Substance Abuse Journal
Background: Patients report that familial support can facilitate initiation and maintenance of antiretroviral therapy (ART) and medications for opioid use disorder (MOUD). However, providing such support can create pressure and additional burdens for families of people with opioid use disorder (OUD) and HIV. We examined perspectives of people with HIV receiving treatment for OUD in Vietnam and their family members. Methods: Between 2015 and 2018, we conducted face-to-face qualitative interviews with 44 patients and 30 of their family members in Hanoi, Vietnam. Participants were people living with HIV and OUD enrolled in the BRAVO study comparing HIV clinic-based buprenorphine with referral to methadone treatment at 4 HIV clinics and their immediate family members (spouses or parents). Interviews were professionally transcribed, coded in Vietnamese, and analyzed using a semantic, inductive approach to qualitative thematic analysis. Results: Family members of people with OUD and HIV in Vietnam reported financially and emotionally supporting MOUD initiation and maintenance as well as actively participating in treatment. Family members described the burdens of supporting patients during opioid use, including financial costs and secondary stigma. Conclusions: Describing the role of family support in the lives of people living with OUD and HIV in the context of Vietnam enriches our understanding of their experiences and will support future treatment efforts targeting the family unit.
Nguyen Xuan Binh Minh, R.B. Hershow, N.A. Blackburn, Q.X. Bui, C.A. Latkin, H. Hutton, G. Chander, D. Dowdy, K.E. Lancaster, C. Frangakis, T. Sripaipan, H.V. Tran, V.F. Go
Social Science and Medicine
Aims: This study explores the effects of two evidence-based alcohol reduction counseling interventions on readiness to change, alcohol abstinence self-efficacy, social support, and alcohol abstinence stigma among people with HIV (PWH) who have hazardous alcohol use in Vietnam. Methods: PWH receiving antiretroviral therapy (ART) were screened for hazardous drinking and randomized to one of three study arms: combined intervention (CoI), brief intervention (BI), and standard of care (SOC). A quantitative survey was conducted at baseline (N = 440) and 3-month post-intervention (N = 405), while indepth interviews were conducted with a subset of BI and CoI participants at baseline (N = 14) and 3 months (N = 14). Data was collected from March 2016 to August 2017. A concurrent mixed-methods model was used to triangulate quantitative and qualitative data to cross-validate findings. Results: At 3 months, receiving the BI and CoI arms was associated with 2.64 and 3.50 points higher in mean readiness to change scores, respectively, compared to the SOC group (BI: β = 2.64, 95% CI: 1.17–4.12; CoI: β = 3.50, 95% CI 2.02–4.98). Mean alcohol abstinence self-efficacy scores were 4.03 and 3.93 points higher among the BI and CoI arm at 3 months, compared to SOC (BI: β = 4.03, 95% CI: 0.17–7.89; CoI: β = 3.93, 95% CI: 0.05–7.81). The impacts of the interventions on social support and alcohol abstinence stigma were not significant. Perceived challenges to refusing drinks at social events remained due to strong alcohol abstinence stigma and perceived negative support from family and friends who encouraged participants to drink posed additional barriers to reducing alcohol use. Conclusions: Both the CoI and BI were effective in improving readiness to change and alcohol abstinence selfefficacy among PWH. Yet, participants still faced significant barriers to reducing their drinking due to social influences and pressure to drink. Interventions at different levels addressing social support and alcohol abstinence stigma are warranted.
