Abstract
SummaryBackgroundAccess to psychiatric care for people who inject drugs (PWID) is limited/absent and stigmatized in most low-middle-income countries (LMICs). Innovative interventions are needed. We aimed to describe and assess the impact of a community-based psychiatric intervention among PWID in Hai Phong, VietnamMethodsIn a cohort study with one year psychiatric follow-up, PWID diagnosed with a psychotic disorder, a major depressive episode, or suicide risk, were recruited from the wider Drug-Related Infections in ViEtnam (DRIVE) project in the city of Hai Phong. The community-based psychiatric intervention included specialized follow-up (free consultations with psychiatrists, free medication, referral to mental health department for hospitalization when necessary) and support from community-based organisations (case management, harm reduction, administrative support, linkage to HIV care, methadone maintenance treatment and mental health support). The main outcome was reduction/remission of symptoms. Access to and retention in psychiatric care, quality-of-life and stigmatization were also measured pre and post-intervention.FindingsAmong the 1212 participants screened from March to May 2019, 271 met the inclusion criteria, 233 (86.3%) accepted the intervention and 170 completed the follow-up (72.9%). At inclusion, 80.6% were diagnosed with current depression, 44.7% with psychotic disorder and 42.4% with suicide risk. After a one-year follow-up, these proportions dropped to 15.9%, 21.8%, and 22.9% respectively. Quality-of-life and perceived stigma related to mental health were also significantly improved, while drug use decreased only marginally.InterpretationCommunity-based psychiatric interventions are both feasible and efficient in the Vietnamese context. Similar interventions should be implemented and evaluated in other, different LMICs.Funding: This work was supported by grants from NIDA (US) (#DA041978) and ANRS (France) (#13353). The funding agencies had no role in designing the research, data analyses, or preparation of the report.
Highlights
people who inject drugs (PWID) were recruited during three successive annual respondent-driven sampling (RDS) surveys (October to December 2016, 2017 and 2018) and some were invited to participate in a cohort for long-term evaluation of the intervention via biannual visits.[33,34]
1212 Drug-Related Infections in ViEtnam (DRIVE) participants were screened for a psychiatric disorder at the DRIVE-Mind M0 visit, 271 were diagnosed with a major depressive episode, a psychotic disorder, suicide risk or significant symptoms requiring a psychiatric intervention, but only 233 signed their consent
85% (32/38) of those who did not sign the consent form were free from current depressive or psychotic disorder. Their eligibility was based almost exclusively on the presence of a history of suicide attempt and their psychiatric symptomatology was mostly normal to mild according to the Clinical Global Impression scale score (CGI) Severity scale at cohort initiation
Summary
Psychiatric disorders are very common among people who use drugs, reaching 40% among people who inject drugs (PWID), mainly mood, anxiety and personality disorders, but they vary considerably according to the drugs.[1−4] The use of stimulants is frequently associated with psychiatric complications, and in particular methamphetamines, with sometimes long-lasting psychotic disorders.[1,5,6] People suffering from mental health disorders are more likely to engage in high-risk behaviours, to have late access methadone treatment when needed, and to have poorer health-seeking behaviour.[7−13]. Successfully referred to psychiatric clinics.[30] The main reasons identified were fees associated with mental health care, lack of awareness and stigma, despite the fact that Hai Phong city had an estimated population of 5,000 PWID in 2016 and is known to possess a high level of harm reduction services cover.[30−32]
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