Impact of a methadone maintenance therapy pilot in Vietnam and its role in a scaled-up response.

Tran Vu Hoang,Nguyen Thi Minh Tam,Tran Thi Thanh Ha,Tran Minh Hoang,Nguyen Cuong Quoc,Nguyen To Nhu,Stephen Mills

doi:10.1186/s12954-015-0075-9

Abstract

BackgroundAs a dual response to the HIV epidemic and the high level of injecting drug use in Vietnam, the Ministry of Health (MOH) initiated a pilot methadone maintenance therapy (MMT) program in Hai Phong and Ho Chi Minh City (HCMC) in early 2009. The objectives of the pilot were to provide evidence on whether MMT could be successfully implemented in Vietnam and scaled up to other localities.MethodsA prospective study was conducted among 965 opiate drug users admitted to the pilot. Data on demographic characteristics, sexual behaviors, substance use behaviors (including heroin use), and blood-borne virus infection (HIV, hepatitis B, and hepatitis C) were collected at treatment initiation and then again at 3-, 6-, 9-, 12-, 18-, and 24-month intervals thereafter.ResultsTwenty-four months after treatment initiation, heroin use as measured by urine test or self-report had reduced from 100 % of participants at both sites to 14.6 % in Hai Phong and 22.9 % in HCMC. When adjusted for multiple factors in Generalized Estimating Equations (GEE) logistic regression modeling, independent predictors of continued heroin use after 24 months of MMT in HCMC were the following: poor methadone adherence (adjusted odds ratio (AOR) = 3.7, 95 % confidence interval (CI) 1.8–7.8); currently on antiretroviral treatment (ART) (AOR = 1.8, 95 % CI 1.4–2.4); currently on TB treatment (AOR = 2.2, 95 % CI 1.4–3.4); currently experiencing family conflict (AOR = 1.6, 95 % CI 1.1–2.4); and currently employed (AOR = 0.8, 95 % CI 0.6–1.0).For Hai Phong participants, predictors were the following: currently on ART (AOR = 2.0, 95 % CI = 1.4–3.0); currently experiencing family conflict (AOR = 2.0, 95 % CI = 1.0–3.9); and moderate adherence to methadone (AOR = 2.1, 95 % CI = 1.2–1.9). In Hai Phong, the percentage of participants who were employed had also increased by end of study from 35.0 to 52.8 %, while in HCMC the level remained relatively unchanged, between 52.2 and 55.1 %.DiscussionStudy findings were used in multiple fora to convince policymakers and the public on the significant and vital role MMT can play in reducing heroin use and improving quality of life for individuals and families. Four years after this study was completed, Vietnam had expanded MMT to 162 clinics in 44 provinces serving 32,000 patients.

Highlights

As a dual response to the HIV epidemic and the high level of injecting drug use in Vietnam, the Ministry of Health (MOH) initiated a pilot methadone maintenance therapy (MMT) program in Hai Phong and Ho Chi Minh City (HCMC) in early 2009
We examine the outcomes of this pilot, including prevalence of drug use, factors that predict continued drug use, methadone dosage patterns, and social factors such as employment and social relationships, among patients enrolled in a cohort study at six MMT outpatient clinics in Hai Phong and Ho Chi Minh City (HCMC), Vietnam
An observational prospective study was conducted among a cohort of participants who were consecutively enrolled in an MMT program in six clinics in Hai Phong and HCMC, Vietnam from January to October 2009

Summary

Introduction

As a dual response to the HIV epidemic and the high level of injecting drug use in Vietnam, the Ministry of Health (MOH) initiated a pilot methadone maintenance therapy (MMT) program in Hai Phong and Ho Chi Minh City (HCMC) in early 2009. HIV prevalence among this population remains as high as 40 % in many locations [11] It is estimated by 2010 that there were more than 130,000 PWID nationwide in Vietnam [12], though this may be a significant underestimation [13]. Key HIV-related risk behaviors among this population include a continuing high frequency of injection, sharing of used needles and syringes, and unprotected sex with both regular and commercial sex partners [11, 14]. One significant barrier to this was that the type of rehabilitation offered was predominantly a network of compulsory rehabilitation centers throughout the country that focused on a mixture of detoxification, labor, and lectures with little evidence-based service and a subsequent high rate of re-incarceration [16]

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Conclusion