New HIV Infection Among Heroin Addictss Attending The Community Based Methadone Maintenance Treatment In China

BackgroundHeroin addicts were one of the main most-at-risk populations of HIV infection in China. Methadone maintenance treatment (MMT) is a very effect method in HIV prevention among injecting heroin users. Since2004, community based MMT program has been implemented in China, among these MMT clients, some new HIV infections were found. It is important to analyse the HIV incidence and the factors associated with new infection for reduce the HIV incidence.Objectives1. To describe the HIVincidence of MMT clients in China2. To explore the HIV infection routes and factors associated with HIV infectionMethodsAnalyse the dynamic corhort data of MMT clients from2004to2011in China, describe the HIV incidence and factors associated with new HIV infection. Acoording the distribution of new HIV infections, qualitative method (indepth interview) were used to interview the workers and HIV new infections from clinics with more HIV infection cases, in order to collect the based information of new HIV infection.1:1nested case-control study were implemented to explore the HIV infection routes and related factors, questionnaire was developed to collect the demology characters, drug use behavior, sex behaviour, daily dosage of methadone, adherence to MMT, the direct risk behaviour(s) related with HIV infection. Univariate anylysis and multivariate condition Logistic regression were used to describe the correlation between HIV infection and factors. Based on the results of qualitative and case-control studies, combined with the foundings of HIV incidence of all MMT clients, a comprehensive summary of the new HIV infection reasons and the relationship of different factors were given.Results 1. The HIV incidence of MMT clients from2004to2011were0.28(0.27-0.30) per100person-years. The incidences were very difference among different provinces/autonomous regions/municipalities, the highest was1.76per100personyears. The regions with high HIV prevalence have more new infections and higher HIV incidence. Being female, younger and minority, having longer drug using duration, injecting drug and sharing needles before accepted MMT, poorer adherence to MMT were risk factors of HIV infection.2. The qualitative study found that the main direct HIV infection routes were needles sharing and sex behaviour during attending MMT. The inducing factors of heroin using included heroin craving, influence by other heroin addicts, phychological disorders, having more free time, lack of support from families and communities. The sex partners which as the reservoir of HIV infection were mainly regular partners (spouses or regular cohabitating friends), and occasional sex partners were mainly knowed persons, unknowed sex partners were infrequent.3. Univariate anylysis indicated some risk factors of HIV infection:heroin using (OR=5.00) and sharing needles (OR=4.60) during attending MMT, shared needles (OR=15.50) and having longer drug using duration (per year, P=0.02) before enrolled in MMT, having more free time (More than5hours per day VS. less than5hours per day OR=2.22). Higher adherence (P<00001), being married (OR=0.33) and living with families (OR=0.05) were protect factors from HIV infecting. Multivariate condition Logistic regression indicated that higher adherence was protect factors (OR=0.61), injecting heroin during attending MMT, having longer heroin using duration before enrolled in MMT were risk factors, the OR values were154.4and1.21respectively.ConclusionThe incidence of MMT clients was lower than heroin addicts who not accepted MMT in communities. Most HIV infections of MMT clients accuried during their caly months of MMT. Provinces with high HIV prevalence have higher HIV incidence and more new infections. Sharing needles and sex behaviour were the main dirccet infecting routes. The different of HIV prevalence, heroin using time and model before enrolled in MMT were related with HIV infection during MMT. Higher adherence to MMT was helpful to reduce the risk of HIV infection. There were lots of factors induced heroin using during MMT, such as heroin craving, influence by other heroin addicts, phychological disorders, having more free time, lack of support from families and communities. Social, family support, psychological intervention were effective means to help heroin addicts back to normal life and recover social functions, reduce heroin using during MMT, and reduce the HIV incidence of MMT clients.