Abstract
BackgroundIntegrating 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.MethodsA 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).ResultsRespondents 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.ConclusionsOutcomes 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.
Highlights
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
The rural MMT clinics integrated with Xuan Truong district health center (DHC) have a large proportion of patients who were Catholic (25.8 %) and who were manual workers or farmers (35.8 %) (Table 2)
While integration and decentralization of HIV/AIDS and substance abuse treatment services with existing health care delivery system is critical in sustaining efforts to fight HIV/AIDS in large injection-driven epidemics, findings of this study showed a significant heterogeneity in outcomes of MMT across different service models
Summary
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. In Asia, since injecting illicit drugs is recognized as a major risk factor for acquiring HIV, opioid substitution treatments have been considered an important component of HIV/AIDS prevention strategies [1,2,3,4]. Given the needs of PWUD for comprehensive medical care, the concept of integrating MMT with general health care services was proposed [9, 19,20,21]. It refers that various components of health services are provided by single or separate providers in one site. A wide range of literatures suggested the benefits of the integrating MMT to
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