of follow-up (PYFU) and 1.9 (CI: 1.4-2.6) per 100 PYFU. In the HIV-positive cohort, in which 81% of participants had undetectable viral load, the two main causes of death were tuberculosis and HIV-related diseases. In the HIV-negative cohort, the two main causes of death were liver-related diseases and overdose. In a time-dependent multivariable model, "unsuppressed viral load" was associated with increased risk of mortality, whereas "being on methadone" or "being employed" was associated with a lower risk.

Conclusion: Despite a very successful HIV and methadone program, the mortality remains high among PWID in Vietnam, largely due to curable infectious diseases such as tuberculosis and viral hepatitis.

Keywords: HIV; Mortality; People who inject drugs; Tuberculosis; Viral hepatitis.

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Conflict of interest statement

Conflict of Interest

None.

The authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Participant study design and flow chart. Three annual RDS surveys recruited about 1500 PWID each. In parallel, a cohort study was implemented with bi-annual visits. Out of RDS participants, all HIV-positive PWID and consecutive HIV-negative PWID up to 400 for the RDS1 and 200 for the subsequent RDS were invited to participate to the cohorts. *Deaths during M36 period
Figure 2.
Figure 2.
Kaplan-Meier survival curves by HIV status among study participants in the HIV-negative and HIV-positive cohorts.
See this image and copyright information in PMC

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