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Hall NY, Le L, Abimanyi-Ochom J, Teesson M, Mihalopoulos C. Identifying the most common barriers to opioid agonist treatment in an Australian setting. Aust J Prim Health 2023; 29:445-454. [PMID: 36934460 DOI: 10.1071/py22269] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/20/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Opioid use disorder is a public health concern in Australia. Opioid agonist treatment (OAT) is effective at treating and minimising harm from opioid use disorder, yet is underused in Australia due to client barriers. Although these barriers have been reported, the barriers that are most important to clients is unclear. The aim of this paper was to determine the most important OAT barriers to Australian clients. METHODS A cross-sectional, self-completed survey was given to 204 opioid-dependent clients who attended needle and syringe sites in Australia. Participants were given 15 OAT barrier statements, which they answered using a 5-point Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree and 5=strongly agree). The Likert scale data are presented using the count method and the mean Likert scores (for the whole sample and for subgroups). RESULTS The two methods determined that the four most important barriers to OAT were stigma, lack of support services, no flexibility and enjoy using opioids. Furthermore, those who used prescription opioids (compared with heroin) were female or non-binary (compared with male), were not currently using OAT (compared with current OAT), were younger (compared with older) and had high dependence scores (compared with low dependence scores) were impacted more by certain OAT barriers. CONCLUSIONS Policies around improving support services, reducing stigma and increasing flexibility would be beneficial to reduce barriers to OAT in Australia. Second, certain groups were more vulnerable to OAT barriers, emphasising the importance to better tailor opioid treatment programs to these specific populations to increase treatment engagement.
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Affiliation(s)
- Natasha Yvonne Hall
- School of Health and Social Development, Deakin University, Burwood, Vic., Australia
| | - Long Le
- Public Health and Preventative Medicine, Monash University, Melbourne, Vic., Australia
| | - Julie Abimanyi-Ochom
- School of Health and Social Development, Deakin University, Burwood, Vic., Australia
| | - Maree Teesson
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Cathy Mihalopoulos
- Public Health and Preventative Medicine, Monash University, Melbourne, Vic., Australia
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2
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Kilonzo SB, Gunda DW, Majinge DC, Jaka H, Manyiri PM, Kalokola F, Mtui G, Shao ER, Bakshi FA, Stephano A. Seroprevalence of hepatitis B virus infection, anti-HCV antibodies and HIV and knowledge among people who use drugs attending methadone therapy clinic in Tanzania; a cross-sectional study. BMC Infect Dis 2021; 21:699. [PMID: 34289801 PMCID: PMC8296674 DOI: 10.1186/s12879-021-06393-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/07/2021] [Indexed: 12/24/2022] Open
Abstract
Background Methadone therapy clinics have been recently introduced in Tanzania, aiming at reducing risk behaviors and infection rates of viral hepatitis and HIV among people who use drugs. The objective of this study was to estimate the prevalence, associated factors and knowledge level of these conditions among people who use drugs attending a methadone clinic in Tanzania. Methods We enrolled 253 People who using drugs receiving Methadone therapy. Clinical data was retrospectively collected from the medical records and face-to face interviews were conducted to determine the behavioral risk factors and respondents’ knowledge on viral hepatitis and HIV. Results An overall seroprevalence of viral hepatitis (either hepatitis B surface antigen or anti-hepatitis C virus) was 6.3%, while that of hepatitis B virus mono infection was 3.5% and anti-hepatitis C antibodies was 3.5%. Seroprevalence of HIV was 12.6%. Viral hepatitis was strongly predicted by advanced age (> 35 years) (p = 0.02) and staying at Kirumba area (p = 0.004), and HIV infection was predicted by increased age (> 37 years) (p = 0.04) and female sex (p < 0.001). Regarding the knowledge of viral hepatitis, majority of the respondents were unaware of the transmission methods and availability of hepatitis B virus vaccines and only 17% were classified as well informed (provided ≥4 correct answers out of 7 questions). Good knowledge was highly predicted by higher education level of the individual (p = 0.001). Conclusions Despite the efforts to curb viral hepatitis and HIV infections through Methadone clinics, infection rates among people who use drugs are still high and the general knowledge on preventive measures is inadequate.
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Affiliation(s)
- Semvua B Kilonzo
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania. .,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania.
| | - Daniel W Gunda
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - David C Majinge
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - Hyasinta Jaka
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - Paulina M Manyiri
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - Fredrick Kalokola
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.,Department of Medicine, Bugando Medical Center, P.O Box 1370, Mwanza, Tanzania
| | - Grahame Mtui
- Department of Medicine, Sekou Toure Regional Referral Hospital, P.O Box 132, Mwanza, Tanzania
| | - Elichilia R Shao
- Department of Medicine Kilimanjaro Christian University College, P.O Box 2240, Moshi, Tanzania
| | - Fatma A Bakshi
- Department of Medicine, Aga Khan Hospital, P.O Box 2289, Dar es Salaam, Tanzania
| | - Alex Stephano
- Department of Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania
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3
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Huang CL, Tsai IJ, Lin WC, Ho IK, Wang RY, Lee CWS. Augmentation in Healthcare Utilization of Patients with Opioid Use Disorder After Methadone Maintenance Treatment: A Retrospective Nationwide Study. Adv Ther 2021; 38:2908-2919. [PMID: 33559050 DOI: 10.1007/s12325-021-01633-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The health benefits of entering methadone maintenance treatment (MMT) for opioid-dependent persons may not be merely limited to therapy of opioid use disorder. We aimed to compare the healthcare utilization of MMT patients before and after MMT. METHODS A retrospective analysis was performed using the Taiwan Illicit Drug Issue Database and the National Health Insurance Research Database (NHIRD) between 2014 and 2016. We included 1255 newly enrolled MMT patients in 2015 and randomly selected 5020 patients from NHIRD matched by age and gender as the comparison group. Changes in healthcare utilization 1 year before and 1 year after the date of the index date (MMT initiation) were compared within and between MMT and comparison groups. RESULTS During the 1-year period following MMT, the hospitalization length was considerably decreased, while the number of outpatient visits, emergency department (ED) visits, and ED expenditure significantly increased in MMT patients. Multivariable linear regression with the difference-in-difference approach revealed that all the categories of healthcare utilization increased, except for a minor increase of outpatient expenditure and a slight decrease of hospitalization length for the MMT group relative to the comparison group. Increases in utilization of the departments of psychiatry and infectious diseases of the MMT patients were considerable. CONCLUSION MMT is associated with increased healthcare utilization, and departments of psychiatry and infectious diseases play substantial roles. Policy-makers should warrant access for all who need healthcare by ensuring the availability of the treatment for drug dependence.
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Affiliation(s)
- Chieh-Liang Huang
- School of Medicine, China Medical University, Taichung, Taiwan
- Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County, Taiwan
| | - I-Ju Tsai
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Wen-Chi Lin
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ing-Kang Ho
- Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Ruey-Yun Wang
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Cynthia Wei-Sheng Lee
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan.
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.
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4
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Tsybina P, Kassir S, Clark M, Skinner S. Hospital admissions and mortality due to complications of injection drug use in two hospitals in Regina, Canada: retrospective chart review. Harm Reduct J 2021; 18:44. [PMID: 33882950 PMCID: PMC8061207 DOI: 10.1186/s12954-021-00492-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infectious complications of injection drug use (IDU) often require lengthy inpatient treatment. Our objective was to identify the number of admissions related to IDU in Regina, Canada, as well as describe patient demographics and comorbidities, yearly mortality, readmission rate, and cumulative cost of these hospitalizations between January 1 and December 31, 2018. Additionally, we sought to identify factors that increased risk of death or readmission. METHODS This study is a retrospective chart review conducted at the two hospitals in Regina. Eligible study cases were identified by querying the discharge database for predetermined International Classification of Diseases code combinations. Electronic medical records were reviewed to assess whether each admission met inclusion criteria, and hospitalization and patient data were subsequently extracted for all included admissions. Mortality data were gleaned from hospital and Ministry of Health databases. Data were analyzed using Excel and IBM SPSS Statistics to identify common comorbidities, admission diagnoses, and costs, as well as to compare patients with a single admission during the study period to those with multiple admissions. Logistic regression analysis was used to identify the relationship between individual variables and in- and out-of-hospital annual mortality. RESULTS One hundred and forty-nine admissions were included, with 102 unique patients identified. Common comorbidities included hepatitis C (47%), human immunodeficiency virus (HIV) (25%), and comorbid psychiatric disorders (19%). In 23% of all admissions, patients left hospital prior to treatment completion, and 27% of patients experienced multiple admissions. Female patients and those with chronic pain were more likely to be readmitted (p = 0.024 and p = 0.029, respectively). Patients admitted with infective endocarditis were more likely to die during hospitalization (p = 0.0001). The overall mortality was 15% in our cohort. The estimated cumulative cost of inpatient treatment of complications of IDU in Regina was $3.7 million CAD in 2018. CONCLUSION Patients with history of IDU and hospital admission experience high mortality rates in Regina, a city with paucity of inpatient supports for persons who use injection drugs. Needle syringe programs, opioid agonist therapy, and safe consumption sites have been shown to improve outcomes as well as reduce healthcare costs for this patient population. We will use our findings to advocate for increased access to these harm reduction strategies in Regina, particularly for inpatients.
