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Kyaw KWY, Platt L, Bijl M, Rathod SD, Naing AY, Roberts B. The effect of different types of migration on symptoms of anxiety or depression and experience of violence among people who use or inject drugs in Kachin State, Myanmar. Harm Reduct J 2023; 20:45. [PMID: 37013591 PMCID: PMC10068727 DOI: 10.1186/s12954-023-00766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/13/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Evidence on the social determinants of mental health conditions and violence among people who inject or use drugs (PWUD) is limited, particularly in conflict-affected countries. We estimated the prevalence of symptoms of anxiety or depression and experience of emotional or physical violence among PWUD in Kachin State in Myanmar and examined their association with structural determinants, focusing on types of past migration (migration for any reason, economic or forced displacement). MATERIALS A cross-sectional survey was conducted among PWUD attending a harm reduction centre between July and November 2021 in Kachin State, Myanmar. We used logistic regression models to measure associations between past migration, economic migration and forced displacement on two outcomes (1) symptoms of anxiety or depression (Patient Health Questionnaire-4) and (2) physical or emotional violence (last 12 months), adjusted for key confounders. RESULTS A total of 406, predominantly male (96.8%), PWUD were recruited. The median age (IQR) was 30 (25, 37) years, most injected drugs (81.5%) and more commonly opioid substances such as heroin or opium (85%). Symptoms of anxiety or depression (PHQ4 ≥ 6) were high (32.8%) as was physical or emotional violence in the last 12 months (61.8%). Almost one-third (28.3%) had not lived in Waingmaw for their whole life (migration for any reason), 77.9% had left home for work at some point (economic migration) and 19.5% had been forced to leave home due to war or armed conflict (forced displacement). A third were in unstable housing in the last 3 months (30.1%) and reported going hungry in the last 12 months (27.7%). Only forced displacement was associated with symptoms of anxiety or depression [adjusted odds ratio, aOR 2.33 (95% confidence interval, CI 1.32-4.11)] and recent experience of violence [aOR 2.18 (95% CI 1.15-4.15)]. CONCLUSION Findings highlight the importance of mental health services integrated into existing harm reduction services to address high levels of anxiety or depression among PWUD, particularly among those who have been displaced through armed conflict or war. Findings reinforce the need to address broader social determinants, in the form of food poverty, unstable housing and stigma, in order to reduce mental health and violence.
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Affiliation(s)
- Khine Wut Yee Kyaw
- Asian Harm Reduction Network (AHRN), Yangon, Myanmar.
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Murdo Bijl
- Asian Harm Reduction Network (AHRN), Yangon, Myanmar
| | - Sujit D Rathod
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Aung Yu Naing
- Asian Harm Reduction Network (AHRN), Yangon, Myanmar
| | - Bayard Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Lemons-Lyn A, Reidy W, Myint WW, Chan KN, Abrams E, Aung ZZ, Benech I, Bingham T, Desai M, Khin EE, Lin T, Olsen H, Oo HN, Wells C, Mital S. Optimizing HIV Services for Key Populations in Public-Sector Clinics in Myanmar. J Int Assoc Provid AIDS Care 2021; 20:23259582211055933. [PMID: 34821151 PMCID: PMC8640295 DOI: 10.1177/23259582211055933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Key populations, ie, female sex workers, men who have sex with men, transgender people, people who inject drugs, and people in prisons and other closed settings, experience stigma, discrimination, and structural barriers when accessing HIV prevention and care. Public health facilities in Myanmar became increasingly involved in HIV service delivery, leading to an urgent need for healthcare workers to provide client-centred, key population-friendly services. Between July 2017-June 2018, the Myanmar Ministry of Health and Sports and National AIDS Programme collaborated with ICAP at Columbia University and the US Centers for Disease Control and Prevention to implement a quasi-experimental, multicomponent intervention including healthcare worker sensitization training with pre- and post- knowledge assessments, healthcare worker and client satisfaction surveys, and structural changes. We observed modest improvements among healthcare workers (n = 50) in knowledge assessments. Classification of clients into key population groups increased and fewer clients were classified as low risk. Key population clients reported favourable perceptions of the quality and confidentiality of care through self-administered surveys. Our findings suggest public health facilities can deliver HIV services that are valued by key population clients.
