The effect of migration, location in mining or borderland areas on HIV incidence among people who use drugs attending a harm reduction programme in Myanmar, 2014-2021: a retrospective cohort study

Background High HIV prevalence has been documented among people who use drugs (PWUD) in Myanmar particularly in mining and borderland areas. We estimated incidence of HIV among PWUD (via injecting and other routes) and examine associations between location in mining or borderland areas, migration and risk of infection. Methods and findings Analysis of data among PWUD registered at harm reduction programmes across Sagaing region, Kachin, and Northern Shan States between 2014-2021. Data on sociodemographic, drug use characteristics and clinic-level data on borderland or mining locations were collected at time of registration. Characteristics, repeat HIV testing and HIV seroconversion were analysed using a cohort approach and Poisson regression models examining associations between location in a borderland or mining area, migration and incidence of HIV, adjusting for confounders. Data were available from 85093 clients, 52526 reported HIV tests and 20.0% were seropositive. 38670 clients had no or only one recorded HIV result. The median time between HIV tests was 1.1 years. Among 13,359 clients with 2 or more HIV tests the HIV seroconversion rate was 3.8 per 100 person years (pyrs) (95% CI 3.6-4.0). Incidence among those who injected drugs was 6.9 per 100/pyrs, 8.9 among those aged ≤ 25 years, 2.3 among women, 2.3 among those who had migrated, 5.6 among those located in border areas, and 3.7 among those in mining areas. After adjusting for confounders HIV incidence remained higher for people located in borderland areas (Incidence Rate Ratio 1.67 95% CI 1.13-2.45) and lower among those who had migrated (IRR 0.56, 95% CI (0.39-0.82). There was no evidence of association between location in a mining area and HIV seroconversion. Conclusions Findings highlight the need to intensify harm reduction interventions with a focus on cross-border interventions. Increasing uptake of HIV testing alongside the scale up of evidenced based interventions to address sexual and injecting risk practices including PrEP, distribution of condoms, needles/syringe distribution and opioid agonist therapies is urgently needed to curb the high rates of HIV transmission among PWUD particularly among young people. Why was this study done? What did the researchers do and find? What do the findings mean? ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was obtained from LSHTM research ethics committee (Ref: 22838). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data cannot be shared publicly because the dataset contains individual level information on a population engaging in illegal activities (drug use) in a country currently led by a military dictatorship. The dataset contains data on demographic characteristics and geographical location of individuals that taken together could lead to deductive disclosure of individuals. If required a restricted dataset could be make available on request to AHRN the data holders following the implementation of a data sharing agreement and ethics approvals.