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Affiliation(s)
- Polina Tsybina
- College of Medicine, Regina General Hospital, University of Saskatchewan, 1440 14th Avenue, Regina, SK, S4P 0W5, Canada.
| | - Sandy Kassir
- Research Department, Saskatchewan Health Authority, Regina, Canada
| | - Megan Clark
- Department of Family Medicine, University of Saskatchewan, Regina, Canada
| | - Stuart Skinner
- Department of Medicine, University of Saskatchewan, Regina, Canada
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Hall NY, Le L, Majmudar I, Mihalopoulos C. Barriers to accessing opioid substitution treatment for opioid use disorder: A systematic review from the client perspective. Drug Alcohol Depend 2021; 221:108651. [PMID: 33667783 DOI: 10.1016/j.drugalcdep.2021.108651] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To update the existing evidence to identify specific barriers to initiation of opioid substitution therapy (OST) for those with opioid use disorder (OUD). METHODS The review follows Preferred Reporting Items for Systematic Reviews andMeta-Analyses (PRISMA) guidelines. Six databases were initially searched in November 2019, with the search updated on 11 November 2020, for qualitative or quantitative studies reporting the barriers to initiating OST from the client with OUD perspective. Thematic analysis of the barriers to OST was undertaken to determine barrier themes and subthemes. RESULTS There were 37 studies included in the review; 18 were qualitative, 15 were quantitative and four were mixed methods. The barrier themes identified were stigma and fear, regulatory, logistical, attitudinal and social factors. Within these barrier themes 19 barrier subthemes were identified. The most reported OST barrier subthemes were negative treatment perceptions, cost, stigma and lack of flexibility. CONCLUSION This review discusses important barriers to OST and examines reported barriers from the client perspective. OST guidelines and programs would benefit by introducing programs that reduce stigma, increase treatment knowledge and health literacy, reduce treatment costs, increase treatment flexibility and allow for easier treatment access.
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Affiliation(s)
- Natasha Yvonne Hall
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Long Le
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Ishani Majmudar
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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6
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Kiriazova T, Go VF, Hershow RB, Hamilton EL, Sarasvita R, Bui Q, Lancaster KE, Dumchev K, Hoffman IF, Miller WC, Latkin CA. Perspectives of clients and providers on factors influencing opioid agonist treatment uptake among HIV-positive people who use drugs in Indonesia, Ukraine, and Vietnam: HPTN 074 study. Harm Reduct J 2020; 17:69. [PMID: 32998731 PMCID: PMC7528574 DOI: 10.1186/s12954-020-00415-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/16/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Opioid agonist treatment (OAT) is an effective method of addiction treatment and HIV prevention. However, globally, people who inject drugs (PWID) have insufficient OAT uptake. To expand OAT access and uptake, policymakers, program developers and healthcare providers should be aware of barriers to and facilitators of OAT uptake among PWID. METHODS As a part of the HPTN 074 study, which assessed the feasibility of an intervention to facilitate HIV treatment and OAT in PWID living with HIV in Indonesia, Ukraine, and Vietnam, we conducted in-depth interviews with 37 HIV-positive PWID and 25 healthcare providers to explore barriers to and facilitators of OAT uptake. All interviews were audio-recorded, transcribed, translated into English, and coded in NVivo for analysis. We developed matrices to identify emergent themes and patterns. RESULTS Despite some reported country-specific factors, PWID and healthcare providers at all geographic locations reported similar barriers to OAT initiation, such as complicated procedures to initiate OAT, problematic clinic access, lack of information on OAT, misconceptions about methadone, financial burden, and stigma toward PWID. However, while PWID reported fear of drug interaction (OAT and antiretroviral therapy), providers perceived that PWID prioritized drug use over caring for their health and hence were less motivated to take up ART and OAT. Motivation for a life change and social support were reported to be facilitators. CONCLUSION These results highlight a need for support for PWID to initiate and retain in drug treatment. To expand OAT in all three countries, it is necessary to facilitate access and ensure low-threshold, financially affordable OAT programs for PWID, accompanied with supporting interventions. PWID attitudes and beliefs about OAT indicate the need for informational campaigns to counter misinformation and stigma associated with addiction and OAT (especially methadone).
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Affiliation(s)
- Tetiana Kiriazova
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, 27, Kyiv, 04050 Ukraine
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina At Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599 USA
| | - Rebecca B. Hershow
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina At Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599 USA
| | - Erica L. Hamilton
- Science Facilitation Department, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC 27701 USA
| | - Riza Sarasvita
- Dr. Cipto Mangunkusumo National Central General Hospital, University of Indonesia, Jalan Pangeran Diponegoro No.71, Salemba, Senen, Jakarta Pusat, Daerah Khusus Ibukota, Jakarta, 10430 Indonesia
| | - Quynh Bui
- UNC Project Vietnam, Yen Hoa Health Clinic, Lot E2, Duong Dinh Nghe Street, Cau Giay District, Hanoi, Vietnam
| | - Kathryn E. Lancaster
- Division of Epidemiology, College of Public Health, The Ohio State University, 300-D Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Kostyantyn Dumchev
- Ukrainian Institute On Public Health Policy, 5 Biloruska Str., Office 20, 27, Kyiv, 04050 Ukraine
| | - Irving F. Hoffman
- Division of Infectious Diseases, School of Medicine, The University of North Carolina At Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC 27599 USA
| | - William C. Miller
- Division of Epidemiology, College of Public Health, The Ohio State University, 300-D Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210 USA
| | - Carl A. Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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7
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Casal B, Rodríguez-Míguez E, Rivera B. Measuring intangible cost-of-morbidity due to substance dependence: implications of using alternative preference-based instruments. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1039-1048. [PMID: 32419059 DOI: 10.1007/s10198-020-01196-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Drug and/or alcohol dependence (DAD) generates substantial costs to society. One of the main consequences of DAD is its negative impact on health-related quality of life (HRQoL). The main objective of this study is to analyse the impact of using EQ-5D-5L, SF-6DSG (SF-6D using standard-gamble as the preference-eliciting method) and SF-6DPG (SF-6D using a paired-gamble method), to estimate the HRQoL burden, attributable to DAD, within the cost-of-illness framework. METHODS A convenience sample of 109 patients with a diagnosis of substance use disorder was recruited. SF-6D and EQ-5D-5L were administered and then the utility scores were computed. The impact of employing different instruments to estimate the HRQoL burden was assessed by comparing the utility scores of patients and general population after controlling for sex and age through regression analysis. The analysis was reproduced for two subgroups of severity. RESULTS All instruments detect that DAD significantly affects the HRQoL. However, the estimated impact changes, according to the instrument used, whose pattern varies by severity group. Nonetheless, regardless of severity, SF-6DPG always estimates a higher or equal DAD burden than the other instruments considered. These results are compatible with the presence of the floor effect in SF-6DSG, the ceiling effect in EQ-ED-5L, and a smaller presence of both biases in SF-6DPG. CONCLUSIONS The SF-6DPG instrument emerges as a good candidate to avoid under-estimating intangible costs within the cost-of-illness framework. However, further research is needed to assess the validity of our results in the context of other health problems.
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Affiliation(s)
- Bruno Casal
- Department of Economics, University of A Coruña, Campus de Elviña, 15071, A Coruña, Spain
| | - Eva Rodríguez-Míguez
- Department of Applied Economics, University of Vigo, Campus As Lagoas-Marcosende, 36310, Vigo, Spain
| | - Berta Rivera
- Department of Economics, University of A Coruña, Campus de Elviña, 15071, A Coruña, Spain.
