Le Minh Giang, Nguyen Thu Trang, Nguyen Bich Diep, Dao Thi Dieu Thuy, Dinh Thanh Thuy, Han Dinh Hoe, Hoang Thi Hai Van, Thai Thanh Truc, Hoa H. Nguyen, Nguyen Ly Lai, Pham Thi Dan Linh, Vu Thi Tuong Vi, Cathy J. Reback, Arleen Leibowitz, Li Li, Chunqing Lin, Michael Li, Do Van Dung, Ste
Background: Methamphetamine use could jeopardize the current efforts to address opioid use disorder and HIV infection. Evidence-based behavioral interventions (EBI) are effective in reducing methamphetamine use. However, evidence on optimal combinations of EBI is limited. This protocol presents a type-1 effectiveness-implementation hybrid design to evaluate the effectiveness, cost-effectiveness of adaptive methamphetamine use interventions, and their implementation barriers in Vietnam. Method: Design: Participants will be first randomized into two frontline interventions for 12 weeks. They will then be placed or randomized to three adaptive strategies for another 12 weeks. An economic evaluation and an ethnographic evaluation will be conducted alongside the interventions. Participants: We will recruit 600 participants in 20 methadone clinics. Eligibility criteria: (1) age 16+; (2) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores ≥ 10 for methamphetamine use or confirmed methamphetamine use with urine drug screening; (3) willing to provide three pieces of contact information; and (4) having a cell phone. Outcomes: Outcomes are measured at 13, 26, and 49 weeks and throughout the interventions. Primary outcomes include the (1) increase in HIV viral suppression, (2) reduction in HIV risk behaviors, and (3) reduction in methamphetamine use. COVID-19 response: We developed a response plan for interruptions caused by COVID-19 lockdowns to ensure data quality and intervention fidelity
BMC Public Health
Background: Heroin use continues to drive HIV transmission in Vietnam, but methamphetamine and alcohol use are growing rapidly and, as in other countries, polysubstance use is widespread. The objective of this study was to understand the interplay between heroin, methamphetamine, and alcohol use among people with opioid use disorder (OUD) and HIV in Vietnam. Methods: We conducted 44 in-depth, face-to-face qualitative interviews with people with OUD and HIV who participated in the BRAVO trial of buprenorphine versus methadone in five Vietnam HIV clinics. Interviews probed participants’ experiences of heroin, methamphetamine, and alcohol use and their interplay with HIV/OUD treatment. Interviews were professionally transcribed and analyzed using a thematic analysis approach. Results: Of 44 participants interviewed 42 were male, on average 38.8 years of age, with 30 reporting a history of methamphetamine use and 33 reporting a history of alcohol use. Several themes emerged: 1) Methamphetamine and alcohol were perceived to have lower addiction potential than heroin 2) Social settings were key facilitators of alcohol and methamphetamine use 3) Some participants, but not all, used methamphetamine to help quit heroin 4) Consuming alcohol blunted the effects of heroin, while paradoxically serving as a catalyst for heroin use 5) Use of methamphetamine was perceived by many participants to be incompatible with treatment for HIV. Conclusions: Participant experiences reflected a significant impact of polysubstance use on treatment of HIV and OUD. Patterns of polysubstance use are subject to common preconceptions of alcohol and methamphetamine as having a low addictive potential, and these substances are deeply enmeshed in the social life of many people with OUD in Vietnam. Interventions to address complex social norms and potential harms of polysubstance use are urgently needed as the population of people receiving medication for OUD (MOUD) increases in Vietnam and globally
Addictive Behaviors
Background: Adolescent substance use is a leading risk factor of medical and social problems in adults. However, evidence-based interventions for substance use
disorders (SUD) among youth in resource-limited countries are lacking. Treatnet Family (TF), developed by United Nations Office on Drugs and Crime (UNODC),
aims to make youth SUD care more affordable and accessible in low- and middle-income countries. This study explores the suitability of TF in Vietnam.
Method: Twenty interviews were conducted with eight adolescents and their family members who participated in TF, and four practitioners who delivered TF.
Questions centred on their experiences with the intervention and suggestions for improvement. Thematic analysis was used to evaluate the data.
Results: All adolescents were male with an average age of 19.3. Seven of them had left school. Most caregivers were female. Both family members and adolescents
expressed a great demand for support, and both groups appreciated the immediate improvement in parent–child communication. However, the impact of TF could be
compromised due challenges in recruiting families, possibly arising from the novelty of a family-based intervention in Vietnam and drug-related stigma. The
perception of drug use as an acute condition instead of a chronic disorder, and the lack of a continuing care system, also made it difficult to retain participants.
Conclusion: Vietnamese adolescents with SUD and their family members were in great need of support and access to evidence-based interventions. Building a
comprehensive, health-centred substance use disorder treatment and care system would enhance treatment impact.
Journal of Substance Abuse Treatment
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