Kathy Trang, Tanja Jovanovic, Devon E. Hinton, Patrick Sullivan, Carol M. Worthman, Le Xuan Lam, Nguyen Kim Chi, Nguyen Cong Thanh, Tran Viet Ha, Vivian Go, Irving Hoffman and Le Minh Giang
Transcult Psychiatry
The purpose of this study was to characterize trauma exposure and mental health burden among men who have sex with men (MSM) in Hanoi, Vietnam. Participants comprise 100 HIV-positive and 98 high-risk, HIV-negative MSM, ranging from 18 to 29 years of age. Data were collected using the Childhood Trauma Questionnaire, Traumatic Events Inventory, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and PTSD Symptom Scale. A subset of participants (n = 12) were also interviewed to evaluate community perception of the prevalence, causation, and available treatment options for mental health issues within the MSM community in Vietnam. In our sample, 23.2% reported having experienced moderate-to-severe childhood physical abuse; 18.7% physical neglect; 13.6% emotional abuse; 11.1% emotional neglect; and 26.8% sexual abuse. Such trauma exposure continued into adulthood and manifested most commonly in the form of interpersonal violence. Approximately 37.4% of the sample met the criteria for probable PTSD; 26.8% for moderate-to-severe depression; and 20.2% for moderate-to-severe anxiety. Neither exposure nor mental health burden differed by serostatus. Linear regression revealed that childhood emotional abuse was the only sub-type of trauma significantly associated with depression, anxiety, and PTSD symptoms. The majority of interviewees believed that mental health burden was higher among MSM relative to the general population and attributed this to their vulnerability to interpersonal violence and lack of available coping resources. However, few believed that these mental health issues warranted clinical attention, and only one participant was able to identify a mental health service provider. Our findings suggest that trauma exposure and mental health burden are prevalent among MSM, irrespective of serostatus, and much higher than what has been previously reported among the general population in Vietnam
AIDS and Behavior
Scientifc fndings and policy guidelines recommend integrating HIV and drug addiction prevention and care into communitybased settings. Systematic capacity-building eforts are warranted to provide technical support for community health workers and improve their confdence in the integrated service provision. An intervention trial was conducted between 2018 and 2019 with 120 community health workers (CHW) from 60 communes in Vietnam’s four provinces. The 60 intervention CHW received in-person training to enhance their HIV/addiction-related service knowledge and skills. Online support groups were established between trained CHW and local HIV and addiction specialists. The intervention outcomes were assessed using mixed-efects regression models with the data collected at baseline and every 3 months for 1 year. Adjusted analyses showed that intervention CHW reported a signifcant increase in the interaction with other treatment providers than the control group at 6 months and remained at the 12-month follow-up. The diference in the improvement of confdence in HIV/addictionrelated service delivery between the intervention and control groups was signifcant at 6-month but became insignifcant at the 12-month. Male CHW were more confdent in providing services than female CHW at baseline, and gender diferences in the changing patterns were observed over time. This capacity-building intervention demonstrated promising outcomes on CHW inter-agency collaborations and confdence in service delivery. Gender divides in healthcare professionals should be attended to in future studies
Ha V Tran, MSc MD Ha T T Nong, PhD Thuy T T Tran, PhD Teresa R Filipowicz, MPH Kelsey R Landrum, MPH Brian W Pence, PhD Giang M Le, PhD; Minh X Nguyen, PhD Dixon Chibanda, PhD Ruth Verhey, PhD Vivian F Go, PhD Hien T Ho, PhD Bradley N Gaynes
JMR Formative Research
Friendship Bench, Vietnam, Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing, ADAPT-ITT, common mental disorders, people living with HIV, PWH, people who inject drugs, PWID, methadone maintenance treatment, MMT, depression, anxiet
Background: The prevalence of common mental disorders (CMDs) among people living with HIV and people who inject drugs
is high worldwide and in Vietnam. However, few evidence-informed CMD programs for people living with HIV who inject drugs
have been adapted for use in Vietnam. We adapted the Friendship Bench (FB), a problem-solving therapy (PST)–based program
that was successfully implemented among patients with CMDs in primary health settings in Zimbabwe and Malawi for use among
people living with HIV on methadone maintenance treatment (MMT) with CMDs in Hanoi, Vietnam.
Objective: This study aimed to describe the adaptation process with a detailed presentation of 4 phases from the third (adaptation)
to the sixth (integration) of the Assessment-Decision-Adaptation-Production-Topical Experts-Integration-Training-Testing
(ADAPT-ITT) framework.
