Impact of a methadone maintenance therapy pilot in Vietnam and its role in a scaled-up response
Tóm tắt
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. The objectives of the pilot were to provide evidence on whether MMT could be successfully implemented in Vietnam and scaled up to other localities. A 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. Twenty-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 %. Study 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.
Tài liệu tham khảo
Mattic RP, Breen C, Kimber J, Davoli M, Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009;3:CD002209.
Uhlmann S, Milloy M-J, Kerr T, Zhang R, Guillemi S, Marsh, D, et al. Methadone maintenance therapy promotes initiation of antiretroviral therapy among injection drug users. Addiction. 2010;105(5):907–13.
Langendam MW, van Brussel, GHA, Coutinho RA, van Ameijden, EJC, et al. The impact of harm-reduction-based methadone treatment on mortality among heroin users. Am J Public Health. 2001;91(5):774–80.
Gowing L, Farrell M, Bornemann R, Ali R, (2008) Substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database of Syst Rev, doi:10.1002/14651858.CD004145.pub3.
Connock M, Juarez-Garcia A, Jowett S, Frew E, Liu Z, Taylor RJ, et al. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technol Assess. 2007;11(9):1–171.
Hien NT, Giang LT, Binh PN, Deville W, Van Ameijden EJC, Wolffers I. Risk factors of HIV infection and needle sharing among injecting drug users in Ho Chi Minh City, Vietnam. J Subst Abuse. 2001;13(1–2):45–58.
Lindan CP, Lieu TX, Giang LT, Lap VD, Thuc NV, Thinh T, et al. Rising HIV infection rates in Ho Chi Minh City herald emerging AIDS epidemic in Vietnam. AIDS. 1997;11 Suppl 1:S5–13.
Chung A, Vu MQ, Dondero TJ. HIV epidemiologic situation in Vietnam: a review of available data. AIDS. 1998;12(Suppl B):S43–9.
Nguyen TA, Hoang LT, Pham VQ, Detels R. Risk factors for HIV-1 seropositivity in drug users under 30 years old in Haiphong, Vietnam. Addiction. 2001;96(3):405–13.
Nguyen TH, Wolffers I. HIV infection in Vietnam. Lancet. 1994;343(8894):410.
Vietnam Ministry of Health, FHI360, HIV/STI integrated behavioral and biological surveillance in Vietnam 2006, 2007. Available at: http://www.aidsdatahub.org/sites/default/files/documents/Results_from_the_2006_Integrated_Biological_and_Behavioral_Survey_IBBS_2005_06_Report.pdf.pdf
MOLISA. Overview of the impact of policies on drug rehabilitation treatment on its implementation in Vietnam. Ministry of Labor, Invalids, and Social Affairs of Vietnam, Hanoi, 2010.
Nguyen VT, Scannapieco M. Drug abuse in Vietnam: a critical review of the literature and implications for future research. Addiction. 2008;103(4):535–43.
Nguyen TH, Le TG, Phan NB, Wolffers I. The social context of HIV risk behaviour by drug injectors in Ho Chi Minh City, Vietnam. AIDS Care. 2000;12(4):483–95.
Quan VM, Chung A, Long HT, Dondero TJ. HIV in Vietnam: the evolving epidemic and the prevention response, 1996 through 1999. J Acquir Immune Defic Syndr. 2000;25(4):360–9.
Vuong T, Ali R, Baldwin S, Mills S. Drug policy in Vietnam: a decade of change?, Int J Drug Policy. 2011;23(4):319–26.
Metzger DS, Woody GE, McLellan AT, O'Brien CP, Druley P, Navaline H, et al. Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: an 18-month prospective follow-up. J Acquir Immune Defic Syndr. 1993;6(9):1049–56.
Pang L, Hao Y, Mi G, Wang C, Luo W, Rou K, et al. Effectiveness of first eight methadone maintenance treatment clinics in China. AIDS. 2007;21 Suppl 8:S103–7.
Camacho LM, Bartholomew NG, Joe GW, Simpson DD. Maintenance of HIV risk reduction among injection opioid users: a 12 month posttreatment follow-up. Drug Alcohol Depend. 1997;47(1):11–8.
Kwiatowski CF, Booth RE. Methadone maintenance as HIV risk reduction with street-recruited injecting drug users. J Acquir Immune Defic Syndr. 2001;26(5):483–9.
Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998;28(3):551–8.
Hsiung P-C, Fang C-H, Sheng W-H, Chen S-C, Wang J-D, Yao G. Validation of the WHOQOL-HIV BREF among HIV-infected patients in Taiwan. AIDS Care. 2011;23(8):1035–42.
Saddki N, Noor MN, Norbanee MA, Rusli Z, Norzila S, Zaharah A. et al. Validity and reliability of the Malay version of WHOQOL-HIV BREF in patients with HIV infection. AIDS Care. 2009;21(10):1271–8.
Homish GH, Edwards EP, Eiden RD, Leonard KE. Analyzing family data: a GEE approach for substance use researchers. Addict Behav. 2010;35(6):558–63.
Caplehorn JRM, Bell J, Kleinbaum DG, Gebski VJ. Methadone dose and heroin use during maintenance treatment. Addiction. 1993;88(1):119–24.
Rhoades HM, Creson D, Elk R, Schmitz J, Grabowski J. Retention, HIV risk, and illicit drug use during treatment: methadone dose and visit frequency. Am J Public Health. 1998;88(1):34–9.
Best D, Gossop M, Stewart D, Marsden J, Lehmann P, Strang J. Continued heroin use during methadone treatment: relationships between frequency of use and reasons reported for heroin use. Drug Alcohol Depend. 1999;53(3):191–5.
Dobler-Mikola A, Hattenschwiler J, Meili D, Beck T, Boni E, Modestin J. Patterns of heroin, cocaine, and alcohol abuse during long-term methadone maintenance treatment. J Subst Abuse Treat. 2005;29(4):259–65.
Roux P, Carrieri PM, Cohen J, Ravaux I, Spire B, Gossop M, et al. Non-medical use of opioids among HIV-infected opioid dependent individuals on opioid maintenance treatment: the need for a more comprehensive approach. Harm Reduct J. 2011;8:31.
Cao XB, Yin WY, Pang L, Zhang CB, Xu JS, Xiao YK, et al. Risk factors which were associated with heroin use during the methadone maintenance treatment among 1301 patients in 9 cities of China. Zhonghua Liu Xing Bing Xue Za Zhi. 2010;31(3):269–72.
Cruber VA, McCance-Katz EF. Methadone, buprenorphine, and street drug interactions with antiretroviral medications. Curr HIV/AIDS Rep. 2010;7(3):152–60.
Faggiano F, Vigna-Taglianti, Versino E, Lemma P. Methadone maintenance at different dosages for opioid dependence. Cochrane Database Syst Rev. 2003;3, CD002208.
Li L, Sangthong R, Chongsuvivatwong, McNeil E, Li J, Multiple substance use among heroin-dependent patients before and during attendance at methadone maintenance treatment program, Yunnan, China. Drug Alcohol Depend. 2011;116(1–3):246–9.
Raistrick D, Hay A, Wolff K. Methadone maintenance and tuberculosis treatment. BMJ. 1996;313(7062):925–6.
Deiss RG, Rodwell TC, Garfein RS. Tuberculosis and illicit drug use: review and update. Clin Infect Dis. 2009;48(1):72–82.
Wong K-H, Lee S-S, Lim W-L, Low H-K, Adherence to methadone is associated with a lower level of HIV-related risk behaviors in drug users. J Subst Abuse Treat. 2003;24(3):233–9.