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Affiliation(s)
| | | | | | - Khin N Chan
- 5798ICAP at Columbia University, Yangon, Myanmar
| | | | - Zaw Zaw Aung
- National AIDS Programme, Ministry of Health and Sports, Yangon, Myanmar
| | - Irene Benech
- 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Trista Bingham
- 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mitesh Desai
- 119199Centers for Disease Control and Prevention, Yangon, Myanmar
| | - Ei Ei Khin
- 119199Centers for Disease Control and Prevention, Yangon, Myanmar
| | - Tharaphi Lin
- 5798ICAP at Columbia University, Yangon, Myanmar
| | - Halli Olsen
- 560848ICAP at Columbia University, New York, USA
| | - Htun Nyunt Oo
- National AIDS Programme, Ministry of Health and Sports, Yangon, Myanmar
| | - Cassia Wells
- 560848ICAP at Columbia University, New York, USA
| | - Sasha Mital
- 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
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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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Kermode M, Choudhurimayum RS, Rajkumar LS, Haregu T, Armstrong G. Retention and outcomes for clients attending a methadone clinic in a resource-constrained setting: a mixed methods prospective cohort study in Imphal, Northeast India. Harm Reduct J 2020; 17:68. [PMID: 32993646 PMCID: PMC7523306 DOI: 10.1186/s12954-020-00413-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 09/10/2020] [Indexed: 11/22/2022] Open
Abstract
Background Opioid substitution therapy (OST) with buprenorphine has been widely available in India since 2007, but the introduction of methadone occurred much later in 2012, and availability remains limited. Illicit injecting drug use is a long-standing public health problem in Manipur, a state in Northeast India characterised by major resource constraints and political unrest. We investigated retention and outcomes for clients attending a methadone-based OST program in Manipur with the aim of strengthening the evidence base for development of relevant policies and programs. Methods All clients enrolling in the methadone clinic over a 1 year period were invited to be part of a prospective cohort study, which followed up and surveyed both retained and defaulting clients for 12 months post-enrollment to assess retention as well as social, behavioural and mental health outcomes. Additionally, we conducted semi-structured qualitative interviews to supplement quantitative information and identify factors contributing to retention and drop-out. Results Of the 74 clients enrolled, 21 had dropped out and three had died (all defaulters) by 12 months post-enrollment, leaving 67.6% still in the program. Using an intention-to-treat analysis, meaningful and statistically significant gains were observed for all social, behavioural and mental health variables. Between baseline and 12 months there were reductions in needle sharing, drug use, property crime, anxiety, depression and suicidal thoughts; and improvements in physical health, mental health, quality of family relationships, employment and hopefulness. Factors contributing to retention and drop-out were identified, including the centrality of family, and general lack of awareness of and misunderstanding about methadone. Conclusion Even in parts of India where resources are constrained, methadone is an effective treatment for opioid dependence. Scaling up the availability of methadone elsewhere in Manipur and in other areas of India experiencing problematic opioid dependence is indicated.
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Affiliation(s)
- Michelle Kermode
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia.
