Seek, Test, Treat Strategies for Vietnamese Drug Users: A Random Controlled Trial

描述（由申请人提供）：注射海洛因使用和艾滋病毒/艾滋病是越南的主要公共卫生问题，艾滋病毒感染继续集中在不断增长的注射毒品使用（IDU）人群中（全国艾滋病毒患病率为20%）。尽管在扩大艾滋病毒预防和抗逆转录病毒治疗（ART）规划方面取得了相当大的进展，但注射吸毒者的艾滋病毒传播率仍然很高（艾滋病毒发病率，每年5%），获得抗逆转录病毒治疗的机会仍然有限（11%），艾滋病毒阳性吸毒者的死亡率仍然很高（每年15%），需要采取干预措施。越南政府减少毒品需求的方法主要依靠其83个毒品治疗中心（DTC）系统，其中大多数被拘留者（85%）是通过警察逮捕而被接纳的。此类治疗后阿片类药物注射的复发率为71%，在dtc释放后6个月内。dtc提供了一个独特的机会，可以识别、检测并向这一边缘化人群中的大部分提供抗逆转录病毒药物。我们建议对注射吸毒者及其网络成员采取寻找、检测和治疗策略的干预措施，确保寻找高风险个体进行艾滋病毒检测，及时转诊并维持抗逆转录病毒治疗，同时向许多艾滋病毒检测呈阴性和艾滋病毒检测呈阳性的人提供艾滋病毒预防干预措施。干预措施将通过dtc使用疾病预防控制中心推荐的刑事司法环境中的常规选择退出艾滋病毒检测来寻找和检测注射吸毒者，并将寻找和检测其网络成员。通过一项两组随机对照试验，将艾滋病毒阳性注射吸毒者转介到艾滋病毒护理，以比较不同程度的护理对抗逆转录病毒药物吸收、抗逆转录病毒药物依从性和治疗结果的影响。审判的总时间为五年。这项研究将在首都河内所有参与的发展中国家进行

DESCRIPTION (provided by applicant): Injection heroin use and HIV/AIDS are major public health problems in Vietnam, with HIV infection continuing to be concentrated among the growing injection drug use (IDU) population (20% HIV prevalence, nationally). Although considerable progress has been made to expand HIV prevention and antiretroviral therapy (ART) programs, the high HIV transmission rate among IDUs continues (HIV incidence, 5% per year), access to antiretroviral therapy still limited (11%), and mortality among HIV-positive drug users remains excessive (15% per year), requiring interventions. The Vietnamese government's approach to drug demand reduction has primarily relied on its system of 83 drug treatment centers (DTC) where most detainees (85%) are admitted through arrests by police. Relapse to opioid injection after such treatment is 71% within 6 months after release from DTCs. DTCs represent a unique opportunity to identify, test, and provide ART to a large segment of this marginalized population. We propose an intervention that employs the seek, test, and treat strategies for the IDU population and their network members, by ensuring that high risk individuals are sought for HIV testing, promptly referred to and maintained on ART, while HIV prevention interventions provided to the many who test HIV-negative, as well as those who test HIV-positive. The intervention will seek and test IDUs via DTCs using CDC-recommended routine opt-out HIV testing in criminal justice settings and also will seek and test their network members. HIV-positive IDUs will be referred to HIV care through a two arm randomized controlled trial to compare the effects of different levels of engagement in care on ART uptake, antiretroviral adherence, and treatment outcome. The total duration of the trial will be five years. The study will be conducted in all participating DTCs in the capital city of Hanoi