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8
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Rodríguez-Míguez E, Casal B, Rivera B. Measuring health-related quality of life in patients treated for substance dependence: differences among instruments and methods of eliciting preferences. Expert Rev Pharmacoecon Outcomes Res 2020; 21:683-690. [PMID: 32744467 DOI: 10.1080/14737167.2020.1804872] [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: 10/23/2022]
Abstract
BACKGROUND Measuring the health-related quality of life is an essential estimation in cost-utility studies. In this research, we provide new evidence about comparing utility scores - in the field of substance dependence. Although the main objective is to compare the EQ-5D-5L and SF-6D with paired gamble, evidence about the SF-6D with standard gamble is also provided. METHODS Ninety-four patients with substance dependence were recruited; the SF-6D and the EQ-5D-5L were administered at the beginning of treatment and 6 months thereafter. Differences in treatment effect were estimated by comparing utility gains. All analyses were reproduced for two subgroups of severity. RESULTS Both the baseline scores and the treatment effect are sensitive to the instrument used. For severe states, the SF-6D with paired gamble (SF-6D with standard gamble) estimates the lowest (highest) utility. With regard to the impact of treatment, the EQ-5D-5L and SF-6D with paired gamble estimate strongly similar effects for severe states (and both estimate greater effects than does the SF-6D with standard gamble). CONCLUSIONS These findings have implications for cost-utility analyses. The incremental cost-utility ratio of treatments intended for severe states is barely sensitive to the choice of EQ-5D-5L or SF-6D with paired gamble.
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Affiliation(s)
- Eva Rodríguez-Míguez
- Department of Applied Economics,Group of Research in Empirical Economics (GRiEE), ECOBAS, University of Vigo, Vigo, Spain.,South Galicia Biomedical Foundation, University Hospital of Vigo, Vigo, Spain
| | - Bruno Casal
- Department of Economics, University of A Coruña, A Coruña, Spain
| | - Berta Rivera
- Department of Economics, University of A Coruña, A Coruña, Spain
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9
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Le TA, Nguyen TA, Dang AD, Nguyen CT, Phan HT, Vu GT, Nguyen THT, Latkin CA, Ho CSH, Ho RCM, Tran BX, Ying J, Zhang MWB. Preferences for methadone clinics among drug users in Vietnam: a comparison between public and private models. Harm Reduct J 2020; 17:1. [PMID: 31906957 PMCID: PMC6945541 DOI: 10.1186/s12954-019-0355-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/27/2019] [Indexed: 12/02/2022] Open
Abstract
Background Methadone maintenance treatment (MMT) has been proven to be effective in treating opioid dependence. In Vietnam, MMT services are provided primarily by public clinics, with only one private MMT clinic established in recent years. Assessing the preferences of patients for different MMT models is important in evaluating the feasibility of these models. This study measured the preferences of drug users enrolling in public and private MMT clinics in Vietnam and examines the related factors of these preferences. Methods A cross-sectional study was performed on 395 participants at 3 methadone clinics in Nam Dinh. Data about the preferences for MMT models and sociodemographic characteristics of participants were collected. Exploratory factor analysis was employed to explore the construct validity of the questionnaire. The chi-square test and Mann-Whitney test were used for analyzing demographic characteristics and preferences of participants. Multivariate logistic regression identified factors associated with participants’ preferences. Results Half the participants received MMT treatment in a private facility (49.4%). Two preference dimensions were defined as “Availability and convenience of service” and “Competencies of clinic and health professionals”. Self-employed patients were more likely to consider these two dimensions when choosing MMT models. Only 9.9% of participants chose “Privacy” as one of the evaluation criteria for an MMT facility. Compared to public clinics, a statistically higher percentage of patients in the private clinic chose the attitudes of health workers as the reason for using MMT service (34.7% and 7.6% respectively). Mean score of satisfaction towards MMT services was 8.6 (SD = 1.0), and this score was statistically higher in a public facility, compared to the private facility (8.7 and 8.4 respectively). Conclusions The study highlighted patterns of patient preferences towards MMT clinics. Compared to the public MMT model, the private MMT model may need to enhance their services to improve patient satisfaction.
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Affiliation(s)
- Tuan Anh Le
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.,Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Anh Duc Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
| | - Hai Thanh Phan
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Trang Huyen Thi Nguyen
- Center of Excellence in Pharmacoeconomics and Management, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jiangbo Ying
- National Psychiatry Residency Program, National Healthcare Group, Singapore, Singapore
| | - Melvyn W B Zhang
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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10
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Chang KC, Lee KY, Lu TH, Hwang JS, Lin CN, Ting SY, Chang CC, Wang JD. Opioid agonist treatment reduces losses in quality of life and quality-adjusted life expectancy in heroin users: Evidence from real world data. Drug Alcohol Depend 2019; 201:197-204. [PMID: 31247504 DOI: 10.1016/j.drugalcdep.2019.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND This study estimated the long-term changes of opioid agonist treatment (OAT) in quality of life (QOL) and quantified the quality-adjusted life years (QALY) from the loss of quality-adjusted life expectancy (QALE) in heroin users. METHODS A total of 1283 heroin users stratified by OAT were linked to the National Mortality Registry for 8 years (2006-2014) to obtain survival functions, which were extrapolated to lifetime by applying a rolling extrapolation algorithm to survival ratio between the sub-cohorts and age- and sex-matched referents simulated from vital statistics of Taiwan. We performed cross-sectional measurement of EQ-5D on 349 participants, including those with a valid state of OAT or non-OAT plus newly recruited consecutive patients, during 2015-2017 for utility values, while the QOL of referents were abstracted from the 2009 National Health Interview Survey. The QALE was calculated by summing the products of the mean QOL and survival rate throughout life. The QALE difference between the cohort and corresponding referents was the loss-of-QALE. RESULTS QOL of the OAT group was significantly better than that of the non-OAT group in every domain of the EQ-5D, which was quantified to be 0.23 for utility after controlling for other variables. After extrapolation to 70 years, the estimated QALE and loss-of-QALE were 17.8 and 18.2 QALY for OAT subjects, respectively, while those of the non-OAT group were 9.2 and 27.9 QALY. CONCLUSIONS Receiving OAT could reduce QALE lost by 9.7 QALYs compared with non-OAT after accounting for QOL differences along time and different age and sex distributions.
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Affiliation(s)
- Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, 539 Yuzhong Rd., Rende Dist., Tainan 71742, Taiwan; Department of Public Health College of Medicine, National Cheng Kung University, 1 University Rd., East Dist., Tainan 701, Taiwan.
| | - Kuan-Ying Lee
- Jianan Psychiatric Center, Ministry of Health and Welfare, 539 Yuzhong Rd., Rende Dist., Tainan 71742, Taiwan.
| | - Tsung-Hsueh Lu
- Department of Public Health College of Medicine, National Cheng Kung University, 1 University Rd., East Dist., Tainan 701, Taiwan.
| | - Jing-Shiang Hwang
- Institute of Statistical Science, Academia Sinica, 128 Academia Road, Section 2, Taipei 11529, Taiwan.
| | - Chia-Ni Lin
- Department of Public Health College of Medicine, National Cheng Kung University, 1 University Rd., East Dist., Tainan 701, Taiwan.
| | - Shuo-Yen Ting
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, 161 YuPin Rd., Caotun Township, Nantou 542, Taiwan.
| | - Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, 901 Zhonghua Rd., Yongkang Dist., Tainan 71004, Taiwan; Department of Health Psychology, Chang Jung Christian University, No.1, Changda Rd., Gueiren District, Tainan 71101, Taiwan.
| | - Jung-Der Wang
- Department of Public Health College of Medicine, National Cheng Kung University, 1 University Rd., East Dist., Tainan 701, Taiwan; Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, 138 ShengLi Rd., North Dist., Tainan 704, Taiwan.
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11
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Changes in Substance Abuse and HIV Risk Behaviors over 12-Month Methadone Maintenance Treatment among Vietnamese Patients in Mountainous Provinces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132422. [PMID: 31288440 PMCID: PMC6651144 DOI: 10.3390/ijerph16132422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/21/2019] [Accepted: 07/04/2019] [Indexed: 11/16/2022]
Abstract
Methadone maintenance treatment (MMT) programs have been used worldwide to reduce the number of drug users and for HIV prevention; however, evidence of their effectiveness in mountainous areas is limited. This study aimed to identify changes in substance abuse and sexual practices among MMT patients after treatment in three Vietnamese mountainous provinces. A survey on risk behaviors was conducted among 300 drug users in six MMT clinics prior to and following one year of MMT. Cramér's effect size of changes was extrapolated to justify the magnitude of the intervention's effectiveness. A generalized estimation equation was used to find the factors associated with respondents' substance use and sexual risk behavior. While drug-related risk behaviors were significantly reduced, alcohol and sex-related behaviors remained risk factors for HIV in this group. Additionally, condom use was common among participants at both time points, but not among those having sex with sex workers. Socio-economic characteristics of ethnic, education, occupation, as well as drug use history influenced the possibility of engaging in drug use and/or sexual risk behavior following treatment. Further emphasis on managing these among MMT patients is required, potentially by providing integrated services including smoking and drinking counseling and condom use promotion in accordance with MMT.