| | | | - Lenin Singh Rajkumar
- Department of Psychiatry, Regional Institute of Medical Science, Imphal, Manipur, India
| | - Tilahun Haregu
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia
| | - Greg Armstrong
- Nossal Institute for Global Health, University of Melbourne, Level 5/333 Exhibition St, Melbourne, VIC, 3010, Australia
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Sevigny EL, Meylakhs P, Feizollahi MJ, Amini MR. Development of a global index measuring national policy commitments to HIV prevention and treatment among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 84:102877. [PMID: 32717705 DOI: 10.1016/j.drugpo.2020.102877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/29/2020] [Accepted: 07/14/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND People who inject drugs (PWID) around the world are disproportionately affected by the HIV epidemic. National policy responses to the epidemic heavily influence risk factors for HIV acquisition among this key group. Prior efforts to monitor national policy responses to HIV/AIDS among PWID were limited both in scope and coverage. In this paper we develop and validate the HIV-PWID Policy Index (HPPI) to benchmark and monitor national commitments to HIV prevention and treatment among PWID. METHODS Composite indicator was constructed employing fuzzy multilayer data envelopment analysis (FMLDEA). Model inputs based on data from 105 countries included 27 variables measured across six conceptual domains, including needle and syringe programs, opioid substitution treatment, testing and counseling, information and education, monitoring and evaluation, and legal and policy climate. RESULTS According to the HPPI, which ranges from 0 to 1, the top performing countries in policy commitments to HIV prevention and treatment among PWID were Spain (0.988), Switzerland (0.982), Luxembourg (0.970), Moldova (0.970), and Kyrgyzstan (0.945), whereas the poorest performing included Nicaragua (0.094), Japan, (0.094), Cape Verde (0.097), Syria (0.174), and Benin (0.185). Regionally, commitment to HIV services targeting PWID was highest among European countries (0.81) and lowest among African countries (0.50), with Oceania (0.76), Asia (0.66), and the Americas (0.56) in the mid-range. Subregional differences were even more prominent, with West and Central European nations (0.84) and Central American nations (0.22) earning the highest and lowest HPPI scores, respectively. CONCLUSIONS The HPPI documented substantial national and regional variation in policy responses to the HIV epidemic among PWID. Our analysis also revealed that many countries have limited HIV/AIDS data collection and monitoring capabilities. Continued enhancement and standardization of global HIV/AIDS monitoring efforts are therefore vital to articulated national and international benchmarking and performance assessment goals.
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Affiliation(s)
- Eric L Sevigny
- Department of Criminal Justice and Criminology, Georgia State University, Atlanta, GA, USA.
| | - Peter Meylakhs
- Laboratory for Comparative Social Research, National Research University Higher School of Economics, St. Petersburg, Russian Federation
| | | | - Mohamad Reza Amini
- Systems Management, Management and Economic Department, Tarbiat Modares University, Tehran, Iran
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Chao E, Hung CC, Lin CP, Ku YCJ, Ain QU, Metzger DS, Lee TSH. Adherence among HIV-positive injection drug users undergoing methadone treatment in Taiwan. BMC Psychiatry 2020; 20:346. [PMID: 32616019 PMCID: PMC7331024 DOI: 10.1186/s12888-020-02764-0] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/25/2020] [Indexed: 01/29/2023] Open
Abstract
AIMS The study aims were to investigate adherence to methadone maintenance treatment (MMT) and to identify associated clinical factors in patients who inject drugs diagnosed with human immunodeficiency virus (HIV) infection in Taiwan. METHODS Data were from the National Health Surveillance System on HIV and the National Drug Treatment System on MMT. HIV-positive people who inject drugs (HIVPWID) were defined as the study population. Information obtained included age, sex, education, marital status, employment, methadone dose, and date of diagnosis of HIV infection. Adherence was defined as taking methadone for the past 90, 180 and 365 days, then categorized as high (> 90%), moderate (51 to 90%), or low (<=50%) adherent respectively. RESULTS Of 1641 HIVPWID registered in the datasets from 2007 to 2012, 961 (58.56%) had received MMT. For HIVPWID evaluated at 90 days (n = 951), 271 (28.5%), 382 (40.2%), and 298 (31.3%) were classified as high, moderate, and low adherent respectively. For HIVPWID evaluated at 180 days (n = 936), 190 (20.3%), 349 (37.3%), and 397 (42.4%) were classified as high, moderate, and low adherent respectively. For HIVPWID evaluated at 365 days (n = 919), 133 (14.5%), 271 (29.5%), and 515 (56.0%) were classified as high, moderate, and low adherent respectively. After controlling for sociodemographics, results showed that methadone dose, location of MMT clinic, and date of HIV diagnosis were significantly associated with MMT adherence. CONCLUSIONS Study findings underscore the importance to MMT adherence of methadone dosage, early diagnosis of patient's HIV infection, and area of patient residence.
