Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial
Abstract Introduction The HIV Prevention Trials Network (HPTN) 074 study demonstrated a positive effect of an integrated systems navigation and psychosocial counseling intervention on HIV treatment initiation, viral suppression, medication assisted treatment (MAT) enrollment, and risk of death among...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-023-08201-3 |
| _version_ | 1797827620374577152 |
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| author | Kostyantyn Dumchev Xu Guo Tran Viet Ha Zubairi Djoerban Oleksandr Zeziulin Vivian F. Go Riza Sarasvita David S. Metzger Carl A. Latkin Scott M. Rose Estelle Piwowar-Manning Paul Richardson Brett Hanscom Kathryn E. Lancaster William C. Miller Irving F. Hoffman |
| author_facet | Kostyantyn Dumchev Xu Guo Tran Viet Ha Zubairi Djoerban Oleksandr Zeziulin Vivian F. Go Riza Sarasvita David S. Metzger Carl A. Latkin Scott M. Rose Estelle Piwowar-Manning Paul Richardson Brett Hanscom Kathryn E. Lancaster William C. Miller Irving F. Hoffman |
| author_sort | Kostyantyn Dumchev |
| collection | DOAJ |
| description | Abstract Introduction The HIV Prevention Trials Network (HPTN) 074 study demonstrated a positive effect of an integrated systems navigation and psychosocial counseling intervention on HIV treatment initiation, viral suppression, medication assisted treatment (MAT) enrollment, and risk of death among people who inject drugs (PWID). In this sub-study, we analyzed the incidence, causes, and predictors of death among HIV-infected and uninfected participants. Methods The HPTN 074 randomized clinical trial was conducted in Indonesia, Ukraine, and Vietnam. HIV-infected PWID with unsuppressed viral load (indexes) were recruited together with at least one of their HIV-negative injection partners. Indexes were randomized in a 1:3 ratio to the intervention or standard of care. Results The trial enrolled 502 index and 806 partner participants. Overall, 13% (66/502) of indexes and 3% (19/806) of partners died during follow-up (crude mortality rates 10.4 [95% CI 8.1–13.3] and 2.1 [1.3–3.3], respectively). These mortality rates were for indexes nearly 30 times and for partners 6 times higher than expected in a population of the same country, age, and gender (standardized mortality ratios 30.7 [23.7–39.0] and 5.8 [3.5–9.1], respectively). HIV-related causes, including a recent CD4 < 200 cells/μL, accounted for 50% of deaths among indexes. Among partners, medical conditions were the most common cause of death (47%). In the multivariable Cox model, the mortality among indexes was associated with sex (male versus female aHR = 4.2 [1.5–17.9]), CD4 count (≥ 200 versus < 200 cells/μL aHR = 0.3 [0.2–0.5]), depression (moderate-to-severe versus no/mild aHR = 2.6 [1.2–5.0]) and study arm (intervention versus control aHR = 0.4 [0.2–0.9]). Among partners, the study arm of the index remained the only significant predictor (intervention versus control aHR = 0.2 [0.0–0.9]) while controlling for the effect of MAT (never versus ever receiving MAT aHR = 2.4 [0.9–7.4]). Conclusions The results confirm that both HIV-infected and uninfected PWID remain at a starkly elevated risk of death compared to general population. Mortality related to HIV and other causes can be significantly reduced by scaling-up ART and MAT. Access to these life-saving treatments can be effectively improved by flexible integrated interventions, such as the one developed and tested in HPTN 074. |
| first_indexed | 2024-04-09T12:51:15Z |
| format | Article |
| id | doaj.art-11f84e8cf4cf456fac52905c6144b639 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-09T12:51:15Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-11f84e8cf4cf456fac52905c6144b6392023-05-14T11:10:05ZengBMCBMC Infectious Diseases1471-23342023-05-0123111510.1186/s12879-023-08201-3Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trialKostyantyn Dumchev0Xu Guo1Tran Viet Ha2Zubairi Djoerban3Oleksandr Zeziulin4Vivian F. Go5Riza Sarasvita6David S. Metzger7Carl A. Latkin8Scott M. Rose9Estelle Piwowar-Manning10Paul Richardson11Brett Hanscom12Kathryn E. Lancaster13William C. Miller14Irving F. Hoffman15Ukrainian Institute On Public Health PolicyVaccine and Infectious Disease Division, Fred Hutchinson Cancer Research CenterDept. of Health Behavior, Gilings School of Global Public Health, University of North Carolina at Chapel HillDepts. of Hematology, Medical Oncology, and Medicine, Univ. of Indonesia/ Cipto Mangunkusumo