Methods: The adaptation phase followed a qualitative study design to explore symptoms of CMDs, facilitators, and barriers to
conducting FB for people living with HIV on MMT in Vietnam, and patient, provider, and caretaker concerns about FB. In the
production phase, we revised the original program manual and developed illustrated PST cases. In the topical expert and integration
phases, 2 investigators (BNG and BWP) and 3 subject matter experts (RV, DC, and GML) reviewed the manual, with reviewer
comments incorporated in the final, revised manual to be used in the training. The draft program will be used in the training and
testing phases.
Results: The study was methodologically aligned with the ADAPT-ITT goals as we chose a proven, effective program for
adaptation. Insights from the adaptation phase addressed the who, where, when, and how of FB program implementation in the
https://formative.jmir.org/2022/7/e37211 JMIR Form Res 2022 | vol. 6 | iss. 7 | e37211 | p. 1
(page number not for citation purposes)
JMIR FORMATIVE RESEARCH Tran et al
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MMT clinics. The ADAPT-ITT framework guided the appropriate adaptation of the program manual while maintaining the core
components of the PST of the original program throughout counseling techniques in all program sessions. The deliverable of this
study was an adapted FB manual to be used for training and piloting to make a final program manual.
Conclusions: This study successfully illustrated the process of operationalizing the ADAPT-ITT framework to adapt a mental
health program in Vietnam. This study selected and culturally adapted an evidence-informed PST program to improve CMDs
among people living with HIV on MMT in Vietnam. This adapted program has the potential to effectively address CMDs among
people living with HIV on MMT in Vietnam
Sarah E. Rutstein, Adams L. Sibley, Hanna E. Huffstetler, Trang Thu Do Nguyen, Ha Viet Tran, Giang Le Minh, Teerada Sripaipan, Minh Nguyen, William C. Miller, d Joseph J. Eron, a Cynthia L. Gay, a, Vivian F. Go
The Lancet Regional Health - Western Pacific
Background In Vietnam, HIV prevalence among people who inject drugs (PWID) is several times higher than in the general population (15% versus 0.3%). PWID also experience higher rates of HIV-related mortality, driven by poor antiretroviral therapy (ART) adherence. Long-acting injectable ART (LAI) is a compelling opportunity to improve treatment outcomes, but acceptability and feasibility among HIV-infected PWID remains unexplored. Methods We conducted key informant in-depth interviews in Hanoi, Vietnam (February-November 2021). Participants were purposively sampled and included policymakers, ART clinic staff, and HIV-infected PWID. We applied the Consolidated Framework for Implementation Research to guide study design and analysis, using thematic coding to develop and iteratively refine a codebook and characterize barriers and facilitators to LAI implementation. Findings We interviewed 38 key stakeholders: 19 PWID, 14 ART clinic staff, and five policymakers. Participants were enthusiastic about LAI convenience, highlighting less frequent and more discreet dosing. However, contrasting providers, several policymakers suggested LAI was not needed given perceived exceptional oral ART outcomes and rare viral failure among PWID. Policymakers also criticized strategies prioritizing PWID for LAI, emphasizing equity, whereas providers identified PWID as an ideal population for LAI given adherence challenges. LAI complexity, including storage and administration logistics, were deemed surmountable with training and resources. Finally, providers and policymakers acknowledged that adding LAI to drug formularies was key, but an onerous process. Interpretation Although anticipated to be resource-intensive, LAI was a welcome addition for interviewed stakeholders and likely an acceptable alternative to oral ART among PWID living with HIV in Vietnam. Despite enthusiasm among PWID and providers that LAI could improve viral outcomes, some policymakers−whose buy-in is critical to LAI implementation −opposed strategies that preferentially distributed LAI to PWID, highlighting values of equity and revealing differences in perceived HIV outcomes among PWID. Results provide a vital foundation for developing LAI implementation strategies. Funding Supported by National Institutes of Health.