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Affiliation(s)
- En Chao
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
- Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Chia-Chun Hung
- Institute of Brain Science, National Yang Ming University, Taipei, Taiwan
- Bali Psychiatric Center, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ching-Po Lin
- Institute of Brain Science, National Yang Ming University, Taipei, Taiwan
| | - Yi-Chien Jacob Ku
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Qurat Ul Ain
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
- Pir Mehr Ali Shah Arid Agriculture University, Rawalpindi, Pakistan
| | - David S Metzger
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan.
- CTBC Center for Addiction Prevention and Policy Research, National Taiwan Normal University, No 162 Sec. 1 He-Ping East Road, Taipei, 10610, Taiwan.
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Dhagudu NK, Ambekar A, Agrawal A, Rao R, Mishra AK, Jain R, Singh S. Is there enough naloxone to deter the diversion? Effect of concurrent administration of intravenous naloxone on opioid agonist effects of intravenous buprenorphine: A randomised, double‐blind, within‐subject, crossover study among opioid‐dependent subjects. Drug Alcohol Rev 2020; 39:595-603. [DOI: 10.1111/dar.13057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Atul Ambekar
- Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment CenterAll India Institute of Medical Sciences New Delhi India
| | - Alok Agrawal
- Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment CenterAll India Institute of Medical Sciences New Delhi India
| | - Ravindra Rao
- Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment CenterAll India Institute of Medical Sciences New Delhi India
| | - Ashwani K. Mishra
- Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment CenterAll India Institute of Medical Sciences New Delhi India
| | - Raka Jain
- Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment CenterAll India Institute of Medical Sciences New Delhi India
| | - Shalini Singh
- Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment CenterAll India Institute of Medical Sciences New Delhi India
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Lu Q, Zou X, Liu Y, Gong C, Ling L. Dose Tapering Strategy for Heroin Abstinence among Methadone Maintenance Treatment Participants: Evidence from A Retrospective Study in Guangdong, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2800. [PMID: 31390750 PMCID: PMC6695604 DOI: 10.3390/ijerph16152800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/26/2019] [Accepted: 08/03/2019] [Indexed: 11/16/2022]
Abstract
Around half of methadone maintenance treatment (MMT) participants choose the tapering phase, however, the guidelines on tapering differ between countries and only include the tapering rate. Physicians need more evidence to guide clinical practice. We aimed to explore a specific tapering strategy to improve heroin abstinence among MMT participants. We conducted a retrospective study from 2006 to 2017 at nine MMT clinics in Guangdong, China, involving 853 participants with 961 treatment episodes. We performed two-level hierarchical logistic regression models to identify tapering phase characteristics associated with heroin abstinence. Among all treatment episodes, 419 (43.6%) were heroin abstinent. Participants who started tapering after 52 weeks, had a taper start dose of less than 60 mg and a taper ratio of less than 5%/week, while a dose reduction in 75%-89% of the tapering weeks provided the highest odds of heroin abstinence. This study highlights the need for a more gradual taper than current guidelines recommend and strongly suggests the inclusion of other tapering phase characteristics. Those who start the tapering phase later, have a lower dose of methadone, with a more gradual rate of taper, and a dose reduction in 75%-89% of the tapering phase increased the odds of heroin abstinence.
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Affiliation(s)
- Qian Lu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xia Zou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yin Liu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Cheng Gong
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Struggling to achieve a 'normal life': A qualitative study of Vietnamese methadone patients. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 68:18-26. [PMID: 30978641 DOI: 10.1016/j.drugpo.2019.03.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/27/2019] [Accepted: 03/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Methadone maintenance treatment, initially introduced in Vietnam for HIV harm reduction, has marked a significant switch in the country's drug policy - from addiction as a moral issue to addiction as a brain disease. After the some initial outstanding achievements, the programme is facing a high dropout rate that threatens both goals of HIV prevention and drug treatment. This sociological study, as part of an HIV intervention research project, explores the challenges and opportunities that individuals who use drugs are faced with in relation to addiction treatment. METHODS A qualitative study among drug users with and without methadone maintenance treatment experiences recruited by peer outreach workers. We conducted 58 in-depth interviews and 2 focus groups between 2016 and 2017. RESULTS The start of treatment brought about significant feelings of success as heroin use was no longer compulsive. However, being in treatment programmes is also challenging with respect to continuing the recovery process. Barriers to retention include a popular fear of methadone as another harmful drug, a feeling of dependence related to the current practices of methadone treatment programmes and a poor therapeutic relationship. In the face of such challenges, the two major motivations that keep patients in care come from the desire to completely break up with heroin and the pursuit of family happiness. CONCLUSION The current practices of methadone programmes pose challenges to patients' recovery efforts from addiction and threaten treatment retention. Prompt interventions are needed to help Vietnam attain its objective of providing better care for larger vulnerable populations.
