CFAR Awards

Carla Zelaya, PhD

Epidemiology, Johns Hopkins University Bloomberg School of Public Health

International Research Scholar Award

Exploration of mechanisms of resilience among HIV-infected IDU in Vietnam, to inform effective, sustainable and acceptable Treatment as Prevention (TASP) interventions

Carla Zelaya, PhD - Image

In Vietnam, while over 70% of prevalent HIV cases are attributed to injecting drug use, only 6.3% of those receiving antiretroviral treatment (ART) are injection drug users (IDU). This project, is an analysis of existing de-identified data collected as part of a randomized controlled trial among HIV-infected IDU to reduce high-risk injecting and sexual behaviors in Thai Nguyen, Vietnam (PI: Vivian Go, 1 R01 DA 22962-01A1). While 70% of our current study participants were found to be eligible for antiretroviral treatment (ART), only 5% of these individuals had ever utilized ART prior to study initiation, and only 27% are currently on ART. This diminished and delayed access to ART among IDUs has been seen elsewhere domestically and internationally. Despite the challenges faced to accessing ART, approximately a quarter of our HIV-infected participants (current and former injectors) are able to navigate the bureaucracy of the health care system, competing life demands, fears or disclosure and stigma, and lack of information to successfully obtain treatment. By identifying factors that predict resilience (i.e., the ability to access and sustain treatment) we can develop interventions that capitalize on these successful coping mechanisms. The objectives of this project are to 1) Qualitatively explore through transcripts of in-depth interviews the barriers to a) accessing HIV related care and treatment, and b) adherence to antiretroviral treatment (ART) once initiated. Then exploring the coping mechanisms adopted to overcome these barriers, and traits of resilience, as reported by HIV-infected IDU (n=30) and their family members (n=15) in Thai Nguyen, Vietnam, and 2) Quantitatively explore social, behavioral and structural factors associated with uptake of antiretroviral treatment (ART), among HIV-infected IDU eligible for ART in Thai Nguyen, Vietnam. HIV-infected individuals who had a CD4 count less than or equal to 250 at baseline, 6 or 12 months will be included in this analysis (n=294).