J Ethn Subst Abuse
Integration of substance use disorder (SUD) treatment and HIV care can increase antiretroviral therapy coverage among people with opioid use disorder (OUD). However, implementation of integrated treatment models remains limited. Stigma towards people with OUD poses a barrier to initiation of, and adherence to, HIV treatment. We sought to understand the extent of stigma towards SUD and HIV among people with OUD in Vietnam, and the effect of stigma on integrated OUD and HIV treatment services utilization. Between 2013 and 2015, we conducted in-depth interviews with 43 patients and 43 providers at 7 methadone clinics and 8 HIV clinics across 4 provinces in Vietnam. We used thematic analysis with a mixed deductive and inductive approach at the semantic level to analyze key topics. Two main themes were identified: (1) Confidentiality concerns about HIV status make patients reluctant to receive integrated care at HIV clinics, given the requirements for daily buprenorphine dosing at HIV clinics. (2) Provider stigma existed mostly toward people with OUD and seemed to center on the belief that substance use causes a deterioration in one’s morals, and was most frequently manifested in the form of providers’ apprehensive approach towards patients. Concerns regarding stigmatization may cause patients to feel reluctant to receive treatment for both OUD and HIV at a single integrated clinic. Interventions to reduce stigma at the clinic and policy levels may thus serve to improve initiation of and adherence to integrated care
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
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
Drugs: Education, Prevention and Policy
Journal of Behavioral Health Services & Research
This study aimed to describe mental health service utilization and examine associated factors among students in Vietnam. Data were collected at eight universities in Hanoi, Vietnam, in 2018 using an administered questionnaire. The total number of participants was 9,120 (95.1% response rate). Among stu dents participating in our survey, 12.5% (95% CI: 10.9–14.1) with depression and/or anxiety symptoms used mental health service in the last 12 months. In the multivariable regression models, significant factors associated with mental health ser vice utilization were marital status, types of housemate, men tal health problems, physical activity, smoking status, and alcohol drinking. Our study made recommendations to stake holders for improving mental health services utilization among students in Vietnam. These findings had important implica tions for future research on factors associated with mental health service utilization among university students.
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