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Go VF, Hershow RB, Kiriazova T, Sarasvita R, Bui Q, Latkin CA, Rose S, Hamilton E, Lancaster KE, Metzger D, Hoffman IF, Miller WC. Client and Provider Perspectives on Antiretroviral Treatment Uptake and Adherence Among People Who Inject Drugs in Indonesia, Ukraine and Vietnam: HPTN 074. AIDS Behav 2019; 23:1084-1093. [PMID: 30306437 DOI: 10.1007/s10461-018-2307-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
HIV-infected people who inject drugs (PWID) have low uptake of HIV services, increasing the risk of transmission to uninfected injection or sexual partners and the likelihood of AIDS-related deaths. HPTN 074 is a vanguard study assessing the feasibility of an integrated intervention to facilitate treatment as prevention to PWID in Indonesia, Ukraine, and Vietnam. We describe barriers to and facilitators of ART uptake and adherence among PWID. We conducted in-depth interviews with 62 participants, including 25 providers and 37 PWID at baseline across all sites. All interviews were recorded, transcribed, translated into English and coded in NVivo for analysis. Matrices were developed to identify emergent themes and patterns. Overall, differences between provider and PWID perspectives were greater than differences in cross-site perspectives. Providers and PWID recognized clinic access, financial barriers, side effects, and lack of information about HIV testing and ART enrollment as barriers to ART. However, providers tended to emphasize individual level barriers to ART, such as lack of motivation due to drug use, whereas PWID highlighted health systems barriers, such as clinic hours and financial burden, fears, and side effects. Providers did not mention stigma as a barrier though their language reflected stereotypes about drug users. The differences between provider and PWID perspectives suggest a gap in providers' understanding of PWID. This misunderstanding has implications for patient-provider interactions that may affect PWID willingness to access care or adhere to ART. Lessons learned from this study will be important as countries with a significant HIV burden among PWID design and implement programs to engage HIV-infected PWID in care and treatment.
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Affiliation(s)
- 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
| | - Tetiana Kiriazova
- Ukrainian Institute on Public Health Policy, Malopidvalna Street, 4, Kiev, 02000, Ukraine
| | - Riza Sarasvita
- National Narcotics Board, Jalan Letnan Jendral M.T. Haryono No.11, RT.1/RW.6, Cawang, Kramatjati, RT.1/RW.6, Cawang, Kramatjati, Kota Jakarta Timur, Daerah Khusus Ibukota, Jakarta, 13630, Indonesia
- Cipto Mangunkusumo 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
| | - Carl A Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Scott Rose
- Science Facilitation Department, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | - Erica Hamilton
- Science Facilitation Department, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | - 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
| | - David Metzger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 4th Floor - Suite 4000, Philadelphia, PA, 19104-3309, USA
| | - 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
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"They don't like us….": Barriers to antiretroviral and opioid substitution therapy among homeless HIV positive people who inject drugs in Delhi: A mixed method study. PLoS One 2018; 13:e0203262. [PMID: 30161255 PMCID: PMC6117039 DOI: 10.1371/journal.pone.0203262] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 08/19/2018] [Indexed: 12/02/2022] Open
Abstract
