THE 6TH
NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS
Couples testing and immediate ART
among sero-discordant couples in
Vietnam
Background
• One quarter of estimated new infection occurs in low risk women 1
•
More than half of new HIV infection in women attributable to male
partner’s risk behaviour 2
• Nearly half of men living HIV may have sero-negative female
partners 3
• HIV prevalence is high among female partners of PWID, even
though who do not engage in ay high risk behaviours themselves
(14% in Dien Bien) 4
• Effective intervention urgently needed to prevent
transmission among the partners
1. VAAC 2013. National estimation and projection.
2. UNAIDS/UN WOMAN 2012; 3. ISDS/VCSPA 2011.
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The 6 National Scientific
Conference
on HIV/AIDS
4. HPI/PHR
2012.
Objectives
1. Assess feasibility of identifying and treating seropositive
partners and track the couples through repeat HTC to
minimize the likelihood of HIV transmission to the seronegative partner;
2. Document HIV transmission within serodiscordant
couples when the seropositive partner is receiving ART;
The 6th National Scientific Conference on HIV/AIDS
Study sites
Study site
Province
Can Tho
Dien Bien
District
Ninh Kieu
Cai Rang
O Mon
Thot Not
General hospital
PAC
General hospital
(Dien Bien City)
PAC
Dien Bien district
Muong Cha
Muong Lay
Tuan Giao
Muong
Ang
th
Couple HTC
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ART &
Couple follow-up
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The 6 National Scientific Conference on HIV/AIDS
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Methods
• two persons in an ongoing sexual relationship including
those in heterosexual or homosexual relationship; and
• residence in Dien Bien or Can Tho province at the time of
enrolment; and
• age ≥ 18 years; and
• one partner of the couple tests HIV seropositive and one
partner tests seronegative; and
• informed consent is granted by both parties
(which includes mutual disclosure through couple counseling &
willingness of the HIV-positive partner to start ART immediately.
Couples were enrolled into study between March and December 2013
The 6th National Scientific Conference on HIV/AIDS
Study procedures and role of each service
•Community outreach
•OPC (pre-ART)
•PITC (ANC, TB, MMT)
•Communes
Whenever new HIV
diagnosis was made
in the 2 provinces,
he/she was
encouraged to invite
partner for couples
HIV testing
Linkage
Refer
VCT
OPC
Couple HTC
Informed consent
Immediate ART
initiation
Follow-up
of couples
Viral load testing
Behaviour assessment and counseling
Concomitant use of other prevention methods was
promoted, through counseling sessions
The 6th National Scientific Conference on HIV/AIDS
Follow-Up and Key Indicators
• Both partners:
– Linkage from diagnosis to OPC
– Upon study enrolment, couples followed for 12 months
– Behavioral assessment at baseline & months 3, 6, and 12
• HIV+ partner:
– Retention and adherence
– HIV viral load (VL) before or at baseline & months 3 and 12
– Adverse drug reactions
• HIV-negative partner:
– HIV testing at months 3, 6, and 12 (HIV serostatus)
The 6th National Scientific Conference on HIV/AIDS
Results
• Of 256 couples tested,
– 146 were sero-discordant (1 partner HIV+, 1 partner HIVnegative):
• 134 couples agreed to attend study
– 22 were concordant positive
(both partners HIV-positive)
– 88 were concordant negative
(both partners HIV-negative)
The 6th National Scientific Conference on HIV/AIDS
Baseline Characteristics
Positive partner
Negative partner
Socioeconomic
Sex (%male)
86
15
Median age, years
33
32
Education (% secondary school or above)
59.7
44.8
Occupation (% employed)
71.6
82.7
Weekly Alcohol-use
67.9
18.7
Ever used illicit drug
56.7
41.8
1.5
44.8
374 (150-564)
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47.4
52.6
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Risk behavior (%)
Having sex without condom (regular partner)
Clinical
Median baseline CD4 (IQR)
Baseline by CD4 Category (%)
≤ 350
> 350
Median baseline viral load (log10 cp/mL)
4.81 (3.96-5.42)
The 6th National Scientific Conference on HIV/AIDS
Viral load vs CD4 at baseline
10000000
Viral load (copies/mL)
1000000
100000
10000
1000
100
10
1
0
250
500
CD4 cell count
750
1000
Many people with CD4 > 350 have high viral load → High risk of
transmitting virus to the partner
The 6th National Scientific Conference on HIV/AIDS
Retention of the index cases
Overall, index cases had relatively high retention rate (~90%) after
one year
The 6th National Scientific Conference on HIV/AIDS
Viral suppression of the index cases
% with viral load < 1000 cp/mL
100%
75%
50%
25%
0%
Month 0
Baseline CD4 ≤ 350
Month 3
Month 12
Baseline CD4 > 350
Most index cases responded to ART and achieved substantial
reduction in viral load after ART initiation regardless of baseline CD4
value
The 6th National Scientific Conference on HIV/AIDS
Self-reported consistent condom use
in the index cases
% reporting consistent condom
use within the couple
100%
90%
80%
70%
60%
50%
Month 0
Month 3
Month 6
Month 12
Condom use in the couples increased during the follow-up
(Behavioral disinhibition not observed in this cohort)
The 6th National Scientific Conference on HIV/AIDS
HIV serostatus of initially negative partners
• Two initially negative partners were tested HIV+ at the visit at
month 3.
• Their HIV positive partners had relative high viral load at
baseline (179,000 and 51,700 copies/ml).
• No partners seroconverted after month 3
• Two cases of sero-conversion were very likely due to:
– Transmission occurred in the early phase of ART before their HIVpositive partner achieved viral suppression; Or
– Baseline HIV testing of negative partner was during the window
period
The 6th National Scientific Conference on HIV/AIDS
Conclusion and recommendation
• Couples testing and immediate ART among sero-discordant
couples is feasibility
• No partners seroconverted in couples with index person having
viral suppression
• Index cases had relatively high retention rate
• These interventions will contribute to 90-90-90 target and
prevent transmission among partners, and should be
strengthened in the whole country.
• Continued efforts and coordination is needed to ensure the
scale-up and quality of the interventions
The 6th National Scientific Conference on HIV/AIDS
Acknowledgements
•
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MOH: Nguyen Thanh Long
Can Tho PAC
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•
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Bui Duc Duong
Do Thi Nhan
Linh An Tong
Do Tuan Kim
Bach Mai Hospital
– Vu Tuong Van and the team
Pasteur Institute in Ho Chi Minh City
– Truong Thi Xuan Lien and the
team
National Center for Adverse Drug Reaction
and Drug Information
– Nguyen Hoang Anh and the team
•
Anh Van Ho
Yen N. Le
Sheryl Lyss
Patrick Nadol
Dao Quang Vinh
Nisha Gupta
WHO/Vietnam
–
–
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•
Do Mai Hoa
Pham Thuy Linh
Duong Kim Tuan
CDC/Vietnam
–
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–
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VAAC
–
–
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•
Lai Kim Anh and the team
Hoang Xuan Chien and the team
Hanoi School of Public Health
–
–
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Dien Bien PAC
–
•
•
Masaya Kato
Amitabh Suthar
Van Thi Thuy Nguyen
FHI 360
–
Nguyen Cuong Quoc and the team
The 6th National Scientific Conference on HIV/AIDS