Trends in HIV incidence following scale-up of harm reduction ... - The Lancet

Total36858976.24735.34.8–5.8n/aPWUD6921295.2131.00.6–1.71non-PWUD7161414.4161.10.7–1.81.240.62–2.480.548PWID22776266.54447.16.5–7.87.684.59–12.85<0.001Male28967288.424476.15.6–6.71Female7891687.7261.51.0–2.30.250.17–0.38<0.001Among PWID only Male PWID22466173.44367.16.4–7.81 Female PWID3193.188.64.3–17.21.210.60–2.430.601 Age <25 yrs7771587.11529.68.2–11.21 Age ≥25 yrs15004679.52926.25.6–7.00.690.60–0.83<0.001 Hopin7732144.81396.55.5–7.71 Mogaung9623076.81866.05.2–7.00.950.76–1.180.646 Myitkyina5421044.911911.49.5–13.61.731.35–2.21<0.001 2008–2011365139.62719.313.3–28.21 2012–20169751253.716513.211.3–15.30.660.44–1.000.053 2017–20209374873.32525.24.6–5.90.280.18–0.42<0.001 Length of follow-up <3 yrs22772468.426210.69.4–12.01 Length of follow-up ≥3 yrs
a

Baseline was client enrolment, and length of follow up at this time was by definition 0 years. At the end of the study, 859 PWID were followed for >3 years.

03798.11824.84.1–5.50.370.28–0.49<0.001 Injected within 6 wks9411769.221612.210.7–14.01.501.21–1.87<0.001 Not injected within 6 wks8291523.01268.36.9–9.91 No response recorded
b

25.1% of PWID were not asked if they had injected within the last 6 weeks, and 45.6% were not asked if they had shared needles in the last 6 weeks.

5072974.41023.42.8–4.20.440.33–0.57<0.001 Shared needles within 6 wks211331.26118.414.3–23.71.921.46–2.54<0.001 Not shared within 6 wks15942898.62819.78.6–10.91 No response recorded
b

25.1% of PWID were not asked if they had injected within the last 6 weeks, and 45.6% were not asked if they had shared needles in the last 6 weeks.

47230361023.42.8–4.00.360.29–0.46<0.001 Unsafe sex within 6 wks71227.8219.26.0–14.11.761.12–2.760.014 Not had unsafe sex within 6 wks6113,625.51895.24.5–6.01 No response recorded15952413.22347.08.5–11.01.731.42–2.11<0.001 NSP low
c

Needle and syringe provision (NSP) coverage was defined by calculating the median coverage over 6-month periods between 2012 and 2020. A low coverage period was assigned if the number of syringes distributed was below the lower quartile of the 6-monthly number of syringes distributed over 2012–2020, while a high coverage period was assigned if the number of syringes distributed was above the upper quartile; otherwise, the period was assigned as being medium coverage (see Supplementary Table S1).

399707.87410.58.3–13.11.190.91–1.540.199 NSP medium
c

Needle and syringe provision (NSP) coverage was defined by calculating the median coverage over 6-month periods between 2012 and 2020. A low coverage period was assigned if the number of syringes distributed was below the lower quartile of the 6-monthly number of syringes distributed over 2012–2020, while a high coverage period was assigned if the number of syringes distributed was above the upper quartile; otherwise, the period was assigned as being medium coverage (see Supplementary Table S1).

10592622.72298.77.6–9.91 NSP high
c

Needle and syringe provision (NSP) coverage was defined by calculating the median coverage over 6-month periods between 2012 and 2020. A low coverage period was assigned if the number of syringes distributed was below the lower quartile of the 6-monthly number of syringes distributed over 2012–2020, while a high coverage period was assigned if the number of syringes distributed was above the upper quartile; otherwise, the period was assigned as being medium coverage (see Supplementary Table S1).

4542796.41144.13.4–4.90.490.39–0.61<0.001 Reports no polydrug use
d

Polydrug use was recorded as 'yes' for PWID taking multiple different classes of drugs. This was typically heroin or other opiates plus either amphetamines, yama (a mixture of methamphetamine and caffeine widely used in South East Asia) or alcohol. The majority of PWID in the study reported taking either heroin and/or opiates, which were considered the same drug class and recorded as 'no polydrug use'.

