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Ardman E, Brown PC, Thuy DTT, Hang NT, Mai PP, Bart G, Hoffman K, Korthuis PT, Giang LM. Patient-provider relationships: Opioid use disorder and HIV treatment in Vietnam. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 7:100151. [PMID: 37082138 PMCID: PMC10111938 DOI: 10.1016/j.dadr.2023.100151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 04/04/2023]
Abstract
Background The provider-patient relationship has been implicated as a positive force in health outcomes. This study examined the provider-patient relationship in the setting of integrated, partially-integrated, and non-integrated opioid use disorder (OUD) and HIV care models in Vietnam. Objective To examine the provider-patient relationship in the setting of integrated, partially integrated, and non-integrated OUD and HIV treatment in North Vietnam. Methods Between 2013 and 2018, we conducted face-to-face qualitative interviews with 44 patients living with HIV and OUD and 43 providers in northern Vietnam. These were analyzed using a semantic, inductive approach to qualitative thematic analysis. Results Several themes were identified. 1) Trust was important to the patient-provider relationship and sensitive to provider attitudes and competence. 2) Patients perceived greater provider competence and understanding of patient health problems in integrated treatment. 3) Patient-provider relationships were initially superficial but deepened over time, facilitated by continuity of care. Conclusions Patient perceptions of competence and respect were important to feeling cared for. Providers felt empathy and competence came with more experience caring for patients with OUD and HIV.
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Affiliation(s)
- Eric Ardman
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- Corresponding author.
| | - Patrick C.M. Brown
- Oregon Health & Science University School of Medicine, Portland, Oregon, USA
| | - Dinh Thi Thanh Thuy
- Center for Training and Research on Substance Abuse – HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Thu Hang
- Center for Training and Research on Substance Abuse – HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Pham Phuong Mai
- Center for Training and Research on Substance Abuse – HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Gavin Bart
- University of Minnesota and Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Kim Hoffman
- Portland State University-Oregon Health & Science University School of Public Health, Portland, Oregon, USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - P Todd Korthuis
- Portland State University-Oregon Health & Science University School of Public Health, Portland, Oregon, USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Le Minh Giang
- Center for Training and Research on Substance Abuse – HIV, Hanoi Medical University, Hanoi, Vietnam
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Prevalence of mental disorders among people with opioid use disorder: A systematic review and meta-analysis. Drug Alcohol Depend 2022; 238:109551. [PMID: 35797876 DOI: 10.1016/j.drugalcdep.2022.109551] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/12/2022] [Accepted: 06/26/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Opioid use disorder (OUD) and mental disorders are major public health issues and comorbidity is common. Among people with OUD, comorbid mental disorders are associated with poorer health outcomes. To our knowledge, this is the first systematic review and meta-analysis to estimate prevalence of specific mental disorders among people with OUD. METHODS We searched Embase, MEDLINE, and PsycInfo from 1990 to 2021 for observational studies of depression, anxiety, post-traumatic stress disorder (PTSD), bipolar, personality, and other pre-specified mental disorders among people with OUD. We pooled current and lifetime estimates of each disorder using random-effects meta-analyses with 95% Confidence Intervals (CIs). Meta-regressions and stratified analyses were used to assess heterogeneity of prevalence estimates by methodological factors and sample characteristics. FINDINGS Of the 36,971 publications identified, we included data from 345 studies and 104,135 people with OUD in at least one pooled estimate. Among people with OUD, the prevalence of current depression was 36.1% (95%CI 32.4-39.7%), anxiety was 29.1% (95%CI 24.0-33.3%), attention-deficit/hyperactivity disorder was 20.9% (95%CI 15.7-26.2%), PTSD was 18.1% (95%CI 15.4-20.9%), and bipolar disorder was 8.7% (95%CI 6.7-10.7%). Lifetime prevalence of anti-social personality disorder was 33.6% (95%CI 29.1-38.0%) and borderline personality disorder was 18.2% (95% CI 13.4-23.1%). Sample characteristics and methodological factors, including sex, were associated with variance of multiple prevalence estimates. INTERPRETATION Our findings emphasise the need for access to mental disorder treatment among people with OUD. Specific mental disorder estimates may inform clinical guidelines, treatment services, and future research for people with OUD, including subpopulations with distinct treatment needs.
