Benefits of a sustained community-based psychiatric intervention on viral exposure among people who inject drugs: The ANRS Drive-Mind 2 cohort study in Hai Phong, Vietnam

Community-based psychiatric interventions for people who inject drugs (PWID) have been proven to be feasible and efficient in low-middle income countries (LMIC) where psychiatric resources are scarce and stigma important. We aimed to show that, on top of mental health improvement, PWID initially diagnosed with psychiatric symptoms and who received a sustained community-based psychiatric intervention were comparable to a control population of PWID in terms of HIV/HCV exposure. In Hai Phong, Vietnam, PWID currently or previously diagnosed with psychiatric symptoms were invited to be recruited in a 12-month follow-up cohort and proposed a community-based psychiatric and harm reduction intervention supported by peers and were compared after intervention to control PWID free from any psychiatric diagnosis who benefited from harm reduction interventions. HIV/HCV exposure was assessed using a composite score taking into account sex and drug-related risk behaviors, weighted according to the viral exposure risk. Psychiatric symptoms, severity of drug use and quality of life were also assessed at each visit. After a 12-month follow-up between March 2022 and April 2023, viral exposure among PWID diagnosed with psychiatric symptoms was considered significantly non-inferior to that of the control group. Their mental health status was significantly improved and severity of drug use or quality of life did not differ significantly from controls. In LMIC, community-based psychiatric intervention supported by trained peers is feasible and efficient for most dimensions. It may represent a valuable alternative to the classical mental health system.