Mortality rates
AIDS, TB, death, overdose, HIV infected, deaths
AIDS, LIVER DISEASES, TUBERCULOSIS
The observed crude mortality rates were consistent with the recent systematic review of cohort studies, reporting the pooled CMR of 2.71/100PY among people who inject opioids [In our study, the risk of death among PWID living with HIV who were not treated effectively was thirty times higher than expected in a general population adjusted by age and gender, which is twice as high as the pooled SMR in the systematic review. The HIV-uninfected PWID had almost six times higher risk of death compared to the general population, primarily due to acute and chronic health conditions and injuries.There were marked differences in mortality rates between the sites. Among male indexes, mortality in Indonesia was about twice as high as in Vietnam and Ukraine. In contrast, the male partner mortality was highest in Ukraine, with almost two times difference with Indonesia, and three times with Vietnam. These findings correlate with the differences in uptake of ART and OAT across three sites in our study [We were not able identify published sources on PWID mortality for Indonesia and Ukraine. We can, however, compare the mortality rates we observed in Vietnam to two intervention trials conducted in Thai Nguyen and a cohort study in Hai Phong provinces. In the first study, conducted in 2005–2007 among male PWID, 23% of whom were HIV infected [If we attribute mortality with unconfirmed cause in participants who met immunologic criteria for AIDS (CD4 < 200 cells/μL) to HIV, the HIV-related causes would be responsible for more than half of all deaths among index participants. The majority of confirmed HIV-related deaths were due to tuberculosis. This confirms the fact that PWID continue to face significant barriers related to life-saving HIV and TB treatment engagement and adherence in all three countries. Other health-related causes such as lung or liver diseases were the second most common cause of death in HIV-infected, and the leading cause of death in HIV-negative participants in our study.Surprisingly, we observed a low rate of death due to overdose, which accounted for almost 1/3 of mortality among opioid injectors in other studies [