Feasibility of Interventions on People Who Inject Drugs in Vietnam

Objectives:

The primary objective of the DRIVE-IN project is to evaluate the feasibility of implementing an interventional cohort of PWID in Haiphong. Such a cohort (DRIVE) will be instrumental in demonstrating the efficacy of a community-involved intervention integrating prevention and care in order to reduce HIV and HCV transmission among PWID in Haiphong.

The main expected result of DRIVE-IN is to demonstrate that enrolment and follow-up of various hard-to-reach subgroups of PWID is feasible in the local context. These feasibility objectives will be evaluated using a set of relevant indicators.

Design:

The research will first include a respondent-driven sampling (RDS) survey, including a maximum of 600 PWID. Then 250 RDS participants (i.e about a quarter of the future DRIVE cohort) will be selected for a longitudinal study, with an enrolment and 3 follow-up visits at week 4, 12 and 24. In parallel, four qualitative studies will be implemented: one study to explore how to reach the hardest-to-reach and most-at-risk PWID, one feed-back study on PWID feeling about their participation in the research, one study investigating the reasons of drop-outs, and a final study on the research process itself.

Endpoints:

The RDS will describe the target population and the patterns of drug use. The feasibility of implementing an interventional cohort will be evaluated on several indicators:

• International multi-disciplinary research network is operational
• Completion of recruitment within the time frame
• Follow-up rate >80% at 24 weeks
• Implementation and increased access to peer-led interventions
• Establishment of a data management center
• Improved laboratory capacities for research
• Documented support of local and national authorities

Study population RDS survey Inclusion criteria Age > 18 years Self-reported drug injector confirmed by a positive urinary test and either skin marks of injection or knowledge of injecting procedures Signed informed consent Non-inclusion criteria Unable of understanding informed consent and answering questionnaires

Longitudinal study Inclusion criteria Having participated to the RDS survey Signed informed consent specific to the longitudinal study Non-inclusion criteria Ongoing Methadone Maintenance Therapy (MMT) Ongoing antiretroviral therapy Health status not compatible with study follow-up Have a plan to move out of Haiphong over the next two years. Have been sentenced recently to a prison term

Follow-up and study visits contents:

Participants of the longitudinal phase will be followed at week 4, 12 and 24 (final visit). During the RDS, face-to-face questionnaires will be applied on drug use, sexual health, and referral to care and repeated at each follow-up visit, along with the record of medical events. In addition, a urinary test will be collected at the RDS to assess the range of recent drugs used, and repeated at the final follow-up visit (week 24). Finally, at the RDS and final visit, HIV, HCV, Hepatitis B Virus (HBV) serology will be done along with appropriate counselling.

Sample size:

• 603 PWID will be enrolled in the RDS survey
• 250 RDS participants will be enroled in the longitudinal phase, including:
• 140 PWID for > 2 years, including females
• 50 recent injectors (< 2 years from first injection)
• 30 FSW who inject drugs
• 30 MSM who inject drugs

• Inclusion criteria

• Being more than 18 years of age
• Being drug injector confirmed by a positive urine drug test with knowledge of injecting procedures
• Having signed the informed consent form
• For the Longitudinal study - having participated in the RDS survey
• Exclusion criteria

• Unable to understand informed consent and how to answer a questionnaire
• For the longitudinal study - being under methadone maintenance therapy and antiretroviral treatment
• Having a health condition not compatible with study follow-up
• Plan to move away from Haiphong in the next 2 years
• Serving a sentence in prison