Examining common mental health disorders in people living with HIV on methadone maintenance therapy in Hanoi, Vietnam

Anisa Y Mughal,Brian W Pence,Bradley N Gaynes,Quynh Bui,Vivian Go,Tran Viet Ha,Melissa Ann Stockton

doi:10.1186/s12954-021-00495-3

Abstract

BackgroundInjection drug use drives HIV transmission in Southeast Asia, where around a quarter of users are living with HIV. Vietnam developed Methadone Maintenance Therapy (MMT) programs to reduce unsafe drug abuse. Common mental health disorders (CMD), including depression, anxiety and post-traumatic stress disorder (PTSD), can worsen MMT outcomes and are highly prevalent among people living with HIV (PLH). We aimed to characterize HIV and CMD among MMT patients and assess the impact of HIV and CMD on MMT engagement outcomes in Hanoi, Vietnam.MethodsThis cross-sectional study was conducted at an urban MMT clinic in Hanoi. Participants were screened for CMD with the relevant sections of the Mini International Neuropsychiatric Interview (MINI). Tabular comparisons and regression models were used to understand the association of HIV and CMD with substance use and methadone compliance.ResultsOf the 400 MMT participants, 22% were living with HIV, 11% a CMD, 27% reported injection drug use, and 27% reported methadone noncompliance. Around 17% of those with HIV also had a CMD. Reporting non injection and injection drug use were each higher among those with CMD regardless of HIV status. In addition, reporting any drug use was much higher among those with both HIV and CMD than among those with neither (73% vs 31%, p value 0.001). While methadone noncompliance was lower among PLH than among those without HIV (16.3% vs 30.1%, p value 0.010), noncompliance was higher among those with CMD than among those without (40.5% vs 25.6%, p value 0.045). Among those without HIV, noncompliance was higher among those with CMD than among those without, but among those with HIV, the opposite relationship was observed.ConclusionThere is complex overlap between substance use and methadone noncompliance among MMT patients living with HIV, CMD or both. In this population, we found a high prevalence of CMD and substance use among PLH, and a high prevalence of substance use and methadone noncompliance among those with CMD. Prioritizing provision of mental health care services to MMT patients living with HIV can help improve engagement with substance use disorder treatment and reduce the risk of HIV transmission.

Highlights

Injection drug use drives human immunodeficiency virus (HIV) transmission in Southeast Asia, where around a quarter of users are living with HIV
In Vietnam it is believed that HIV is primarily transmitted through injecting drug use where an estimated 30% of people living with HIV (PLH) inject drugs; this has major implications for forward transmission of HIV in Vietnam through unprotected sex, groups injecting, and needle sharing practices [2,3,4,5,6]
Prevalence of Common mental health disorders (CMD) among PLH on Methadone Maintenance Therapy (MMT) Of the 420 patients receiving MMT at the study site, 400 MMT patients enrolled in this study

Summary

Introduction

Injection drug use drives HIV transmission in Southeast Asia, where around a quarter of users are living with HIV. Vietnam developed Methadone Maintenance Therapy (MMT) programs to reduce unsafe drug abuse. The prevalence of injection drug use globally is estimated to be over 15 million persons [1], who are considered high risk for viral transmission of infectious diseases. The global prevalence of human immunodeficiency virus (HIV) in people who inject drugs (PWID) is estimated to be between 10.8 and 24.8% with the highest number of PWID present in East and Southeast Asia [1]. Methadone maintenance therapy (MMT) has been implemented globally as a way to reduce injecting drug use, minimize withdrawal symptoms and treat opiate dependency [3]. Over a decade of experience providing MMT services suggest that streamlining antiretroviral therapy (ART) and MMT programs is both feasible and may present an opportunity to effectively respond to both pandemics in Vietnam [10]

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