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Grall-Bronnec M, Laforgue EJ, Challet-Bouju G, Cholet J, Hardouin JB, Leboucher J, Guillou-Landréat M, Victorri-Vigneau C. Prevalence of Coaddictions and Rate of Successful Treatment Among a French Sample of Opioid-Dependent Patients With Long-Term Opioid Substitution Therapy: The OPAL Study. Front Psychiatry 2019; 10:726. [PMID: 31681038 PMCID: PMC6812413 DOI: 10.3389/fpsyt.2019.00726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/10/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Opioid use disorder (OUD) is a worldwide major health concern due to increased early mortality and morbidity. Opioid substitution therapy (OST) is approved in the context of a global OUD treatment (OUDT), in conjunction with psychosocial interventions. Many factors can explain why unsuccessful treatment rates remain high. While the phenomenon of addiction switching is often proposed, it is not known whether this also includes gambling addiction. The primary objective of the OPAL study was to determine the prevalence of coaddictions, including problem gambling, among patients with OUDT. Secondary objectives were to assess the rate of unsuccessful OUDT and to characterize the associated factors. Methods: For this observational transversal multicenter study, patients with OUDT including OST for at least 6 months were recruited. Clinical assessment was based on a clinically structured interview and a set of self-reported questionnaires. Coaddictions were screened using the Fagerström, the CRAFFT, and the Lie/Bet questionnaires. Unsuccessful OUDT was defined as the persistence of opioid use and/or the worsening of another substance use or gambling practice. After a descriptive analysis, a multivariate analysis was performed to identify the factors associated with unsuccessful OUDT. Results: The sample consisted of 263 patients. Prevalence of coaddictions reached 97% of the sample. Problem gambling was associated with 10% of the patients. OUDT was considered as "unsuccessful" for 60% of the patients. Associated factors included having drug-using friends, psychiatric and professional negative consequences related to opioid use, more than one OST-prescribing physician, and impulsivity, especially high scores for lack of premeditation and sensation seeking. Conclusions: This study provides further evidence of the need to consider coaddictions and the usefulness of global addictive evaluations. Poor prognostic factors must alert the clinician to initiate more sustained care. Further implications are discussed.
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Affiliation(s)
- Marie Grall-Bronnec
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,HUGOPSY Network, Nantes, France
| | - Edouard-Jules Laforgue
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,Clinical Pharmacology Department, CHU Nantes, Nantes, France
| | - Gaëlle Challet-Bouju
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France.,INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France
| | - Jennyfer Cholet
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France
| | - Jean-Benoit Hardouin
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,Methodology and Biostatistic Department, DRCI, CHU Nantes, Nantes, France
| | - Juliette Leboucher
- Addictive Medicine and Psychiatry Department, CHU Nantes, Nantes, France
| | - Morgane Guillou-Landréat
- HUGOPSY Network, Nantes, France.,Addictive Medicine Department, CHU Brest, Brest, France.,Université de Bretagne Occidentale, ERCR SPURBO, Brest, France
| | - Caroline Victorri-Vigneau
- INSERM UMR 1246, SPHERE, Methods in Patient-Centered Outcomes and Health Research, Nantes and Tours University, Nantes, France.,Clinical Pharmacology Department, CHU Nantes, Nantes, France
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13
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Health-related work productivity loss is low for patients in a methadone maintenance program in Vietnam. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 60:1-7. [DOI: 10.1016/j.drugpo.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/17/2018] [Accepted: 07/15/2018] [Indexed: 01/01/2023]
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14
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Nghiem VT, Bui TC, Nadol PP, Phan SH, Kieu BT, Kling R, Hammett TM. Prevalence and correlates of HIV infection among men who inject drugs in a remote area of Vietnam. Harm Reduct J 2018; 15:8. [PMID: 29444685 PMCID: PMC5813411 DOI: 10.1186/s12954-018-0210-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/19/2018] [Indexed: 11/13/2022] Open
Abstract
Background Lack of information on the HIV epidemic among men who inject drugs (MWID) in northwestern Vietnam, a remote area, may hamper national efforts to control the disease. We examined HIV prevalence, needle–syringe sharing behaviors, and associated factors among MWID in three areas of northwestern Vietnam. Methods We used descriptive analysis to report the characteristics, frequency of risk behaviors, and of access to healthcare services among the MWID. Univariable logistic regression was used to assess the associations between the HIV infection, needle–syringe sharing behaviors, and their independent variables. We further explored these associations in multivariable analyses where we included independent variables based on a priori knowledge and their associations with the dependent variables determined in univariable analyses (p < 0.25). Results The HIV prevalence was 37.9, 16.9, and 18.5% for Tuan Giao, Bat Xat, and Lao Cai City, respectively, and 25.4% overall. MWID of Thai minority ethnicity were more likely to be HIV-positive (adjusted odds ratio (AOR) 3.55; 95% confidence interval (CI) 1.84–6.87). The rate of needle–syringe sharing in the previous 6 months was approximately 9% among the MWID in Tuan Giao and Lao Cai City, and 27.8% in Bat Xat. Two thirds of the participants never underwent HIV testing before this study. Ever having been tested for HIV before this study was not associated with any needle–syringe sharing behaviors. Among the HIV-positive MWID, those who received free clean needles and syringes were less likely to give used needles and syringes to peers (AOR 0.21; 95% CI 0.06–0.79). Going to a “hotspot” in the previous week was associated with increased odds of needle–syringe sharing in multiple subgroups. Conclusion Our findings on HIV prevalence and testing participation among a subset of MWID in the northwestern Vietnam were corroborated with trend analysis results from the most recent HIV/STI Integrated Biological and Behavioral Surveillance report (data last collected in 2013.) We provided important insights into these MWID’s risky injection behaviors. We suggest heightened emphasis on HIV testing and needle and syringe provision for this population. Also, policymakers and program implementers should target hotspots as a main venue to tackle HIV epidemics.
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Affiliation(s)
- Van T Nghiem
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, 77030, USA. .,Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA.
| | - Thanh C Bui
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Patrick P Nadol
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Hanoi, Vietnam
| | - Son H Phan
- International Health Division, Abt Associates, Bethesda, MD, 20814, USA
| | | | - Ryan Kling
- U.S. Health Division, Abt Associates, Cambridge, MA, 02138, USA
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15
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Khuong LQ, Vu TVT, Huynh VAN, Thai TT. Psychometric properties of the medical outcomes study: social support survey among methadone maintenance patients in Ho Chi Minh City, Vietnam: a validation study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2018; 13:8. [PMID: 29444687 PMCID: PMC5813430 DOI: 10.1186/s13011-018-0147-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/11/2018] [Indexed: 01/28/2023]
Abstract
Background Social support plays a crucial role in the treatment and recovery process of patients engaging in methadone maintenance treatment (MMT). However, there is a paucity of research about social support among MMT patients, possibly due to a lack of appropriate measuring tools. This study aimed to evaluate the psychometric properties of the Vietnamese version of the Medical Outcomes Study: Social Support Survey (MOS-SSS) among MMT patients. Methods A cross-sectional survey of 300 patients was conducted in a methadone clinic in Ho Chi Minh City, Vietnam. MMT patients who agreed to participate in the study completed a face-to-face interview in a private room. The MOS-SSS was translated into Vietnamese using standard forward-backward process. Internal consistency was measured by Cronbach’s alpha. The intra-class correlation coefficient was used to determine the test-retest reliability of the MOS-SSS in 75 participants two weeks after the first survey. Concurrent validity of the MOS-SSS was evaluated by correlations with the Multidimensional Scale of Perceived Social Support (MSPSS) and the Perceived Stigma of Addiction Scale (PSAS). Construct validity was investigated by confirmatory factor analysis. Results The MOS-SSS had good internal consistency with Cronbach’s alpha from 0.95 to 0.97 for the four subscales and 0.97 for the overall scale. The two-week test-retest reliability was at moderate level with intra-class correlation coefficients of 0.61–0.73 for the four subscales and 0.76 for the overall scale. Strong significant correlations between the MOS-SSS and the MSPSS (r = 0.77; p < 0.001) and the PSAS (r = − 0.76; p < 0.001) indicated good concurrent validity. Construct validity of the MOS-SSS was established since a final four-factor model fitted the data well with Comparative Fit Index (0.97), Tucker-Lewis Index (0.97), Standardized Root Mean Square Residual (0.03) and Root Mean Square Error of Approximation (0.068; 90% CI = 0.059–0.077). Conclusions The MOS-SSS is a reliable and valid tool for measuring social support in Vietnamese MMT patients. Further studies among methadone patients at different stages of their treatment and among those from different areas of Vietnam are needed. Electronic supplementary material The online version of this article (10.1186/s13011-018-0147-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Long Quynh Khuong
- Faculty of Public Health, Ho Chi Minh City University of Medicine and Pharmacy, 159 Hung Phu Street, Ward 8, District 8, Ho Chi Minh City, Vietnam
| | - Tuong-Vi Thi Vu
- South Vietnam HIV- Addiction Technology Transfer Center, Ho Chi Minh City University of Medicine and Pharmacy, 15th Floor, Central Building, 217 Hong Bang, Ward 11, District 5, Ho Chi Minh City, Vietnam
| | - Van-Anh Ngoc Huynh
- Faculty of Public Health, Ho Chi Minh City University of Medicine and Pharmacy, 159 Hung Phu Street, Ward 8, District 8, Ho Chi Minh City, Vietnam
| | - Truc Thanh Thai
- Faculty of Public Health, Ho Chi Minh City University of Medicine and Pharmacy, 159 Hung Phu Street, Ward 8, District 8, Ho Chi Minh City, Vietnam. .,Training and Scientific Research, University Medical Center, 215 Hong Bang Street, Ward 11, District 5, Ho Chi Minh City, Vietnam.
