Integrating and decentralizing services are essential to
increase the accessibility and provide comprehensive care for methadone
patients. Moreover, they assure the sustainability of a HIV/AIDS prevention
program by reducing the implementation cost. This study aimed to measure the
preference of patients enrolling in a MMT program for integrated and
decentralized MMT clinics and then further examine related factors.
A cross-sectional study was conducted among 510 patients
receiving methadone at 3 clinics in Hanoi. Structured questionnaires were used
to collect data about the preference for integrated and decentralized MMT
services. Covariates including socio-economic status; health-related quality of
life (using EQ-5D-5 L instrument) and HIV status; history of drug use
along with MMT treatment; and exposure to the discrimination within family and
community were also investigated. Multivariate logistic regression with polynomial
fractions was used to identify the determinants of preference for integrative
and decentralized models.
Of 510 patients enrolled, 66.7 and 60.8 % preferred
integrated and decentralized models, respectively. The main reason for
preferring the integrative model was the convenience of use of various services
(53.2 %), while more privacy (43.5 %) was the primary reason to
select stand-alone model. People preferred the decentralized model primarily
because of travel cost reduction (95.0 %), while the main reason for not
selecting the model was increased privacy (7.7 %). After adjusting for
covariates, factors influencing the preference for integrative model were poor
socioeconomic status, anxiety/depression, history of drug rehabilitation, and ever
disclosed health status; while exposure to community discrimination inversely
associated with this preference. In addition, people who were self-employed,
had a longer duration of MMT, and use current MMT with comprehensive HIV
services were less likely to select decentralized model.
In conclusion, the study confirmed the high preference of
MMT patients for the integrative and decentralized MMT service delivery models.
The convenience of healthcare services utilization and reduction of geographical
barriers were the main reasons to use those models within drug use populations
in Vietnam. Countering community stigma and encouraging communication between
patients and their societies needed to be considered when implementing those
models.
1Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
3School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
4Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
5Illinois Wesleyan University, Bloomington, USA
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