Intravenous heroin use in Haiphong, Vietnam: Need for comprehensive care including methamphetamine use-related interventions

Laurent Michel , Don C. Des Jarlais , Huong Duong Thi (1) , Oanh Khuat Thi Hai , Khuê Pham Minh , Marianne Peries (2) , Roselyne Vallo (2) , Thanh Nham Thi Tuyet , Giang Hoang Thi , Mai Le Sao , Jonathan Feelemyer , Vinh Vu Hai (3) , Jean-Pierre Moles (2) , Didier Laureillard (4, 2) , Nicolas Nagot (2, 5) , Drive Study Team

1 Dpt of Public Health [Hai Phong]
2 Pathogénèse et contrôle des infections chroniques (PCCI)
3 Dpt of Infectious and Tropical Diseases [Hai Phong]
4 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
5 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]

BACKGROUND: The aim of this study was to describe patterns among people who inject drugs (PWID), risk-related behaviours and access to methadone treatment, in order to design a large-scale intervention aiming to end the HIV epidemic in Haiphong, Vietnam. METHODS: A respondent-driven sampling (RDS) survey was first conducted to identify profiles of drug use and HIV risk-related behaviour among PWID. A sample of PWID was then included in a one-year cohort study to describe access to methadone treatment and associated factors. RESULTS: Among the 603 patients enrolled in the RDS survey, 10% were female, all were injecting heroin and 24% were using methamphetamine, including 3 (0.5%) through injection. Different profiles of risk-related behaviours were identified, including one entailing high-risk sexual behaviour (n=37) and another involving drug-related high-risk practices (n=22). High-risk sexual activity was related to binge drinking and methamphetamine use. Among subjects with low sexual risk, sexual intercourse with a main partner with unknown serostatus was often unprotected. Among the 250 PWID included in the cohort, 55.2% initiated methadone treatment during the follow-up (versus 4.4% at RDS); methamphetamine use significantly increased. The factors associated with not being treated with methadone after 52 weeks were fewer injections per month and being a methamphetamine user at RDS. CONCLUSION: Heroin is still the main drug injected in Haiphong. Methamphetamine use is increasing markedly and is associated with delay in methadone initiation. Drug-related risks are low but sexual risk behaviours are still present. Comprehensive approaches are needed in the short term.

Mots clés: Vietnam; Methadone; People who inject drugs; Methamphetamine; Heroin

Domaines: Sciences du Vivant [q-bio]

Laurent Michel, Don C. Des Jarlais, Huong Duong Thi, Oanh Khuat Thi Hai, Khuê Pham Minh, et al.. Intravenous heroin use in Haiphong, Vietnam: Need for comprehensive care including methamphetamine use-related interventions. Drug and Alcohol Dependence, 2017, 179, pp.198--204. ⟨10.1016/j.drugalcdep.2017.07.004⟩. ⟨hal-01760385⟩