HospitalUkrainian Institute On Public Health PolicyDept. of Health Behavior, Gilings School of Global Public Health, University of North Carolina at Chapel HillNational Narcotics BoardHIV Prevention Research Division, Department of Psychiatry, School of Medicine, University of PennsylvaniaDept. of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins UniversityScience Facilitation DepartmentDept. of Pathology, School of Medicine, Johns Hopkins UniversityDept. of Pathology, School of Medicine, Johns Hopkins UniversityVaccine and Infectious Disease Division, Fred Hutchinson Cancer Research CenterDivision of Epidemiology, College of Public Health, The Ohio State UniversityDivision of Epidemiology, College of Public Health, The Ohio State UniversityDept. of Medicine, School of Medicine, University of North Carolina at Chapel HillAbstract Introduction The HIV Prevention Trials Network (HPTN) 074 study demonstrated a positive effect of an integrated systems navigation and psychosocial counseling intervention on HIV treatment initiation, viral suppression, medication assisted treatment (MAT) enrollment, and risk of death among people who inject drugs (PWID). In this sub-study, we analyzed the incidence, causes, and predictors of death among HIV-infected and uninfected participants. Methods The HPTN 074 randomized clinical trial was conducted in Indonesia, Ukraine, and Vietnam. HIV-infected PWID with unsuppressed viral load (indexes) were recruited together with at least one of their HIV-negative injection partners. Indexes were randomized in a 1:3 ratio to the intervention or standard of care. Results The trial enrolled 502 index and 806 partner participants. Overall, 13% (66/502) of indexes and 3% (19/806) of partners died during follow-up (crude mortality rates 10.4 [95% CI 8.1–13.3] and 2.1 [1.3–3.3], respectively). These mortality rates were for indexes nearly 30 times and for partners 6 times higher than expected in a population of the same country, age, and gender (standardized mortality ratios 30.7 [23.7–39.0] and 5.8 [3.5–9.1], respectively). HIV-related causes, including a recent CD4 < 200 cells/μL, accounted for 50% of deaths among indexes. Among partners, medical conditions were the most common cause of death (47%). In the multivariable Cox model, the mortality among indexes was associated with sex (male versus female aHR = 4.2 [1.5–17.9]), CD4 count (≥ 200 versus < 200 cells/μL aHR = 0.3 [0.2–0.5]), depression (moderate-to-severe versus no/mild aHR = 2.6 [1.2–5.0]) and study arm (intervention versus control aHR = 0.4 [0.2–0.9]). Among partners, the study arm of the index remained the only significant predictor (intervention versus control aHR = 0.2 [0.0–0.9]) while controlling for the effect of MAT (never versus ever receiving MAT aHR = 2.4 [0.9–7.4]). Conclusions The results confirm that both HIV-infected and uninfected PWID remain at a starkly elevated risk of death compared to general population. Mortality related to HIV and other causes can be significantly reduced by scaling-up ART and MAT. Access to these life-saving treatments can be effectively improved by flexible integrated interventions, such as the one developed and tested in HPTN 074.https://doi.org/10.1186/s12879-023-08201-3HIVPeople who inject drugsMortalityHPTN 074Prevention trialOpioid agonist treatment |
| spellingShingle | Kostyantyn Dumchev Xu Guo Tran Viet Ha Zubairi Djoerban Oleksandr Zeziulin Vivian F. Go Riza Sarasvita David S. Metzger Carl A. Latkin Scott M. Rose Estelle Piwowar-Manning Paul Richardson Brett Hanscom Kathryn E. Lancaster William C. Miller Irving F. Hoffman Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial BMC Infectious Diseases HIV People who inject drugs Mortality HPTN 074 Prevention trial Opioid agonist treatment |
| title | Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial |
| title_full | Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial |
| title_fullStr | Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial |
| title_full_unstemmed | Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial |
| title_short | Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial |
| title_sort | causes and risk factors of death among people who inject drugs in indonesia ukraine and vietnam findings from hptn 074 randomized trial |
| topic | HIV People who inject drugs Mortality HPTN 074 Prevention trial Opioid agonist treatment |
| url | https://doi.org/10.1186/s12879-023-08201-3 |
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