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16
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Lin C, Tuan NA, Li L. Commune Health Workers' Methadone Maintenance Treatment (MMT) Knowledge and Perceived Difficulties Providing Decentralized MMT Services in Vietnam. Subst Use Misuse 2018; 53:194-199. [PMID: 28704128 PMCID: PMC5758416 DOI: 10.1080/10826084.2017.1310248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND With the initial establishment of countrywide methadone maintenance therapy (MMT) system, Vietnam is in the process of expanding and decentralizing the MMT program to community-based healthcare settings. OBJECTIVE The study aimed to measure the MMT-related knowledge and perceived difficulties in treating patient who use drugs (PWUD) among community-based healthcare providers, e.g., commune health workers (CHW), and examine its correlated factors. METHODS A total of 300 CHW from 60 communes in two provinces of Vietnam completed a survey using Audio Computer-Assisted Self-Interview (ACASI) method. Twelve true-or-false questions were used to assess the CHW's MMT-related knowledge. The CHW's background characteristics and perceived difficulties treating PWUD were recorded. RESULTS The mean MMT knowledge score was 8.2 (SD = 1.2; range: 5-11). Misconceptions toward the benefits, procedure, and side effects of MMT were prevalent. The participants perceived varying degrees of difficulties in recruiting, engaging, and communicating with PWUD. With all covariates holding constant, younger age (standardized ẞ = -0.166; p = 0.0078) was associated with less MMT-related knowledge. Number of PWUD seen in a month and MMT-related knowledge was associated with less perceived difficulties treating PWUD. Conclusions/importance: The finding shed lights on the CHW's knowledge gap, which need to be addressed to facilitate the decentralization of MMT services in Vietnam. In preparation for a decentralized MMT service delivery model, specially designed training is warranted to equip CHW with knowledge and confidence to provide MMT-related services to PWUD.
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Affiliation(s)
- Chunqing Lin
- a Semel Institute for Neuroscience and Human Behavior, Center for Community Health , University of California , Los Angeles , California , USA
| | - Nguyen Anh Tuan
- b National Institute of Hygiene and Epidemiology , Hanoi , Vietnam
| | - Li Li
- a Semel Institute for Neuroscience and Human Behavior, Center for Community Health , University of California , Los Angeles , California , USA
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17
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Tran BX, Nguyen LH, Tran TT, Latkin CA. Social and structural barriers for adherence to methadone maintenance treatment among Vietnamese opioid dependence patients. PLoS One 2018; 13:e0190941. [PMID: 29346444 PMCID: PMC5773191 DOI: 10.1371/journal.pone.0190941] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 12/22/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Methadone maintenance treatment (MMT) services may reduce the risk of HIV transmission if patients completely adhere to the treatment. Identifying adherence patterns and potential related factors is vital for the sustainability of MMT program in Vietnam. This study examined social and structural factors associated with adherence to MMT among patients in different service delivery models. Materials and methods A total of 510 patients at three MMT clinics in Hanoi were interviewed. Measures of self-reported adherence included the number of missed doses in the past 7 days and the level of adherence in the past 30 days using a visual analog scale (VAS) scoring from 0 (non-adherence) to 100 (perfect adherence). Multivariate regressions were employed to identify factors associated with non-adherence to MMT. Results A total of 17.7% of participants reported incomplete MMT adherence in the last 30 days and 8.3% reported missing a dose in the last seven days, respectively. Living with HIV/AIDS, poor self-care and usual activities, and disclosure of health issues to spouses or intimate partners were associated with non-adherence. Those patients with pain or depression were more likely to report better adherence. Disclosing health status to spouse/partner increased the risk of incomplete adherence, while disclosing to friends reduced the number of missed dose in the last seven days. Patients attending clinics with comprehensive services had a lower VAS score of adherence compared to those enrolling in clinics with only MMT and general health care. Conclusions Sustaining the compliance of patients to MMT is principal in the rapid expansion of this service in Vietnam. It is necessary to address the complexity of health care demands of drug users, their difficulties to be rehabilitated into workforce and society, and the stigmatization to maximize the outcomes of MMT program.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail: ,
| | - Long Hoang Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tung Thanh Tran
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Carl A. Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Nong VM, Boggiano VL, Nguyen LHT, Nguyen CT, Nguyen LH, Xuan Bach T, Nguyen HV, Hoang CD, Latkin CA, Vu MTT. Ability to join the workforce and work productivity among drug users under methadone maintenance treatment in a mountainous area of Northern Vietnam: a cross-sectional study. BMJ Open 2017; 7:e016153. [PMID: 28751487 PMCID: PMC5642751 DOI: 10.1136/bmjopen-2017-016153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES A major measure of treatment success for drug users undergoing rehabilitation is the ability to enter the workforce and generate income. This study examines the absenteeism and productivity among people who inject drugs (PWID) enrolled in methadone maintenance treatment (MMT) in Northern Vietnam. SETTING We conducted a cross-sectional study in two clinics in Tuyen Quang province. PARTICIPANTS A total of 241 patients enrolled in MMT. PRIMARY AND SECONDARY OUTCOME MEASURES Patients' work productivity was measured using the WPAI-GH instrument (Work Productivity and Activity Impairment Questionnaire: General Health V2.0). We also collected additional characteristics about participants' employment history, such as proficient jobs, whether they actively found a new job and be accepted by employers. RESULTS Most of the participants (>90%) were employed at the time of the study. Rates of absenteeism (missed work), presenteeism (impairment while working) and overall loss of productivity were 15.8%, 5.6% and 11.2%, respectively, as measured by the WPAI-GH questionnaire. The most proficient job was 'freelancer' (17.5%), followed by 'blue-collar worker' (10.6%) and 'farmer' (10.2%). Only 26.8% of patients reported that they actively sought jobs in the past. About half of them had been refused by employers because of their drug use history and/or HIV status. We found no statistically significant difference between patients enrolled in MMT for <1 year and those who had been enrolled >1 year. Factors associated with higher work productivity included not endorsing problems in mobility, self-care or pain; being HIV-negative and having greater MMT treatment adherence. CONCLUSION Our study highlights the high employment rate and work productivity among PWID in MMT programmes in remote areas of Northern Vietnam. The results can help to improve the quality and structure of MMT programmes across Vietnam and in other countries.
