Abstract
BackgroundIntegration of methadone maintenance therapy (MMT) and HIV services is an evidence-based intervention (EBI) that benefits HIV care and reduces costs. While MMT/HIV integration is recommended by the World Health Organization and the Centers for Disease Control and Prevention, it is not widely implemented, due to organizational and operational barriers. Our study applied an innovative process to identify implementation strategies to address these barriers.MethodsOur process was adapted from the Expert Recommendations for Implementing Change (ERIC) protocol and consisted of two main phases. In Phase 1, we conducted 16 in-depth interviews with stakeholders and developed matrices to display barriers to integration. In Phase 2, we selected implementation strategies that addressed the barriers identified in Phase 1 and conducted a poll to vote on the most important and feasible strategies among a panel with expertise in cultural context and implementation science.ResultsBarriers fell into two broad categories: policy and programmatic. At the policy level, barriers included lack of a national mandate, different structures (MMT vs. HIV clinic) for cost reimbursement and staff salaries, and resistance on the part of staff to take on additional tasks without compensation. Programmatic barriers included the need for cross-training in MMT and HIV tasks, staff accountability, and commitment from local leaders. In Phase 2, we focused on programmatic challenges. Based on voting results and iterative dialogue with our expert panel, we selected several implementation strategies in the domains of technical assistance, staff accountability, and local commitment that targeted these barriers.ConclusionsKey programmatic barriers to MMT/HIV integration in Vietnam may be addressed through implementation strategies that focus on technical assistance, staff accountability, and local commitment. Our process of identifying implementation strategies was simple, low cost, and potentially replicable to other settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0420-8) contains supplementary material, which is available to authorized users.
Highlights
Integration of methadone maintenance therapy (MMT) and HIV services is an evidence-based intervention (EBI) that benefits HIV care and reduces costs
Phase 1 Definitions of integration Not all stakeholders had direct experience with MMT/ HIV integration, yet all knew about integration and identified co-location of services, shared clinic staff, and joint management as essential components of integration
Clinic providers from a pilot integration clinic emphasized the need for all three components, noting that their clinic has co-located MMT and HIV departments but is not fully integrated since the departments do not share a management board or staff
Summary
Integration of methadone maintenance therapy (MMT) and HIV services is an evidence-based intervention (EBI) that benefits HIV care and reduces costs. The process of translating evidence-based interventions (EBIs) to real-world settings is a critical step in the research to practice continuum. This step is frequently neglected in the public health sector [1,2,3,4]. Service settings vary substantially with regard to contextual factors such as patient characteristics [19, 20], provider attitudes toward an EBI [21], organizational readiness [22], leadership [23], and policies [24] These contextual factors can, in turn, influence the success of implementation strategies [4, 14]. The Expert Recommendations for Implementing Change (ERIC) protocol is a four-stage, mixed-methods process to develop expert recommendations regarding implementation strategies for a given context [14]
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