Epidémiolgie - Santé Publique (Epidemiology - Public Health) - Évaluation de l'impact des mesures de lutte contre l'épidémie de COVID-19 sur les comportements à risque pour le VIH et le VHC et sur l'accès à la prévention et aux soins pour les usagers de drogues injectables à Hai Phong, Vietnam (DRIVE-COVID) DRug use & Infections in ViEtnam: Evaluating the impact of lockdown measures to control the COVID-19 epidemic on HIV and HCV risk behaviours and access to prevention and care for people who inject drugs in Hai Phong, Vietnam (DRIVE-COVID)

Primary objective: To assess changes in HIV and HCV risk behaviours and in access to prevention and care for people who inject drugs (PWID) in Hai Phong city, following the implementation of restrictive and lockdown measures taken to control the COVID-19 epidemic in Vietnam. More specifically, the study will assess changes for PWID in terms of: (i) risk behaviours for HIV and HCV infections related to drug use; (ii) access and adherence to opioid substitution therapy (OST); (iii) access and adherence to antiretroviral treatment (ART) for those HIV-infected; (iv) access to harm reduction materials. Secondary Objectives: - To assess changes for PWID in terms of: (i) access to drugs and patterns of drug use; (ii) risk behaviours related to sex practices; (iii) access to counselling and support from health care staff, peer educators and members of community-based organizations (CBO); (iv) quality of life; (v) mental health, with a focus on suicidal risk, depression, psychotic syndrome and anxiety; (vi) individual social and economic situation; (vii) occurrence of administrative events (including incarceration); (viii) occurrence of life-threatening events (including overdose, suicide) and episodes of violence; (ix) access and adherence to psychiatric treatment for patients enrolled in the ANRS 12410 DRIVE-MIND study. We will also model the impact in terms of excess HIV and HCV infections and relative increase in HIV and HCV incidence resulting from changes due to the lockdown compared to if pre-lockdown behaviours and access to interventions had remained. Methodology Study design: before-after design approach, supplemented by a qualitative component and mathematical modelling. The measurement of study outcomes during the 'before' (restriction) period will be drawn from the latest visit of either NIDA RO1DA041978/ANRS 12353 DRIVE, ANRS 12380 DRIVE-C or ANRS 12410 DRIVE-MIND studies. The same outcomes will be measured during the 'after' (restriction) period through a cross-sectional survey, conducted after the lifting of restrictive measures: during a specific follow-up visit organized for DRIVE participants; during the 'End of study' visit for DRIVE-C participants as planned in the DRIVE-C study; during the month-18 follow-up visit for DRIVE-MIND participants as planned in the DRIVE-MIND study. Potential changes that occurred specifically during the restriction period will be assessed retrospectively during this survey, that will also be complemented by data collection in treatment clinics and from CBO. The qualitative component will include 2 phases: (i) a preliminary work based on focus group discussions (FGD) with CBO members, and (ii) in-depth interviews with participants during the study data collection period. The modelling component will use a HIV and HCV transmission model being developed for the ANRS 12380 DRIVE-C study, utilising new data collected by DRIVE-COVID to parameterise how lockdown has changed behaviours and intervention outcomes. - Estimated enrolment: (i) cross-sectional survey: 930 participants; (ii) qualitative component: 20-30 participants. Primary endpoint: The changes in HIV and HCV risk behaviours and in access to prevention and care for PWID will be assessed through four main indicators, compared before and after the period of COVID-19-related restrictive measures: (i) self-reported frequency of sharing needles/syringes and water/Novocain; (ii) proportion of PWID receiving OST and adherence to OST (urine testing, self-assessment and medical file); (iii) proportion of HIV-infected PWID receiving ART and adherence to ART (HIV viral load testing for all HIV-infected, self-assessment and medical file); (iv) self-reported number of sterile needles/syringes accessed per month. Inclusion criteria: - The following participants of the ongoing NIDA ROIDA041978/ANRS 12353 DRIVE, ANRS 12380 DRIVE-C and/or ANRS 12410 DRIVE-MIND studies will be enrolled: - DRIVE participants who were enrolled in the 4th respondent-driven sampling survey of DRIVE (RDS4) and agreed in the DRIVE informed consent form to be contacted again for a future study; - DRIVE-C participants still on follow-up and having their DRIVE-C 'End of study' visit planned during the 'after' period; - DRIVE-MIND participants still on follow-up. Non-inclusion criteria: inability to understand the study or unwillingness to sign the consent form for this study after receiving information. Intervention: Cross-sectional survey: a standardized questionnaire will be applied and biological testing (blood, urine) will be performed to collect the measurements of study outcomes during different follow-up visits for DRIVE, DRIVE-C and DRIVE-MIND participants, either on community study sites or at HCV study clinics. Those will be complemented by data collection in OST and ART clinics, as well as from CBO. Qualitative component: focus group discussions with CBO members and in-depth interviews with participants will be conducted on community study sites. Study agenda: - Study preparation: May - June 2020 (2 months) - Data collection: July - September 2020 (3 months) - Data analysis: October - December 2020 (3 months) - Overall duration of the study: 8 months.