Background Provision of Anti-Retroviral Therapy (ART) and Opioid Substitution Therapy (OST) are important components of the targeted intervention (TI) programme for people who inject drugs (PWID). Homeless HIV positive PWIDs in Delhi is a key population experiencing gaps in uptake of these services, especially the ART uptake which is reportedly far from 90%, UNAIDS’ 90-90-90 target to end the AIDS epidemic. Objective To assess the gaps and barriers in accessing the ART and OST services uptake among HIV positive homeless PWID in Delhi and to explore experiences and perspectives of the PWIDs and service providers. Methodology We used a convergent parallel mixed methods design which included a cross-sectional quantitative survey and a qualitative study. Two hundred thirty five homeless HIV positive PWID were interviewed and in-depth interviews were conducted with five PWIDs and nine health providers. Results While only 12% of PWIDs were on ART, 80% were availing OST services. The top individual, health system related and structural barriers for ART service access were insufficient and incorrect knowledge (63%), long waiting time (86%) and lack of family support (44%) respectively. Inconvenient timings, stringent registration requirements and negative attitude of health providers were expressed as major barriers of accessing ART services during the interviews while these were not a concern in OST services. Homelessness, poverty, stigma were common barriers for both services. Integrated, ‘single window’ service and provision of additional support like nutrition and shelter were suggested as measures to improve access by both health providers and the PWIDs themselves. Conclusion There is an urgent need for structural and health systems changes to improve access to ART and OST services. These include integrated service delivery, flexibility in timing of the centers, accelerated ART initiation, simplification of bureaucratic procedures, nutritional and social support to all homeless HIV positive PWIDs.
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Hayashi K, Ti L, Ayutthaya PPN, Suwannawong P, Kaplan K, Small W, Kerr T. Barriers to retention in methadone maintenance therapy among people who inject drugs in Bangkok, Thailand: a mixed-methods study. Harm Reduct J 2017; 14:63. [PMID: 28882155 PMCID: PMC5590145 DOI: 10.1186/s12954-017-0189-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/30/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Methadone maintenance therapy (MMT) is a mainstay for treating opioid use disorder and preventing and managing HIV among people who inject drugs (PWID). While previous research suggested low dosing of methadone and high rates of discontinuation of MMT among PWID in Thailand, little is known about patients' lived experiences with MMT in this setting. Therefore, we conducted a mixed-methods study to examine barriers to retention in MMT among PWID in Bangkok, Thailand, with particular attention to methadone dosing. METHODS Bivariate statistics were used to analyze quantitative survey data collected from methadone-treated PWID between July and October 2011. Qualitative data collected through semi-structured interviews with 16 methadone-treated PWID between July 2011 and June 2012 were analyzed thematically, with a focus on individual-level, social-structural, and environmental barriers to accessing MMT. RESULTS Among 158 survey participants, a median dosage of methadone was 30 mg/day (interquartile range 20-50). Of these, 15.8% reported having acquired street methadone due to low prescribed dosages of methadone and 19.0% reported recent syringe sharing. Qualitative interview data indicated some methadone provider-related barriers, including discouraging patients from using methadone due to it being a Western medicine, difficulty negotiating higher doses of methadone, and abrupt dose reductions without patient consultation (involving the provision of non-medicated "syrup" in some cases). Social-structural and environmental barriers to optimal MMT access included intense police surveillance of methadone clinics; and frequent incarceration of PWID and a lack of access to methadone in prisons. CONCLUSIONS Among our sample of methadone-treated PWID, methadone dosages were suboptimal according to the international guidelines. Poor adherence to international guidelines for opioid agonist therapies, aggressive law enforcement, and a lack of methadone in prisons need to be addressed to optimize MMT and reduce harms associated with untreated opioid use disorder in Thailand.