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Nguyen Thu T, Dinh TTT, Nguyen Bich D, Hoffman K, Nguyen Thu H, Edsall A, Bart G, Korthuis PT, Le Minh G. Stigma as a barrier to integrated substance use and HIV care in Vietnam: A qualitative examination of patient and provider perspectives. J Ethn Subst Abuse 2022; 23:182-197. [PMID: 35635379 PMCID: PMC9708927 DOI: 10.1080/15332640.2022.2080785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
| | | | | | - Kim Hoffman
- Oregon Health and Science University, Portland, Oregon
| | | | | | - Gavin Bart
- Hennepin Healthcare and University of Minnesota, Minneapolis, Minnesota
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Brown PCM, Thuy DTT, Edsall A, Hang NT, Mai PP, Hoffman K, Bart G, Korthuis PT, Giang LM. Familial support in integrated treatment with antiretroviral therapy and medications for opioid use disorder in Vietnam: A qualitative study. Subst Abus 2022; 43:1004-1010. [PMID: 35435799 PMCID: PMC9678077 DOI: 10.1080/08897077.2022.2060435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
| | | | - Andrew Edsall
- Oregon Health & Science University School of Medicine
| | | | | | - Kim Hoffman
- Portland State University-Oregon Health & Science University School of Public Health, Portland, OR
| | - Gavin Bart
- University of Minnesota Medical School and Hennepin Healthcare
| | - P. Todd Korthuis
- Oregon Health & Science University School of Medicine,Portland State University-Oregon Health & Science University School of Public Health, Portland, OR
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Hoffman KA, Baker R, Fanucchi LC, Lum PJ, Kunkel LE, Ponce Terashima J, McCarty D, Jacobs P, Korthuis PT. Perspectives on extended-release naltrexone induction among patients living with HIV and opioid use disorder: a qualitative analysis. Addict Sci Clin Pract 2021; 16:67. [PMID: 34758887 PMCID: PMC8579672 DOI: 10.1186/s13722-021-00277-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The CHOICES study randomized participants with HIV and opioid use disorder (OUD) to HIV clinic-based extended-release naltrexone (XR-NTX), which requires complete cessation of opioid use, versus treatment-as-usual (i.e., buprenorphine, methadone). Study participants randomized to XR-NTX were interviewed to assess their experiences with successful and unsuccessful XR-NTX induction. METHODS Semi-structured qualitative interviews were completed with a convenience sample of study participants with HIV and OUD (n = 37) randomized to XR-NTX in five HIV clinics between 2018 and 2019. All participants approached agreed to be interviewed. Interviews were digitally recorded, professionally transcribed, and analyzed using thematic analysis. RESULTS Participants included women (43%), African Americans (62%) and Hispanics (16%), between 27 to 69 years of age. Individuals who completed XR-NTX induction (n = 20) reported experiencing (1) readiness for change, (2) a supportive environment during withdrawal including comfort medications, and (3) caring interactions with staff. Four contrasting themes emerged among participants (n = 17) who did not complete induction: (1) concern and anxiety about withdrawal including past negative experiences, (2) ambivalence about or reluctance to stop opioids, (3) concerns about XR-NTX effects, and (4) preferences for other medications. CONCLUSIONS The results highlight opportunities to improve initiation of XR-NTX in high-need groups. Addressing expectations regarding induction may enhance XR-NTX initiation rates. Trial Registration ClinicalTrials.gov: NCT03275350. Registered September 7, 2017. https://clinicaltrials.gov/ct2/show/NCT03275350?term=extended+release+naltrexone&cond=Opioid+Use .
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Affiliation(s)
- Kim A Hoffman
- Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA.
| | - Robin Baker
- Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA
| | | | - Paula J Lum
- Department of Medicine, Division of HIV, ID & Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Lynn E Kunkel
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Dennis McCarty
- Department of Medicine, Division of HIV, ID & Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Petra Jacobs
- National Institute on Drug Abuse, Center for the Clinical Trials Network, North Bethesda, MD, USA
| | - P Todd Korthuis
- Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA.,Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
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