18473230.532610.19.1–11.20.870.57–1.320.511 Reports polydrug use
d

Polydrug use was recorded as 'yes' for PWID taking multiple different classes of drugs. This was typically heroin or other opiates plus either amphetamines, yama (a mixture of methamphetamine and caffeine widely used in South East Asia) or alcohol. The majority of PWID in the study reported taking either heroin and/or opiates, which were considered the same drug class and recorded as 'no polydrug use'.

150277.1248.75.8–12.91 No response recorded2802758.9943.42.8–4.20.350.28–0.45<0.001 IDU duration <2 yrs
e

Injecting drug use (IDU) duration was calculated by taking the self-reported duration at the first recorded HIV test and adding the length of time followed-up after this.

22173.42230.019.7–45.51 IDU duration 2–<5 yrs
e

Injecting drug use (IDU) duration was calculated by taking the self-reported duration at the first recorded HIV test and adding the length of time followed-up after this.

666752.313317.714.9–21.00.480.30–0.760.002 IDU duration 5–<10 yrs
e

Injecting drug use (IDU) duration was calculated by taking the self-reported duration at the first recorded HIV test and adding the length of time followed-up after this.

5442061.51366.65.6–7.80.170.10–0.27<0.001 IDU duration ≥10 yrs
e

Injecting drug use (IDU) duration was calculated by taking the self-reported duration at the first recorded HIV test and adding the length of time followed-up after this.

3722233.3853.83.1–4.70.100.06–0.17<0.001 No response recorded4741146.0685.94.7–7.50.160.09–0.26<0.001 Never on OAT during follow-up
f

Considerable scale-up of OAT was observed throughout the study. By the end of the study, 260 PWID were recorded going onto OAT at a later time point, 81 PWID had stopped taking OAT, and 859 were currently taking OAT. For the analysis of OAT, 'Prior to starting OAT' includes all test records of PWID that take OAT during follow-up but have not started yet. 'After OAT stopped' includes all test records of PWID that take OAT during follow-up but have now stopped taking OAT. 'Never on OAT during follow-up' includes test records of PWID who never took OAT. 'Currently on OAT' includes the test records of PWID after their start date of taking OAT and excludes test records of PWID after they discontinued OAT.

11402376.42319.78.5–11.11 Prior to starting OAT
f

Considerable scale-up of OAT was observed throughout the study. By the end of the study, 260 PWID were recorded going onto OAT at a later time point, 81 PWID had stopped taking OAT, and 859 were currently taking OAT. For the analysis of OAT, 'Prior to starting OAT' includes all test records of PWID that take OAT during follow-up but have not started yet. 'After OAT stopped' includes all test records of PWID that take OAT during follow-up but have now stopped taking OAT. 'Never on OAT during follow-up' includes test records of PWID who never took OAT. 'Currently on OAT' includes the test records of PWID after their start date of taking OAT and excludes test records of PWID after they discontinued OAT.

10361117.011510.38.6–12.41.040.83–1.300.741 After OAT stopped
f

Considerable scale-up of OAT was observed throughout the study. By the end of the study, 260 PWID were recorded going onto OAT at a later time point, 81 PWID had stopped taking OAT, and 859 were currently taking OAT. For the analysis of OAT, 'Prior to starting OAT' includes all test records of PWID that take OAT during follow-up but have not started yet. 'After OAT stopped' includes all test records of PWID that take OAT during follow-up but have now stopped taking OAT. 'Never on OAT during follow-up' includes test records of PWID who never took OAT. 'Currently on OAT' includes the test records of PWID after their start date of taking OAT and excludes test records of PWID after they discontinued OAT.

0217.7198.75.6–13.70.920.58–1.470.728 Currently on OAT
f

Considerable scale-up of OAT was observed throughout the study. By the end of the study, 260 PWID were recorded going onto OAT at a later time point, 81 PWID had stopped taking OAT, and 859 were currently taking OAT. For the analysis of OAT, 'Prior to starting OAT' includes all test records of PWID that take OAT during follow-up but have not started yet. 'After OAT stopped' includes all test records of PWID that take OAT during follow-up but have now stopped taking OAT. 'Never on OAT during follow-up' includes test records of PWID who never took OAT. 'Currently on OAT' includes the test records of PWID after their start date of taking OAT and excludes test records of PWID after they discontinued OAT.

1012555.4793.12.5–3.90.330.26–0.43<0.001

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