International journal of STD & AIDS
Background: People living with HIV who use drugs (PLHWUD) face enormous challenges to access antiretroviral therapy (ART), addiction treatment, and other healthcare services. This study evaluated the effect of a community capacity-building approach on PLHWUD’s access to healthcare services. Methods: A cluster randomized controlled trial was conducted in four provinces of Vietnam. Trained commune health workers in the intervention condition were encouraged to provide services to PLHWUD in the community and engage them in HIV/addiction treatment and care using learned knowledge and skills. A total of 241 PLHWUD participated in surveys at the baseline and every three months for one year. The primary outcome was PLHWUD’s reported barriers to seeking healthcare. A linear mixed-effects regression model with a difference in difference approach was used to estimate the intervention effect on the primary outcome. Results: Adjusted analyses indicated that significant intervention effects were observed at the Sixth and ninth month follow-ups for those on ART at the baseline and increased motivation to engage in treatment at the 3-month follow-up (60.2% vs 34.4% for the intervention and control groups, respectively). Conclusions: The community capacity-building intervention had shown promising yet limited outcomes among a subset of PLHWUD in the community, that is, PLHWUD who had already initiated ART
Late HIV treatment remains a global public health issue despite significant efforts. To better understand what shapes this issue, we interviewed 36 Vietnamese ART-naive patients who came to HIV treatment in 2017. Half of them had intake CD4 counts fewer than 100 cells/mm3/the others had intake CD4 counts of 350 cells/mm3 and above. Late diagnosis was the reason of late treatment in our sample. Most late presenters were not members of the key populations at increased risk of HIV (e.g., people who inject drugs, commercial sex workers, and men who have sex with men). Individual-level factors included low risk appraisal, habit of self-medication, and fear of stigma. Network and structural-level factors included challenges to access quality health care, normalization of HIV testing in key populations and inconsistent provider-initiated HIV testing practices. Structural interventions coupled with existing key population–targeted strategies would improve the issue of late HIV diagnosis.
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
Tạp chí Y học dự phòng
Community - based organizations (CBO) have implemented various activities and have contributed to the successful responses to HIV/AIDS epidemic in Vietnam. However, in the context of donor phase-out, little information of current CBO’s activities has been published. This study aims to describe the diversity of CBO’s activities and to assess factors associated with implementing activities. A survey of CBO established before October 2014 and still operated after June 2014 was conducted from November 2014 to June 2015 in Vietnam. Their characteristics and participation in implementing any activities, related or not related to HIV were collected. Majority of 277 CBOs were established 2 to 10 years ago (83%) and were the group of people living with HIV (45%). Ten percent of them had legal status but most of them had leadership and an organization goal. Among 30 activities enlisted, Vietnamese CBOs provided approximately 14 activities on average. Disseminate HIV-related knowledge, outreach most at risk-people and support people to do HIV testing are three most popular activities implemented by Vietnamese CBOs. On the contrary, support for elderly/ homeless people, non-profit activities and other relevant activities are least implemented. A multiple linear regression model found six factors associated with increased activities: Older establishment, having leadership, having legal status, experienced CBO founders, having specific organization goal, and the number of partners. Vietnamese CBOs are implementing diverse activities in terms of types and numbers, remaining the key actor in HIV/AIDS prevention. Future interventions and investment in CBO are necessary to end the epidemic
Tạp chí nghiên cứu Y học
Thiết kế nghiên cứu mô tả cắt ngang với mục tiêu mô tả mức độ hỗ trợ của gia đình đối với người nhiễm HIV điều trị muộn và một số yếu tố liên quan. Đối tượng nghiên cứu bao gồm 242 bệnh nhân điều trị HIV muộn tại thành phố Hồ Chí Minh (TPHCM) năm 2017. Tiêu chuẩn lựa chọn: từ 18 tuổi trở lên, sống ở TPHCM ít nhất 6 tháng, chưa từng điều trị ARV và số lượng CD4 khi đăng ký điều trị dưới 100 tế bào/mm3. Kết quả cho thấy hỗ trợ đối tượng nhận được từ gia đình hầu hết tập trung vào hỗ trợ liên quan HIV và chăm sóc sức khỏe, rất ít hỗ trợ khác. Có gia đình hạt nhân (bố/mẹ hoặc vợ/chồng) là điều kiện thuận lợi (aOR=10,2; 95% CI: 4,4 – 23,9) để nhận được hỗ trợ so với mối quan hệ khác (anh/chị/em ruột, anh/em họ, họ hàng). Đã tiết lộ với gia đình về tình trạng nhiễm HIV (aOR=6,9; 95% CI: 2,7 – 17,3) và nhóm tuổi ≥40 so với nhóm
Mục tiêu:
1. Xác định tỷ lệ nam quan hệ tình dục đồng giới nhiễm HIV biết kết quả xét nghiệm dương tính và tiếp cận điều trị tại Hà Nội giai đoạn 2017- 2019.