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Affiliation(s)
- Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
- Research Scientist, BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital Chair in Substance Use Research and Assistant Professor, Faculty of Health Science, Simon Fraser University, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Lianping Ti
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Prempreeda Pramoj Na Ayutthaya
- International Reference Group on Transgender Women and HIV/AIDS, Global Forum on MSM & HIV, 436 14th Street, Suite 100, Oakland, CA 94612 USA
| | - Paisan Suwannawong
- Thai AIDS Treatment Action Group, 18/89 Vipawadee Rd., soi 40 Chatuchak, Bangkok, 10900 Thailand
| | - Karyn Kaplan
- Asia Catalyst, 1270 Broadway, Suite 1109, New York, NY 10001 USA
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
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Pendse R, Gupta S, Yu D, Sarkar S. HIV/AIDS in the South-East Asia region: progress and challenges. J Virus Erad 2016; 2:1-6. [PMID: 28303199 PMCID: PMC5353351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The South-East Asia region, with 11 member states, has an estimated 3.5 million people living with HIV (PLHIV). More than 99% of PLHIV live in five countries where HIV prevalence among the population aged 15-49 remains low but is between 2% and 29% among key populations. Since 2010, the region has made progress to combat the epidemic. Mature condom programmes exist in most countries but opioid substitution therapy, and needle and syringe exchange programmes need to be scaled up. HIV testing is recommended nationwide in four countries and is prioritised in high prevalence areas or for key populations in the rest. In 2015, PLHIV aware of their HIV status ranged from 26% to 89%. Antiretroviral therapy (ART) is recommended for all PLHIV in Thailand and Maldives while six countries recommend ART at CD4 cell counts <500 cells/mm3. In 2015, 1.4 million (39%) PLHIV were receiving ART compared to 670,000 (20%) in 2010. Coverage of HIV testing and treatment among HIV-positive pregnant women has also improved but remains low in all countries except Thailand, which has eliminated mother-to-child transmission of HIV and syphilis. Between 2010 and 2015, AIDS-related deaths and new HIV infections have shown a declining trend in all the high-burden countries except Indonesia. But the region is far from achieving the 90-90-90 target by 2020 and the end of AIDS by 2030. The future HIV response requires that governments work in close collaboration with communities, address stigma and discrimination, and efficiently invest domestic resources in evidence-based HIV testing and treatment interventions for populations in locations that need them most.
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Affiliation(s)
- Razia Pendse
- World Health Organization South-East Asia Region,
New Delhi,
India
| | - Somya Gupta
- World Health Organization South-East Asia Region,
New Delhi,
India
| | - Dongbao Yu
- World Health Organization South-East Asia Region,
New Delhi,
India
| | - Swarup Sarkar
- World Health Organization South-East Asia Region,
New Delhi,
India
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George P, Vicknasingam B, Thurairajasingam S, Ramasamy P, Mohd Yusof H, Yasin MABM, Shah ZUBS. Methadone complications amongst opioid-dependent patients in Malaysia: A case series. Drug Alcohol Rev 2016; 37:147-151. [PMID: 27859761 DOI: 10.1111/dar.12456] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/21/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Opioid dependence remains the main type of illicit substance used in Malaysia, which has an estimated 187 771 opiate users. There are currently 333 active methadone maintenance treatment centres nationwide. Although methadone has proven to be an effective maintenance therapy, it has clinical concerns which can have an impact on its effectiveness and safety. DESIGN, METHODS AND RESULTS A case series of seven patients from Malaysian private and public hospital settings who had an adverse reaction with methadone is discussed. DISCUSSION AND CONCLUSION Despite methadone being an effective therapy for opioid dependence, there is a need for other alternative effective therapies, such as naltrexone, buprenorphine and the co-formulation of buprenorphine-naloxone, to be made available to physicians in both public and private sectors. There is need for individual treatment consideration to avoid adverse effects, drug-drug interactions, overdosing and in the presence of co-morbidities. An emphasis on safe storage of takeaway methadone is also needed. [George P, Vicknasingam B, Thurairajasingam S, Ramasamy P, Mohd Yusof H, Yasin MABM, Shah ZUBS. Methadone complications amongst opioid-dependent patients in Malaysia: A case series. Drug Alcohol Rev 2018;37:147-151].
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Affiliation(s)
- Philip George
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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Shoptaw S. A few words on 'Which medications are suitable for agonist drug maintenance?'. Addiction 2016; 111:778-9. [PMID: 26913986 DOI: 10.1111/add.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Steven Shoptaw
- UCLA Department of Family Medicine, 10880 Wilshire Boulevard, Suite 1800, Los Angeles, CA, 90095-7087, USA.