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Affiliation(s)
- Vuong Minh Nong
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Victoria L Boggiano
- University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Lan Huong Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Long Hoang Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tran Xuan Bach
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Hung Van Nguyen
- Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Canh Dinh Hoang
- Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | - Carl A Latkin
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Minh Thuc Thi Vu
- Department of Immunology and Allergy, National Otolaryngology Hospital, Hanoi, Vietnam
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Tran BX, Nguyen QL, Nguyen LH, Phan HTT, Le HT, Tran TD, Vu TTM, Latkin CA. Expanding co-payment for methadone maintenance services in Vietnam: the importance of addressing health and socioeconomic inequalities. BMC Health Serv Res 2017; 17:480. [PMID: 28701208 PMCID: PMC5508786 DOI: 10.1186/s12913-017-2405-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 06/21/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Ensuring high enrollment while mobilizing resources through co-payment services is critical to the success of the methadone maintenance treatment (MMT) program in Vietnam. This study assessed the willingness of patients to pay (WTP) for different MMT services delivery models and determined its associated factors. METHODS A facility based survey was conducted among 1016 MMT patients (98.7% male, 42% aged 35 or less, and 67% living with spouse) in five MMT clinics in Hanoi and Nam Dinh province in 2013. Socioeconomic, HIV and health status, history of drug use and rehabilitation, and MMT experience were interviewed. WTP was assessed using contingent valuation method, including a set of double-bounded binary questions and a follow-up open-ended question. Point and interval data models were used to estimate maximum willingness to pay. RESULTS 95.5% patients were willing to pay for MMT at the monthly mean price of US$ 32 (95%CI = 28-35). Higher WTP was associated with higher level of educational attainment, higher income, male sex, and had high expenses on opiates prior to MMT. Patients who reported having any problem in Pain/ Discomfort, and who did not have outpatient care last year were willing to pay less for MMT than others. CONCLUSION High level of WTP supports the co-payment policies as a strategy to mobilize resources for the MMT program in Vietnam. However, it is necessary to ensure equalities across patient groups by acknowledging socioeconomic status of different settings and providing financial supports for disadvantaged patients with severe health status.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Quyen Le Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | - Long Hoang Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | | | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Tho Dinh Tran
- Department of Hepatobiliary Surgery, Viet-Duc Hospital, Hanoi, Vietnam
| | - Thuc Thi Minh Vu
- Department of Immunology and Allergy, National Otolaryngology Hospital, Hanoi, Vietnam
| | - Carl A. Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Willingness to pay for opioid agonist treatment among opioid dependent people who inject drugs in Ukraine. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017. [PMID: 28628853 DOI: 10.1016/j.drugpo.2017.05.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND In the context of decreasing external and limited Ukrainian governmental funding for opioid agonist treatments (OAT) for opioid dependent people who inject drugs in Ukraine, information on sustainable financial models is needed. METHODS Data on 855 opioid dependent people who inject drugs (PWID) were drawn from a cross-sectional nationwide survey of 1613 PWID. They comprised 434 participants who were receiving OAT and 421 who were on OAT in the past or have never been on OAT and were interested in receiving the treatment. Multivariate logistic regression was used to examine factors associated with willingness-to-pay (WTP) for OAT, stratified by OAT experience. Variation in the price which respondents were willing to pay for OAT and its effect on their monthly income among PWID with different OAT experience were assessed as a continuous variable using one-way ANOVA and Kruskal-Wallis test. RESULTS Overall, 378 (44%) expressed WTP for OAT. Factors independently associated with WTP differed by OAT experience. Among those using OAT, independent predictors of WTP included: city (Dnipro - aOR=1.9; 95%CI=1.1-4.8 and Lviv - (aOR=2.2; 95%CI=1.1-4.8) compared to those elsewhere in Ukraine), higher income (aOR=1.8; 95%CI=1.2-2.7) and receiving psychosocial counseling (aOR=1.8; 95%CI=1.2-2.7). Among those who had previously been on OAT, positive attitude towards OAT (aOR=1.3; 95%CI=1.1-1.6) and family support of OAT (aOR=2.5; 95%CI=1.1-5.7) were independently associated with WTP. Among PWID who had never been on OAT, being male (aOR=2.2; 95%CI=1.1-4.2), younger age (aOR=1.9; 95%CI=1.2-3.2), higher income (aOR=2.0; 95%CI=1.2-3.4) and previous unsuccessful attempts to enter OAT (aOR=2.3; 95%CI=1.1-4.7) were independently associated with WTP. PWID were willing to commit a large percentage of their monthly income for OAT, which, however, varied significantly based on OAT experience: current OAT: 37% of monthly income, previous OAT: 53%, and never OAT: 60% (p-value=0.0009). CONCLUSIONS WTP for OAT was substantial among PWID in Ukraine, supporting the implementation of self-pay or co-payment programs. Such strategies, however, must remain affordable, provide better access to OAT, and consider specific needs of PWID.
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Quality of life and healthcare service utilization among methadone maintenance patients in a mountainous area of Northern Vietnam. Health Qual Life Outcomes 2017; 15:77. [PMID: 28427471 PMCID: PMC5399322 DOI: 10.1186/s12955-017-0633-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/17/2017] [Indexed: 02/02/2023] Open
Abstract
Background The expansion of methadone maintenance treatment in mountainous areas in still limited and little is known about its health impacts on drug users. This study aimed to examine health-related quality of life (HRQOL) and health care access among patients engaging in methadone maintenance treatment (MMT) in Tuyen Quang, a mountainous province in Vietnam. Methods We conducted a cross-sectional survey with 241 patients conveniently recruited in two MMT clinics (Son Duong and Tuyen Quang). EuroQol-5 Dimensions – 5 levels (EQ-5D-5 L) and Visual analogue scale (VAS) were employed to measure HRQOL. Multivariate logistic and tobit regressions were used to determine the factors associated with HRQOL and health care utilization. Results The overall mean score of the EQ-5D index and EQ-VAS were 0.88 (SD = 0.20) and 81.8% (SD = 15.27%), respectively. Only 8.7% utilized inpatient services, and 14.9% used outpatient services. Being more highly educated, suffering acute diseases, and using health service within the last 12 months were associated with a decreased EQ-5D index. Individuals who were multiple substance abusers and those who recently had inpatient care were more likely to have a lower VAS. Older respondents, those taking their medications at the more impoverished clinic, substance abusers, and individuals who were struggling with anxiety/depression or their usual daily activities were more likely to use both inpatient and outpatient care. Conclusions In summary, we observed good HRQOL, but high prevalence of anxiety/depression and low rates of service utilization among MMT patients in Tuyen Quang province. To improve the outcomes of MMT services in mountainous areas, it is necessary to introduce personalized and integrative services models with counseling and interventions on multiple substance use.
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Abstract
BACKGROUND The economic costs associated with opioid misuse are immense. Effective interventions for opioid use disorders are available; however, given the scarce resources faced by substance use treatment providers and payers of all kinds, evidence of effectiveness is not always sufficient to encourage adoption of a given therapy-nor should it be. Economic evaluations can provide evidence that will help stakeholders efficiently allocate their resources. OBJECTIVE The purpose of this study was to review the literature on economic evaluations of opioid use disorder interventions. METHODS We performed a systematic review of the major electronic databases from inception until August 2015. A sensitive approach was used to ensure a comprehensive list of relevant articles. Given the quality of the existing reviews, we narrowed our search to studies published since 2007. The Drummond checklist was used to evaluate and categorize economic evaluation studies according to their quality. RESULTS A total of 98 articles were identified as potentially relevant to the current study. Of these 98 articles, half (n = 49) were included in this study. Six of the included articles were reviews. The remaining 43 articles reported economic evaluation studies of interventions for opioid use disorders. In general, the evidence on methadone maintenance therapy (MMT) supports previous findings that MMT is an economically advantageous opioid use disorder therapy. The economic literature comparing MMT with other opioid use disorder pharmacotherapies is limited, as is the literature on other forms of therapy. CONCLUSION With the possible exception of MMT, additional high-quality economic evaluations are needed in order to assess the relative value of existing opioid use disorder interventions.
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Affiliation(s)
- Sean M Murphy
- Department of Health Policy and Administration, Washington State University, P.O. Box 1495, Spokane, WA, 99210-1495, USA.
| | - Daniel Polsky
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Determinants of willingness to enroll in opioid agonist treatment among opioid dependent people who inject drugs in Ukraine. Drug Alcohol Depend 2016; 165:213-20. [PMID: 27370527 PMCID: PMC5094181 DOI: 10.1016/j.drugalcdep.2016.06.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/10/2016] [Accepted: 06/11/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Coverage with opioid agonist treatments (OAT) that include methadone and buprenorphine is low (N=8400, 2.7%) for the 310,000 people who inject drugs (PWID) in Ukraine. In the context of widespread negative attitudes toward OAT in the region, patient-level interventions targeting the barriers and willingness to initiate OAT are urgently needed. METHODS A sample of 1179 PWID with opioid use disorder not currently on OAT from five regions in Ukraine was assessed using multivariable logistic regression for independent factors related to willingness to initiate OAT, stratified by their past OAT experience. RESULTS Overall, 421 (36%) PWID were willing to initiate OAT. Significant adjusted odds ratios (aOR) for covariates associated with the willingness to initiate OAT common for both groups included: higher injection frequency (previously on OAT: aOR=2.7; never on OAT: aOR=1.8), social and family support (previously on OAT: aOR=2.0; never on OAT: aOR=2.0), and positive attitude towards OAT (previously on OAT: aOR=1.3; never on OAT: aOR=1.4). Among participants previously on OAT, significant correlates also included: HIV-negative status (aOR=2.6) and depression (aOR=2.7). Among participants never on OAT, however, living in Kyiv (aOR=4.8) or Lviv (aOR=2.7), previous imprisonment (aOR=1.5), registration at a Narcology service (aOR=1.5) and recent overdose (aOR=2.6) were significantly correlated with willingness to initiate OAT. CONCLUSIONS These findings emphasize the need for developing interventions aimed to eliminate existing negative preconceptions regarding OAT among PWID with opioid use disorder in Ukraine, which should be tailored to meet the needs of specific characteristics of PWID in geographically distinct setting based upon injection frequency, prior incarceration, and psychiatric and HIV status.