2. Phân tích một số yếu tố liên quan đến biết kết quả xét nghiệm dương tính và tiếp cận điều trị ART ở nhóm đối tượng trên.
Đối tượng nghiên cứu: Nam quan hệ tình dục đồng giới, tuổi lớn hơn hoặc bằng 16 tuổi, sống ở Hà Nội ít nhất 3 tháng, có kết quả xét nghiệm HIV dương tính tại thời điểm tham gia nghiên cứu, có quan hệ tình dục đồng giới trong 12 tháng qua.
Phương pháp nghiên cứu: Thiết kế nghiên cứu mô tả cắt ngang
- Chọn mẫu có chủ đích, cỡ mẫu 217
Kết quả nghiên cứu chính: 68,7% nam quan hệ tình dục nhiễm HIV có biết tình trạng nhiễm HIV, 31,3% không biết tình trạng nhiễm HIV của mình. 88,2% những người biết tình trạng nhiễm HIV đã tiếp cận điều trị ARV, 11,8% những người biết tình trạng nhiễm HIV nhưng chưa tiếp cận điều trị ARV. Từng xét nghiệm STIs là yếu tố liên quan đến biết kết quả nhiễm HIV với OR=2; 95%CI: [1,02-4,25], từng được chẩn đoán nhiễm STIs là yếu tố liên quan đến biết tình trạng nhiễm HIV với OR=3,8; 95%CI: [1,85-7,79].
Tạp chí nghiên cứu Y học
Nghiên cứu mô tả cắt ngang được thực hiện trên 323 người nhiễm HIV/AIDS đang điều trị ARV tại Bệnh viện đa khoa thành phố Vinh, tỉnh Nghệ An nhằm mô tả chất lượng cuộc sống và các yếu tố liên quan đến chất lượng cuộc sống của người có HIV tại tỉnh Nghệ An năm 2021. Dữ liệu được thu thập bằng phỏng vấn trực tiếp dựa vào bộ câu hỏi thiết kế sẵn và thang đo lường chất lượng cuộc sống WHOQOL-HIV BREF. Trên thang điểm từ 4 – 20, điểm số chất lượng cuộc sống trung bình của người nhiễm HIV/AIDS trong nghiên cứu này là 14,5 ± 1,8, điểm số chất lượng cuộc sống cao nhất ở lĩnh vực sức khỏe thể chất (15,4 ± 2,6) và mức độ độc lập (15,4 ± 2,4), thấp nhất ở lĩnh vực quan hệ xã hội (13,4 ± 2,1). Giới tính, nghề nghiệp, trình độ học vấn và sống chung với người khác là các yếu tố liên quan đến các lĩnh vực cụ thể của chất lượng cuộc sống của người nhiễm HIV. Nam giới, trình độ học vấn thấp hơn làm tăng điểm số lĩnh vực niềm tin cá nhân; Thất nghiệp là yếu tố làm giảm chất lượng cuộc sống ở nhiều lĩnh vực; Sống chung với người khác là yếu tố làm cải thiện điểm số ở lĩnh vực sức khỏe tinh thần.
Tạp chí nghiên cứu Y học
Tạp chí Y học dự phòng
P Todd Korthuis, Caroline King, Ryan R Cook, Tong Thi Khuyen, Lynn E Kunkel, Gavin Bart, Thuan Nguyen, Dinh Thanh Thuy, Sarann Bielavitz, Diep Bich Nguyen, Nguyen Thi Minh Tam, Le Minh Giang
Drug Alcohol Depend
J Interpers Violence
J Subst Abuse Treat
BMC Public Health
Social Science & Medicine
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