Methadone Maintenance Treatment Promotes Referral and Uptake of HIV Testing and Counselling Services amongst Drug Users and Their Partners

BACKGROUND:

Methadone maintenance treatment (MMT) reduces HIV risk behaviors and improves access to HIV-related services among drug users. In this study, we assessed the uptake and willingness of MMT patients to refer HIV testing and counseling (HTC) service to their sexual partners and relatives.

METHODS:

Health status, HIV-related risk behaviors, and HTC uptake and referrals of 1,016 MMT patients in Hanoi and Nam Dinh were investigated. Willingness to pay (WTP) for HTC was elicited using a contingent valuation technique. Interval and logistic regression models were employed to determine associated factors.

RESULTS:

Most of the patients (94.2%) had received HTC, 6.6 times on average. The proportion of respondents willing to refer their partners, their relatives and to be voluntary peer educators was 45.7%, 35.3%, and 33.3%, respectively. Attending MMT integrated with HTC was a facilitative factor for HTC uptake, greater WTP, and volunteering as peer educators. Older age, higher education and income, and HIV positive status were positively related to willingness to refer partners or relatives, while having health problems (mobility, usual care, pain/discomfort) was associated with lower likelihood of referring others or being a volunteer. Over 90% patients were willing to pay an average of US $17.9 for HTC service.

CONCLUSION:

The results highlighted the potential role of MMT patients as referrers to HTC and voluntary peer educators. Integrating HIV testing with MMT services and applying users' fee are potential strategies to mobilize resources and encourage HIV testing among MMT patients and their partners.

Below:   Sexual behaviors among respondents

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

By:  Tran BX1,2, Nguyen LH1,3, Nguyen LP4, Nguyen CT5, Phan HT6, Latkin CA2.

• 1Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
• 2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
• 3School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
• 4Harvard T.H Chan School of Public Health, Boston, Massachusetts, United States of America.
• 5Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
• 6Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam. 

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Economic Vulnerability of Methadone Maintenance Patients: Implications for Policies on Co-Payment Services

Background

Co-payment for methadone maintenance treatment (MMT) services is a strategy to ensure the financial sustainability of the HIV/AIDS programs in Vietnam. In this study, we examined health services utilization and expenditure among MMT patients, and further explored factors associated with catastrophic health expenditure among affected households.

Methods

A multi-site cross-sectional study was conducted among 1,016 patients in two epicentres: Hanoi and Nam Dinh province in 2013.

Results

Overall, 8.2% and 28.7% respondents used inpatient and outpatient health care services in the past 12 months apart from receiving MMT. There were 12.8% respondents experiencing catastrophic health expenditure given MMT is provided free-of-charge, otherwise 63.5% patients would suffer from health care costs. MMT integrated with general health or HIV services may encourage health care services utilization of patients. Patients, who were single, lived in the rural, had inpatient care and reported problems in Mobility were more likely to experience catastrophic health expenditure than other patient groups.

Conclusions

The health care costs are still financially burden to many drug users and remained over the course of MMT that implies the necessity of continuous supports from the program. Scaling-up and decentralizing integrated MMT clinics together with economic empowerments for treated drug users and their families should be prioritized in Vietnam.

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By:  Bach Xuan Tran, Huong Thu Thi Phan, Long Hoang Nguyen, Cuong Tat Nguyen, Anh Tuan Le Nguyen, Tuan Nhan Le, Carl A. Latkin

Affiliations

Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America

Correspondence

Corresponding author.at: Lecturer in Health Economics Hanoi Medical University, Vietnam Bloomberg School of Public Health Johns Hopkins University, USA. +84-982228662.

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Patient Satisfaction with Methadone Maintenance Treatment in Vietnam: A Comparison of Different Integrative-Service Delivery Models

Patient satisfaction is an important component of quality in healthcare delivery. To inform the expansion of Methadone Maintenance Treatment (MMT) services in Vietnam, we examined the satisfaction of patients with regards to different services delivery models and identified its associated factors.

We interviewed 1,016 MMT patients at 5 clinics in Hanoi and Nam Dinh province. The modified SATIS instrument, a 10-item scale, was used to measure three dimensions: “Services quality and convenience”, “Health workers’ capacity and responsiveness” and “Inter-professional care”.

The average score was high across three SATIS dimensions. However, only one third of patients completely satisfied with general health services and treatment outcomes. Older age, higher education, having any problem in self-care and anxiety/depression were negatively associated with patient’s satisfaction. Meanwhile, patients receiving MMT at clinics, where more comprehensive HIV and general health care services were available, were more likely to report a complete satisfaction.

Patients were highly satisfied with MMT services in Vietnam. However, treatment for drug users should go beyond methadone maintenance to address complicated health demands of drug users. Integrating MMT with comprehensive HIV and general health services together with improving the capacity of health workers and efficiency of services organisation to provide interconnected health care for drug users are critical for improving the outcomes of the MMT program.

Full article at:  http://goo.gl/8kQhtt

By:

Bach Xuan Tran, Long Hoang Nguyen

Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam

Bach Xuan Tran, Carl A. Latkin

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America

Long Hoang Nguyen

School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam

Huong Thu Thi Phan

Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam

 

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Effects of Cigarette Smoking & Nicotine Dependence on Adherence to Antiretroviral Therapy among HIV-Positive Patients in Vietnam

Cigarette smoking is increasingly recognized as an indicator for inferior adherence to antiretroviral therapy (ART) among HIV-positive patients. Given the limited body of work on this issue, we aimed to explore the relations between cigarette smoking, nicotine dependence, and ART adherence in Vietnam. 

A cross-sectional study of 1050 HIV-positive people was conducted from January to September 2013 in Hanoi (the capital) and Nam Dinh (a rural city). Adherence to ART during the last 30 days was measured by the 100-point visual analog scale (VAS). Smoking history and nicotine dependence (Fagerstrom Test of Nicotine Dependence) were self-reported by participants. 

Multiple logistic regression was performed to examine the association of current smoking and nicotine dependence with ART nonadherence. Using the established VAS cut point of 95 to indicate adequate adherence, the prevalence of ART nonadherence was 30.9%. Approximately 35.5% of the sample reported current smoking. No association between smoking status and ART nonadherence was found. However, participants with greater nicotine dependence were more likely to be nonadherent. Also, individuals who were female, receiving ART in Nam Dinh, and currently feeling anxiety had a higher likelihood of ART nonadherence. Additionally, current smokers reporting current pain were more likely to be nonadherent. Conversely, protective factors included living with a spouse/partner  and having more than a high school education. 

Given the high prevalence of suboptimal adherence and current smoking among HIV-positive patients, screening for smoking status and nicotine dependence during ART treatment may help to improve patients' adherence to medication. More efforts should be targeted to women, patients with mental health problems, and ART clinics in rural areas.

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By: Nguyen NT1, Tran BX2,3, Hwang LY4, Markham CM4, Swartz MD4, Vidrine JI5, Phan HT6, Latkin CA3, Vidrine DJ5.

• 1a Department of Pharmacoeconomics & Pharmacoepidemiology , Hanoi University of Pharmacy , Hanoi , Vietnam.
• 2b Institute for Preventive Medicine and Public Health , Hanoi Medical University , Hanoi , Vietnam.
• 3c Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
• 4d The University of Texas Health Science Center at Houston , Houston , TX , USA.
• 5e Department of Family and Preventive Medicine , The University of Oklahoma Health Science Center , Oklahoma City , OK , USA.
• 6f Authority of HIV/AIDS Control, Ministry of Health , Hanoi , Vietnam.  

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