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Tran BX, Nguyen LH, Nong VM, Nguyen CT. Health status and health service utilization in remote and mountainous areas in Vietnam. Health Qual Life Outcomes 2016; 14:85. [PMID: 27267367 PMCID: PMC4895985 DOI: 10.1186/s12955-016-0485-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 05/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-rated health status and healthcare services utilization are important indicators to evaluate the performance of health system. In disadvantaged areas, however, little is known about the access and outcomes of health care services. This study aimed to assess health-related quality of life (HRQOL), health status and healthcare access and utilization of residents in mountainous and remote areas in Vietnam. METHODS A cross-sectional study was conducted in a convenient sample of residents in two provinces of Vietnam. Information about socio-economic, health status, HRQOL, healthcare seeking and services utilization were interviewed. EuroQol - 5 Dimensions - 5 Levels (EQ-5D-5 L) was used to measure HRQOL. RESULTS Of 200 respondents, mean age was 44.9 (SD = 13.9), 38.0 % were male. One third reported having any problem in Mobility, Usual activities, Pain or Discomfort, Anxiety or Depression. Women tended to suffer more problems in Pain/Discomfort and Anxiety/Depression and lower overall HRQOL than men. Over 90 % of respondents reported at least one health problem. Flu, cold and headache were the most commonly reported symptoms (41.5 %). Most of people preferred community health center when they had illness (96.0 %). Only 18.5 % people used traditional healers with the average of 5.8 times per year. Ethnicity, households' expenditure, illness and morbidity status, difficulty in accessing health care services were related to HRQOL.; Meanwhile, socioeconomic status, health problems, quality of services, and distances were associated with access to healthcare and traditional medicine services. CONCLUSIONS Residents in difficult-to-reach areas had high prevalence of health problems and experienced social and structural barriers of healthcare services access. It is necessary to improve the availability and quality of healthcare and traditional medicine services to improve the health status of disadvantaged people.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Long Hoang Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Vuong Minh Nong
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.
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Methadone Maintenance Treatment Promotes Referral and Uptake of HIV Testing and Counselling Services amongst Drug Users and Their Partners. PLoS One 2016; 11:e0152804. [PMID: 27046029 PMCID: PMC4821610 DOI: 10.1371/journal.pone.0152804] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 02/25/2016] [Indexed: 11/30/2022] Open
Abstract
Background Methadone maintenance treatment (MMT) reduces HIV risk behaviors and improves access to HIV-related services among drug users. In this study, we assessed the uptake and willingness of MMT patients to refer HIV testing and counseling (HTC) service to their sexual partners and relatives. Methods Health status, HIV-related risk behaviors, and HTC uptake and referrals of 1,016 MMT patients in Hanoi and Nam Dinh were investigated. Willingness to pay (WTP) for HTC was elicited using a contingent valuation technique. Interval and logistic regression models were employed to determine associated factors. Results Most of the patients (94.2%) had received HTC, 6.6 times on average. The proportion of respondents willing to refer their partners, their relatives and to be voluntary peer educators was 45.7%, 35.3%, and 33.3%, respectively. Attending MMT integrated with HTC was a facilitative factor for HTC uptake, greater WTP, and volunteering as peer educators. Older age, higher education and income, and HIV positive status were positively related to willingness to refer partners or relatives, while having health problems (mobility, usual care, pain/discomfort) was associated with lower likelihood of referring others or being a volunteer. Over 90% patients were willing to pay an average of US $17.9 for HTC service. Conclusion The results highlighted the potential role of MMT patients as referrers to HTC and voluntary peer educators. Integrating HIV testing with MMT services and applying users’ fee are potential strategies to mobilize resources and encourage HIV testing among MMT patients and their partners.
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Tran BX, Vu PB, Nguyen LH, Latkin SK, Nguyen CT, Phan HTT, Latkin CA. Drug addiction stigma in relation to methadone maintenance treatment by different service delivery models in Vietnam. BMC Public Health 2016; 16:238. [PMID: 26956741 PMCID: PMC4784456 DOI: 10.1186/s12889-016-2897-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 02/19/2016] [Indexed: 11/24/2022] Open
Abstract
Background The rapid expansion of methadone maintenance treatment (MMT) services has significantly improved health status and quality of life of patients. However, little is known about its impacts on addiction-related stigma and associated factors. Methods A cross-sectional survey was conducted in 2013 in Vietnam’s capital, Hanoi, and Nam Dinh province among 1016 methadone maintenance patients; 26.6 % at provincial AIDS centers (PAC) and 73.4 % at district health centers (DHC), respectively. Drug addiction history and related stigma, health status, MMT-related covariates, and sociodemographic characteristics were interviewed. Results More than one-sixth of the sample reported experiencing felt or enacted stigma, including Blame or Judgement (17.2 %), Shame (19.9 %), or Others’ fear of HIV transmission (17.1 %). These proportions were higher in PACs than in DHCs, which are integrated with other HIV or general health care services. Very few patients reported being discriminated at the workplace (2.5 %) or at health care services (1.7 %); however, 15.6 % of patients at PACs and 10.6 % of patients at DHCs reported discrimination in their communities. Drug users taking MMT for longer periods were less likely to report felt stigma. Other factors associated with stigma against MMT patients included the lack of comprehensive services, higher education, presence of pain/discomfort, and anxiety/depression, self-reported HIV positive, and number of previous drug rehabilitation episodes. Conclusion The study shows a high level of stigma against MMT patients and emphasizes the necessity to integrate MMT with comprehensive health and support services. Mass communication campaigns to reduce stigma against people with drug addiction and HIV/AIDS, as well as vocational trainings and jobs referrals for MMT patients, are needed to maximize the benefits of MMT programs in Vietnam.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, vietnam. .,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Phuong Bich Vu
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, vietnam
| | - Long Hoang Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, vietnam.,School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | | | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | | | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Prospects for ending the HIV epidemic among persons who inject drugs in Haiphong, Vietnam. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 32:50-6. [PMID: 27006257 DOI: 10.1016/j.drugpo.2016.02.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 02/11/2016] [Accepted: 02/19/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND To examine the prospects for "ending the HIV epidemic" among persons who inject drugs (PWID) in Haiphong, Vietnam. Reaching an incidence of <0.5/100 person-years at risk (PY) was used as an operational definition for "ending the epidemic." METHODS A respondent driven sampling study of 603 PWID was conducted from September to October 2014. Current heroin use (verified with urine testing and marks of injection) was an eligibility requirement. A structured questionnaire was administered by trained interviewers to obtain demographic, drug use, and risk behavior data; HIV counseling and testing and HCV testing was also conducted. Two methods (by assuming all new injectors were HIV negative at first injection and by slope of prevalence by years injecting) were used for estimating HIV among persons injecting for <5 years ("new injectors"). Comparisons were made to the HIV epidemic among PWID in New York City and modeling of the HIV epidemic in Can Tho province. RESULTS HIV prevalence was 25% in 2014, down from 68% in 2006 and 48% in 2009; overall HCV prevalence in the study was 67%. Among HIV seropositive PWID, 33% reported receiving antiretroviral treatment. The great majority (83%) of subjects reported pharmacies as their primary source of needles and syringes and self-reported receptive and distributive syringe sharing were quite low (<6%). Estimating HIV incidence among non-MSM male new injectors with the assumption that all were HIV negative at first injection gave a rate of 1.2/100 person-years (95% CI -0.24, 3.4). Estimating HIV incidence by the slope of prevalence by years injecting gave a rate of 0.8/100 person-years at risk (95% CI -0.9, 2.5). CONCLUSIONS The current HIV epidemic among PWID in Haiphong is in a declining phase, but estimated incidence among non-MSM new injectors is approximately 1/100 person-years and there is a substantial gap in provision of ART for HIV seropositives. Scaling up interventions, particularly HIV counseling and testing and antiretroviral treatment for all seropositive PWID, should accelerate the decline. Ending the epidemic is an attainable public health goal.
