Background: In Myanmar, with an HIV prevalence of 0.6%, an estimated 29% of new infections occur among people who inject drugs (PWID). Identifying gaps in the HIV prevention and treatment cascade among PWID is crucial to understanding and controlling the epidemic.
Methods: From October 2017-January 2018, we conducted a cross-sectional bio-behavioral survey (BBS) among PWID using respondent driven sampling (RDS) in eleven townships and two cities in Myanmar. Eligibility criteria included age ≥15 years, having injected drugs in the past month, and having lived in the township or city for ≥6 months. Participants completed an interview and were counseled and tested for HIV, hepatitis B, hepatitis C and syphilis. HIV prevalence data was compared with the 2014 BBS conducted in eight townships and two cities among 3,275 PWIDs. Weighted data analysis was conducted with RDS Analyst and SAS.
Results: Overall, 6,061 PWIDs were enrolled (98.5% male; median age of 30 years). The majority (83.0%) reported injecting more than once a day. Only 5.9% reported that they had used a needle or syringe used previously by someone else at last injection. One-third (35.1%) had received drug treatment to stop drug use and 17.4% had received methadone treatment in the past 12 months. Among the 76.6% that had sexual intercourse in the last month, condom use was low (21.3%). Less than half (47.8%) had ever been tested for HIV and only 51.2% of these were tested in the past year. HIV prevalence among PWID was 34.9% (range 7.6-60.9%) and six townships had an increase in HIV prevalence since the 2014 BBS. Among the HIV-positive, 38.8% were aware of their status; and of these 67.0% were currently on antiretroviral treatment (ART). ART coverage was 34%. Prevalence of hepatitis B, hepatitis C, and syphilis was 7.7%, 56% and 1.5%, respectively.

 Population %95% Confidence Interval (CI)Range by Site (N=13)
% Male98.598.0, 98.993.2 - 100.0
Median age in years, interquartile range (IQR)30 (25, 37)N/A25 - 33
Ever taken an HIV test47.845.9, 49.824.4 - 73.5
HIV prevalence34.933.0, 36.87.6 - 60.9
1st 90: Known HIV status38.835.6, 42.020.7 - 73.8
2nd 90: On ART67.161.4, 72.847.7 - 89.4
Hepatitis B Prevalence7.76.7, 8.84.3 - 10.6
Hepatitis C Prevalence56.054.0, 57.927.4 - 84.5
Syphilis Prevalence1.51.1, 1.90 - 5.7
[Table 1. 2017 BBS Results among PWID in Myanmar]

Conclusions: Our results highlight the critical gaps in controlling the HIV epidemic among PWID in Myanmar. The low proportion aware of their HIV status as well as the low ART coverage emphasizes the need for increased interventions, policies and resources to improve coverage and effectiveness of HIV prevention and treatment services for PWID.