HIV Insight: Behavioral & Quality-of-Life Outcomes in Different Service Models for Methadone Maintenance Treatment in Vietnam

BACKGROUND:

Integrating HIV/AIDS and methadone maintenance treatment (MMT) services with existing health care delivery system is critical in sustaining efforts to fight HIV/AIDS in large injection-driven epidemics. However, efficiency of different integrative service models is unknown. This study assessed behavioral and health-related quality-of-life (HRQOL) outcomes of MMT in four service delivery models and explored factors associated with these outcomes of interest.

METHODS:

A cross-sectional survey was conducted in two HIV epicenters in Vietnam: Hanoi and Nam Dinh Province. All patients in five selected MMT clinics were invited to participate, and 1016 were interviewed (80-90 % response rate).

RESULTS:

Respondents had a mean age of 35.8, taken MMT for average 16.5 months and 3.3 % on MMT for 36-60 months. The MMT integrated with rural district health center (DHC) has the highest prevalence of concurrent drug use (11.3 %). The percentage of condom use (last sexual intercourse) with primary and casual partners was lowest in the MMT at urban DHCs. Patients at the rural DHC reported very high proportions of pain/discomfort (37.8 %), anxiety/depression (43.1 %), and mobility (13.3 %). In regression models, poorer HRQOL outcomes were found in MMT models in the rural areas or without general health care, and among those patients who were HIV positive, reported concurrent drug use, and had higher numbers of previous drug rehabilitation episodes. Mobility and anxiety/depression are factors that increased the likelihood of concurrent drug use among MMT patients.

CONCLUSIONS:

Outcomes of MMT were diverse across different integrative service models. Policies on rapid expansion of the MMT program in Vietnam should also emphasize on the integration with comprehensive health care services including psychological supports for patients.

History of drug use and rehabilitation

			MMT + VCT + ART + DGH
	MMT + VCT		Rural		Urban		MMT + RPC		All		p value
	Mean	SD	Mean	SD	Mean	SD	Mean	SD	Mean	SD
History of drug use
Age first used drug	24.3	7.0	26.6	7.4	25.3	6.7	23.5	6.1	24.1	6.5	0.21
Time since first episode (year)	13.5	5.1	11.2	5.3	12.2	5.9	14.5	6.2	13.5	5.7	<0.01
Time since first drug injection (year)	10.9	4.4	7.9	3.9	9.2	4.6	11.0	5.5	10.9	4.9	0.02
Drug rehabilitation
Number of episodes	5.7	7.2	3.4	3.0	4.2	5.2	5.1	6.9	4.8	6.2	0.02
	N	%	N	%	N	%	N	%	N	%
Location of rehabilitation
Home, self-managed	213	85.9	103	75.7	132	68.8	226	61.8	674	71.6	<0.01
Voluntary centers	108	43.6	50	36.8	97	50.5	195	53.3	450	47.8	<0.01
Compulsory centers	74	29.8	13	9.6	32	16.7	137	37.4	256	27.2	<0.01
Reason for relapse
Boredom	91	36.7	31	22.8	80	41.7	162	44.3	364	38.6	<0.01
Peer inducement	115	46.4	67	49.3	106	55.2	189	51.6	477	50.6	0.30
Craving	107	43.2	62	45.6	96	50.0	168	45.9	433	46.0	0.56
Unemployment	11	4.4	3	2.2	6	3.1	29	7.9	49	5.2	0.02

Full article at: http://goo.gl/gQ6GS4

By: Tran BX1,2, Nguyen LH3,4, Nong VM3, Nguyen CT5, Phan HT6, Latkin CA7.

1Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. bach@hmu.edu.vn.
2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. bach@hmu.edu.vn.
3Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
4School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
5Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
6Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam.
7Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Harm Reduct J. 2016 Feb 2;13(1):4. doi: 10.1186/s12954-016-0091-4.