{"doi":"10.1016/j.lanwpc.2023.100718","title":"Trends in HIV incidence following scale-up of harm reduction interventions among people who inject drugs in Kachin, Myanmar, 2008–2020: analysis of a retrospective cohort dataset","abstract":"Background: People who inject drugs (PWID) in Kachin, Myanmar, have a high HIV prevalence (>40%), but there is no data on incidence. We used HIV testing data from three harm reduction drop-in centres (DIC) in Kachin (2008-2020) to determine HIV incidence trends among PWID and associations with intervention uptake. Methods: Individuals were HIV-tested at first DIC visit and periodically thereafter, during which demographic and risk behaviour data were collected. Two DIC provided opioid agonist therapy (OAT) from 2008. Monthly DIC-level needle/syringe provision (NSP) data was available from 2012. Site-level 6-monthly NSP coverage was denoted low, high, or medium if it was below the lower quartile, above upper quartile, between these quartiles of provision levels over 2012-2020, respectively. HIV incidence was estimated by linking subsequent test records for those initially testing HIV-negative. Associations with HIV incidence were examined using Cox regression. Findings: Follow-up HIV testing data was available for 31.4% (2227) of PWID initially testing HIV-negative, with 444 incident HIV infections during 6266.5 person years (py) of follow-up. Overall HIV incidence was 7.1 per 100 py (95% confidence interval 6.5-7.8), which decreased from 19.3 (13.3-28.2) in 2008-11 to 5.2 per 100 py (4.6-5.9) in 2017-20. In the full PWID incidence dataset after adjustment for various factors, recent (≤6 weeks) injecting (aHR 1.74, 1.35-2.25) and needle sharing (aHR 2.00, 1.48-2.70) were associated with higher incidence, while longer injection careers were associated with reduced incidence (aHR 0.54, 0.34-0.86, for 2-5 yrs vs <2 yrs). In a reduced dataset including data on OAT access and NSP coverage (2012-2020 for two DIC providing OAT), being on OAT during follow-up was associated with reduced HIV incidence (aHR 0.36, 0.27-0.48, compared to never being on OAT) as was high NSP coverage (aHR 0.64, 0.48-0.84, compared to medium syringe coverage). Interpretation: Although HIV incidence is high among PWID in Kachin, data suggests it has decreased since the scale-up in harm reduction interventions. Funding: US NIH, Médecins du Monde.","journal":"The Lancet Regional Health - Western Pacific","year":2023,"id":360285,"datarank":0.49684071863644996,"base_score":2.302585092994046,"endowment":2.302585092994046,"self_citation_contribution":0.3453877639491069,"citation_network_contribution":0.15145295468734307,"self_endowment_contribution":0.3453877639491069,"citer_contribution":0.15145295468734307,"corpus_percentile":61.42956602459967,"corpus_rank":4987,"citation_count":9,"citer_count":5,"citers_with_citation_signal":3,"citers_with_endowment":3,"datacite_reuse_total":0,"is_dataset":true,"is_dataset_confidence":0.5711,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":476551,"name":"Jack Stone","orcid":"0000-0002-4584-0068","position":1,"is_corresponding":false},{"id":1112134,"name":"Khine Thet Oo","orcid":null,"position":2,"is_corresponding":false},{"id":1112135,"name":"Zaw Zen Let","orcid":null,"position":3,"is_corresponding":false},{"id":1112136,"name":"Mar Taw","orcid":null,"position":4,"is_corresponding":false},{"id":1112137,"name":"Minn Thit Aung","orcid":null,"position":5,"is_corresponding":false},{"id":1112138,"name":"Aung Myo Min","orcid":null,"position":6,"is_corresponding":false},{"id":467452,"name":"Aaron G. Lim","orcid":"0000-0002-3141-7496","position":7,"is_corresponding":false},{"id":1111716,"name":"Ernst Wisse","orcid":"0000-0002-8849-2454","position":8,"is_corresponding":false},{"id":301344,"name":"Peter Vickerman","orcid":"0000-0002-8291-5890","position":9,"is_corresponding":false},{"id":1020265,"name":"Anna McNaughton","orcid":"0000-0002-7436-8727","position":0,"is_corresponding":true}],"reference_count":16,"raw_metadata":null,"created_at":"2026-07-19T01:14:01.896928Z","pmid":"37283982","pmcid":"PMC10240370","fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}