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Economic vulnerability of methadone maintenance patients: Implications for policies on co-payment services. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 31:131-7. [PMID: 26922633 DOI: 10.1016/j.drugpo.2016.01.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 11/29/2015] [Accepted: 01/21/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Co-payment for methadone maintenance treatment (MMT) services is a strategy to ensure the financial sustainability of the HIV/AIDS programs in Vietnam. In this study, we examined health services utilization and expenditure among MMT patients, and further explored factors associated with catastrophic health expenditure among affected households. METHODS A multi-site cross-sectional study was conducted among 1016 patients in two epicentres: Hanoi and Nam Dinh province in 2013. RESULTS Overall, 8.2% and 28.7% respondents used inpatient and outpatient health care services in the past 12 months apart from receiving MMT. There were 12.8% respondents experiencing catastrophic health expenditure given MMT is provided free-of-charge, otherwise 63.5% patients would suffer from health care costs. MMT integrated with general health or HIV services may encourage health care services utilization of patients. Patients, who were single, lived in the rural, had inpatient care and reported problems in Mobility were more likely to experience catastrophic health expenditure than other patient groups. CONCLUSIONS The health care costs are still financially burden to many drug users and remained over the course of MMT that implies the necessity of continuous supports from the program. Scaling-up and decentralizing integrated MMT clinics together with economic empowerments for treated drug users and their families should be prioritized in Vietnam.
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Tran BX, Nguyen LH, Nong VM, Nguyen CT, Phan HTT, Latkin CA. Behavioral and quality-of-life outcomes in different service models for methadone maintenance treatment in Vietnam. Harm Reduct J 2016; 13:4. [PMID: 26837193 PMCID: PMC4736621 DOI: 10.1186/s12954-016-0091-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrating HIV/AIDS and methadone maintenance treatment (MMT) services with existing health care delivery system is critical in sustaining efforts to fight HIV/AIDS in large injection-driven epidemics. However, efficiency of different integrative service models is unknown. This study assessed behavioral and health-related quality-of-life (HRQOL) outcomes of MMT in four service delivery models and explored factors associated with these outcomes of interest. METHODS A cross-sectional survey was conducted in two HIV epicenters in Vietnam: Hanoi and Nam Dinh Province. All patients in five selected MMT clinics were invited to participate, and 1016 were interviewed (80-90% response rate). RESULTS Respondents had a mean age of 35.8, taken MMT for average 16.5 months and 3.3% on MMT for 36-60 months. The MMT integrated with rural district health center (DHC) has the highest prevalence of concurrent drug use (11.3%). The percentage of condom use (last sexual intercourse) with primary and casual partners was lowest in the MMT at urban DHCs. Patients at the rural DHC reported very high proportions of pain/discomfort (37.8%), anxiety/depression (43.1%), and mobility (13.3%). In regression models, poorer HRQOL outcomes were found in MMT models in the rural areas or without general health care, and among those patients who were HIV positive, reported concurrent drug use, and had higher numbers of previous drug rehabilitation episodes. Mobility and anxiety/depression are factors that increased the likelihood of concurrent drug use among MMT patients. CONCLUSIONS Outcomes of MMT were diverse across different integrative service models. Policies on rapid expansion of the MMT program in Vietnam should also emphasize on the integration with comprehensive health care services including psychological supports for patients.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Long Hoang Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Vuong Minh Nong
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | | | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Tran BX, Nguyen LH, Do HP, Nguyen NPT, Phan HTT, Dunne M, Latkin C. Motivation for smoking cessation among drug-using smokers under methadone maintenance treatment in Vietnam. Harm Reduct J 2015; 12:50. [PMID: 26518600 PMCID: PMC4628307 DOI: 10.1186/s12954-015-0085-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/27/2015] [Indexed: 12/31/2022] Open
Abstract
Background Smoking cessation treatment service is concerned to be a critical element in methadone maintenance treatment (MMT) in order to diminish the effect of smoke on health outcomes. To implement the smoking cessation services in Vietnam, we examined the stages of change to quit and determined associated factors among MMT patients. Methods We conducted a cross-sectional survey with 1016 MMT patients in five clinics in Hanoi and Nam Dinh province, of those, 932 (91.7 %) were ever-smokers. Patients were classified into four groups: “pre-contemplation,” “contemplation,” “preparation,” and “action and maintenance” by using the transtheoretical model. Multivariate logistic regression was applied to determine the associated factor for intention and action to quit smoking. Results Overall, 96 % were not actively trying to quit or maintain abstinence. Age older than 45, HIV-positive status, and residence in Hanoi were negatively associated with intention to quit. Meanwhile, higher levels of nicotine dependence and number of years of smoking negatively associated with quitting and abstinence. Conclusions The study indicated the high rate of MMT smokers being in pre-contemplation stage but low proportion of quitting and maintaining abstinence. It emphasizes the importance of availability and accessibility of information about smoking cessation therapies and services. Integrating cessation programs into health-care services should be considered to provide tailored interventions for different patient groups.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Long Hoang Nguyen
- School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Huyen Phuc Do
- School of Public Health and Social Work, The Queensland University of Technology, Brisbane, Australia
| | | | | | - Michael Dunne
- School of Public Health and Social Work, The Queensland University of Technology, Brisbane, Australia
| | - Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Tran BX, Nguyen LH, Phan HTT, Nguyen LK, Latkin CA. Preference of methadone maintenance patients for the integrative and decentralized service delivery models in Vietnam. Harm Reduct J 2015; 12:29. [PMID: 26377824 PMCID: PMC4574353 DOI: 10.1186/s12954-015-0063-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 08/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Integrating and decentralizing services are essential to increase the accessibility and provide comprehensive care for methadone patients. Moreover, they assure the sustainability of a HIV/AIDS prevention program by reducing the implementation cost. This study aimed to measure the preference of patients enrolling in a MMT program for integrated and decentralized MMT clinics and then further examine related factors. METHODS A cross-sectional study was conducted among 510 patients receiving methadone at 3 clinics in Hanoi. Structured questionnaires were used to collect data about the preference for integrated and decentralized MMT services. Covariates including socio-economic status; health-related quality of life (using EQ-5D-5 L instrument) and HIV status; history of drug use along with MMT treatment; and exposure to the discrimination within family and community were also investigated. Multivariate logistic regression with polynomial fractions was used to identify the determinants of preference for integrative and decentralized models. RESULTS Of 510 patients enrolled, 66.7 and 60.8 % preferred integrated and decentralized models, respectively. The main reason for preferring the integrative model was the convenience of use of various services (53.2 %), while more privacy (43.5 %) was the primary reason to select stand-alone model. People preferred the decentralized model primarily because of travel cost reduction (95.0 %), while the main reason for not selecting the model was increased privacy (7.7 %). After adjusting for covariates, factors influencing the preference for integrative model were poor socioeconomic status, anxiety/depression, history of drug rehabilitation, and ever disclosed health status; while exposure to community discrimination inversely associated with this preference. In addition, people who were self-employed, had a longer duration of MMT, and use current MMT with comprehensive HIV services were less likely to select decentralized model. CONCLUSION In conclusion, the study confirmed the high preference of MMT patients for the integrative and decentralized MMT service delivery models. The convenience of healthcare services utilization and reduction of geographical barriers were the main reasons to use those models within drug use populations in Vietnam. Countering community stigma and encouraging communication between patients and their societies needed to be considered when implementing those models.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Long Hoang Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,School of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | | | | | - Carl A Latkin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Yeung MW, Young J, Moodie E, Rollet-Kurhajec KC, Schwartzman K, Greenaway C, Cooper C, Cox J, Gill J, Hull M, Walmsley S, Klein MB. Changes in quality of life, healthcare use, and substance use in HIV/hepatitis C coinfected patients after hepatitis C therapy: a prospective cohort study. HIV CLINICAL TRIALS 2015; 16:100-10. [DOI: 10.1179/501100000024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Barriers to health and social services for street-involved youth in a Canadian setting. J Public Health Policy 2015; 36:350-63. [PMID: 25811385 DOI: 10.1057/jphp.2015.8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Although street-involved youth contend with many health and social problems, the extent to which vulnerable youth engage with supportive services has not been well described. This study sought to examine the prevalence and correlates associated with having difficulty accessing health and social services among a prospective cohort of street-involved youth in Vancouver, Canada. Among 1019 street-involved youth, 650 (64 per cent) reported having difficulty accessing services during the study period. In a multivariate analysis, youth who reported having difficulty accessing services were significantly more likely to be socially and economically vulnerable. Specifically, they were more likely to report severe housing instability, high-intensity drug use, recent interactions with law enforcement, drug dealing, and histories of violence and physical abuse. Study findings point to opportunities to improve access to services among vulnerable youth through removal of blanket age restrictions for youth services, establishing youth-centric social housing, and supporting peer-driven, low-threshold services.
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Wilson DP, Donald B, Shattock AJ, Wilson D, Fraser-Hurt N. The cost-effectiveness of harm reduction. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 26 Suppl 1:S5-11. [PMID: 25727260 DOI: 10.1016/j.drugpo.2014.11.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
Abstract
HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But scale-up of all three approaches is essential. These interventions can be cost-effective by most thresholds in the short-term and cost-saving in the long-term.
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Affiliation(s)
| | | | | | - David Wilson
- Global HIV/AIDS Program, World Bank, United States
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