YiMing Arthur Chen M.D., M.S., Sc.D.

1
Evaluation of the Harm-Reduction Program in Taiwan

• Yi-Ming Arthur Chen M.D., M.S., Sc.D.
• AIDS Prevention and Research Center
• Institute of Microbiology and Immunology
• National Yang-Ming University
• Taipei, Taiwan

2
The Warning Sign of an Outbreak of HIV-1
Infection among IDUs in Taiwan in 2004

3
EID 12 703-705, 2006
4
The possible transmission routes of HIV-1
CRF07_BC from mainland China to Taiwan
Phylogenetic analysis of two full-length CRF07_BC
isolates from Taiwan
Lin et al. JID 20071951283-1293.
5
The prevalence of different HIV-1 subtypes, HBV
and HCV infections in HIV-1-infected IDUs in
Taiwan
6
Education and counseling program in prisons and
detention centers started in September 2004 in
Taiwan
7
Multivariate logistic regression of the risk
factors associated with HIV-1 infection among
IDUs in Taiwan.
OR adjusted by occupation and Education
8
Harm Reduction Programs (HRP) in Taiwan

• Education, counseling, and anonymous testing
  program (ECAP)
• Needle syringe program (NSP)
• Methadone maintenance program (MMP)

Pilot program started at Nov. 2005 at four
cities/counties
Nationwide program Aug 2006-till now
9
Methods of Evaluation of the HRP in Taiwan

• Conduct serological tests on the returned
  syringes collected from different NSP sites in
  March and October 2007, respectively.
• Survey on the KAP and risk behaviors among IDUs
  in Taiwan.
• Survey of the personnel from 860 NSP sites.
• Survey of IDUs participated in the NSP.

10
Containers used for collecting syringes
11
Anti-HIV-1 antibody sero-positive rates of used
syringes collected from NSP sites
Results of the program evaluation in 2007
Used syringes were collected from 33 cities or
counties in Taiwan Particle agglutination test
12

• Anti-HIV Ab positive rates of used syringes
  collected from different cities or counties in
  Taiwan in Oct. 2007

13
Anti-HIV Ab positive rates of used syringes
collected from different cities or counties in
Taiwan in Oct. 2007
14
Comparison of the Risk Behavior of syringe usage
among HIV - and HIV IDUs between 2006 and 2007
plt0.001
15

• Results of a survey conducted among IDUs from six
  prisons in Taiwan in 2007

In 2006, only 20 of IDUs used new syringes
every time.
16
Statistics from Taiwan CDC on NSP
Resource www.cdc.gov.tw
17
Survey of the NSP site personnel

• 414 (48) questionnaires from NSP personnel
  received. 49.5 of them had medical/nursing
  background, 42.5 were pharmacists, 3.1 were
  social workers, 1.2 were medical technologist.
• The NSP sites of the respondents 46.9 drug
  stores, 30.4 local health clinics, 8.5
  diagnostic labs, 0.5 NGOs. NSP types 42.1 give
  free syringes 43.8 emphasize exchange program
  1.7 sell syringes with lower price 3.4 no
  clients.
• 24 of them suggested that counseling and
  anonymous testing at their sites needed to be
  improved. 38 of the respondents had experience
  of offering counseling to NSP clients and
  referred them to MMP or VCT. The main reasons
  that they did not offer counseling were the
  attitude of the NSP clients and the duration that
  the clients visited the sites.

18
Survey of the IDUs participated in the NSP.

• 112 questionnaires received (85.8 males, 12.9
  females).
• 87.1 have been in jail due to illegal drug
  usage, i.e., 12.9 will not be reachable if there
  is no NSP.
• 50 had history of drug usage before 20 years of
  age and 46 of them used heroine, 38 used
  amphetamine.
• 14 had HIV infection, 30 were HIV-1 negative,
  41 did not have HIV-1 test in the past 1 years
  and 12 had the test but did not know the
  results.
• 78 agreed that NSP increased their interests to
  join the MMP

19
Annual Numbers of Newly Reported HIV Cases by
Mode of Transmission, 1984-2007
Case number
year
20
Reported HIV/AIDS Cases by Month of Diagnosis in
Taiwan (Jan 2004-Oct 2007)
21
Discussion and conclusion

• The rates of used new syringes every time among
  IDUs increased from 20 in 2006 to 83 in 2007.
  The HIV-1 seropositive rates of new inmates when
  whey entered the prisons dropped from 15 in 2005
  to 4.3 in 2007 and the rates of HIV Ab
  seropositive rates in used syringes also dropped
  from 18 in early 2007 to 9 in late 2007.
• Diverse services of NSP were observed in
  different cities in Taiwan.
• New strategies of increasing syringe return rate
  needed to be developed. Continuous support and
  training for NSP site personnel is critical.
• The HRP of Taiwan proved to be effective in
  controlling the HIV-1 infection among IDUs and
  the ECP was particularly helpful in the early
  stage of controlling the epidemic.

22
Acknowledgements

• Kuan-Chuen Chen, Se-Yu Lin, Yu-Huei Huang, Yen-Ju
  Chen, Ya-Wen Yang from AIDS Center of National
  Yang-Ming University
• Dr. Tsai, Tze-Yi, Department of Nursing, NYMU
• Dr. Yu-Ching Lan from China Medical University
• Dr. Shu-Yu Lu from Taipei Medical University.
• Inmates from prisons and detention centers
  participated in this study
• Social workers and peer educators from Living
  with Hope organization
• Taiwan Centers for Disease Control

23
Why Taiwanese IDUs had an explosive outbreak of
HIV-1 infection in 2004?

• Insufficient education V
• sharp decrease of heroine trafficking during SARS
  epidemic V
• Different HIV-1 subtypes V
• Social factors ?
• SARS epidemic V
• HIV-HCV interaction ?

24
HIV epidemic among injecting drug users in Asia
80
70
60
HIV prevalence()
50
40
30
20
10
0
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
1987
1988