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Trends and predictors of HIV-associated risk behaviors among injecting drug users participating in an HIV prevention trial, Bangkok
Presented by Suphak Vanichseni, Thailand.
Vanichseni S.1, Martin M.2, Suntharasamai P.1, Sangkum U.1, van Griensven F.2, Mock P.2, Chuachoowong R.2, Leethochawalit M.3, Chiamwongpaet S.3, Choopanya K.1
1Bangkok Tenofovir Study Group, Bangkok, Thailand, 2Thailand MOPH - U.S. CDC Collaboration, Nonthaburi, Thailand, 3Bangkok Metropolitan Administration, Bangkok, Thailand
Objectives: The Bangkok Tenofovir Study (BTS) is a phase II/III, randomized, placebo-controlled, double-blind study being conducted in 17 Bangkok Metropolitan Administration drug treatment clinics to determine if tenofovir is safe and if it prevents HIV infection among injecting drug users (IDUs). At the clinics, IDUs receive risk reduction counseling and have access to methadone treatment, condoms, and bleach with instructions on how to clean needles, all free of charge. To assess the effectiveness of these risk reduction activities, we examined the prevalence and potential predictors of risk behaviors during study follow-up.
Methods: Participant demographic characteristics and risk behaviors (i.e., injecting drugs, sharing needles/syringes) were assessed at enrollment and risk behaviors every 3 months thereafter. The proportion of participants who reported injecting drugs and sharing needles and/or syringes was compared at months 0, 3, 6, 9, and 12. Generalized estimation logistic regression analysis was used to identify predictors of injecting and sharing.
Results: From June 2005 through December 2006, 1,465 participants enrolled; median age was 31 years, 79% were male, and 48% had a primary education (6 years of schooling) or less. Risk data were available on 1,455. At enrollment 919 (63%) reported injecting and 238 (16%) reported sharing in the past 3 months. Reported injection and sharing decreased at month 3 (injection 31%, sharing 3%) and remained steady through month 12 (both p <0.0001). Overall, 558 (38%) injected methamphetamine, 431 (30%) midazolam, and 425 (29%) heroin. Age >26 years, >6 years of education, and male sex were independent predictors of injecting (all p <0.0001); male sex (p <0.001) was a predictor of sharing.
Conclusions: BTS participants reported decreased risk behavior during trial follow-up but remain at risk for HIV infection. There is an urgent need for effective biological and behavioral interventions to prevent HIV infection of IDUs.
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