Impact of a Methadone Maintenance Therapy Pilot in Vietnam & Its Role in a Scaled-Up Response

As a dual response to the HIV epidemic and the high level of injecting drug use in Vietnam, the Ministry of Health (MOH) initiated a pilot methadone maintenance therapy (MMT) program in Hai Phong and Ho Chi Minh City (HCMC) in early 2009. The objectives of the pilot were to provide evidence on whether MMT could be successfully implemented in Vietnam and scaled up to other localities.

A prospective study was conducted among 965 opiate drug users admitted to the pilot. Data on demographic characteristics, sexual behaviors, substance use behaviors (including heroin use), and blood-borne virus infection (HIV, hepatitis B, and hepatitis C) were collected at treatment initiation and then again at 3-, 6-, 9-, 12-, 18-, and 24-month intervals thereafter.

Twenty-four months after treatment initiation, heroin use as measured by urine test or self-report had reduced from 100 % of participants at both sites to 14.6 % in Hai Phong and 22.9 % in HCMC. When adjusted for multiple factors in Generalized Estimating Equations (GEE) logistic regression modeling, independent predictors of continued heroin use after 24 months of MMT in HCMC were the following: poor methadone adherence (adjusted odds ratio (AOR) = 3.7, 95 % confidence interval (CI) 1.8–7.8); currently on antiretroviral treatment (ART); currently on TB treatment; currently experiencing family conflict; and currently employed.

For Hai Phong participants, predictors were the following: currently on ART; currently experiencing family conflict; and moderate adherence to methadone. In Hai Phong, the percentage of participants who were employed had also increased by end of study from 35.0 to 52.8 %, while in HCMC the level remained relatively unchanged, between 52.2 and 55.1 %.

Study findings were used in multiple fora to convince policymakers and the public on the significant and vital role MMT can play in reducing heroin use and improving quality of life for individuals and families. Four years after this study was completed, Vietnam had expanded MMT to 162 clinics in 44 provinces serving 32,000 patients.

Below:  Trends in heroin use over time among participants

Table 3
Participants’ social characteristics and behaviors
Variables of interest	Follow-up periods						p value
	0–3 months	4–6 months	7–9 months	10–12 months	13–18 months	19–24 months
	(n = 930)	(n = 900)	(n = 871)	(n = 852)	(n = 802)	(n = 751)
Percent of participants who were employed full-time and had stable monthly income (n)
Hai Phong	35.0	47.4	49.0	54.4	51.6	52.8	0.000 a
HCMC	52.2	57.9	61.5	56.1	53.2	55.1	0.705 a
Total	43.8	52.7	55.2	55.3	52.4	53.9	0.002 a
Percent of participants who reported having conflict within their family
Hai Phong	2.0	3.8	2.8	2.3	0.7	0.8	0.005 a
HCMC	17.3	3.1	4.2	2.6	6.1	3.9	0.000 a
Total	9.8	3.4	3.4	2.5	3.4	2.3	0.000 a
Percent of participants who reported having troubled relationships with family and community members
Hai Phong	2.4	3.1	1.8	2.3	2.2	1.8	0.394 a
HCMC	9.7	9.8	5.3	5.9	6.1	4.4	0.001 a
Total	6.1	6.4	3.6	4.1	4.1	3.1	0.001 a

a Test for trend

Hoang et al.

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

By: Tran Vu Hoang¹, Tran Thi Thanh Ha², Tran Minh Hoang³, Nguyen To Nhu², Nguyen Cuong Quoc², Nguyen thi Minh Tam⁴ and Stephen Mills^5*

¹Partners in Health Research, 47 Yen Phu Street, Tay Ho District, Hanoi, Vietnam

²FHI 360, 7th floor, Hanoi Tourist Building, 8 Ly Thuong Kiet Street, Hanoi, Vietnam

³Hanoi Medical University, No. 1, Ton That Tung Street, Hanoi, Vietnam

⁴Vietnam Administration for AIDS Control, Vietnam Ministry of Health, 5th floor, 138a Giang Vo Street, Ba Dinh District, Hanoi, Vietnam

⁵FHI 360, 19th Floor, Sindhorn Building, Wittayu Road, Bangkok, Thailand

  

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