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17
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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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Stuart RM, Lief E, Donald B, Wilson D, Wilson DP. The funding landscape for HIV in Asia and the Pacific. J Int AIDS Soc 2015; 18:20004. [PMID: 26578252 PMCID: PMC4649013 DOI: 10.7448/ias.18.1.20004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 09/11/2015] [Accepted: 09/20/2015] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Despite recent and robust economic growth across the Asia-Pacific region, the majority of low- and middle-income countries in the region remain dependent on some donor support for HIV programmes. We describe the availability of bilateral and multilateral official development assistance (ODA) for HIV programmes in the region. METHODS The donor countries considered in this analysis are Australia, Canada, Denmark, France, Germany, Netherlands, Norway, Sweden, the United Kingdom and the United States. To estimate bilateral and multilateral ODA financing for HIV programmes in the Asia-Pacific region between 2004 and 2013, we obtained funding data from the Organisation for Economic Co-operation and Development Creditor Reporting System database. Where possible, we checked these amounts against the funding data available from government aid agencies. Estimates of multilateral ODA financing for HIV/AIDS were based on the country allocations announcement by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) for the period 2014 to 2016. RESULTS Countries in the Asia-Pacific region receive the largest share of aid for HIV from the Global Fund. Bilateral funding for HIV in the region has been relatively stable over the last decade and is projected to remain below 10% of the worldwide response to the epidemic. Bilateral donors continue to prioritize ODA for HIV to other regions, particularly sub-Saharan Africa; Australia is an exception in prioritizing the Asia-Pacific region, but the United States is the bilateral donor providing the greatest amount of assistance in the region. Funding from the Global Fund has increased consistently since 2005, reaching a total of US$1.2 billion for the Asia-Pacific region from 2014 to 2016. CONCLUSIONS Even with Global Fund allocations, countries in the Asia-Pacific region will not have enough resources to meet their epidemiological targets. Prevention funding is particularly vulnerable and requires greater domestic leadership and coordination. Bilateral donors are still crucially important in the response to HIV throughout the Asia-Pacific region.
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Affiliation(s)
- Robyn M Stuart
- The Kirby Institute, University of New South Wales, Sydney, Australia
- Department of Mathematical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Burnet Institute, Melbourne, Australia
| | | | - Braedon Donald
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - David Wilson
- Global HIV/AIDS Program, The World Bank, Washington, DC, USA
| | - David P Wilson
- The Kirby Institute, University of New South Wales, Sydney, Australia
- The Burnet Institute, Melbourne, Australia;
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Tanguay P, Kamarulzaman A, Aramrattana A, Wodak A, Thomson N, Ali R, Vumbaca G, Lai G, Chabungbam A. Facilitating a transition from compulsory detention of people who use drugs towards voluntary community-based drug dependence treatment and support services in Asia. Harm Reduct J 2015; 12:31. [PMID: 26470779 PMCID: PMC4608322 DOI: 10.1186/s12954-015-0071-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/15/2015] [Indexed: 11/13/2022] Open
Abstract
Evidence indicates that detention of people who use drugs in compulsory centers in the name of treatment is common in Cambodia, China, Indonesia, Lao PDR, Malaysia, Myanmar, Philippines, Thailand, and Vietnam. The expansion of such practices has been costly, has not generated positive health outcomes, and has not reduced supply or demand for illicit drugs. United Nations agencies have convened several consultations with government and civil society stakeholders in order to facilitate a transition to voluntary evidence- and community-based drug dependence treatment and support services. In an effort to support such efforts, an informal group of experts proposes a three-step process to initiate and accelerate national-level transitions. Specifically, the working group recommends the establishment of a national multisectoral decision-making committee to oversee the development of national transition plans, drug policy reform to eliminate barriers to community-based drug dependence treatment and support services, and the integration of community-based drug dependence treatment in existing national health and social service systems.In parallel, the working group recommends that national-level transitions should be guided by overarching principles, including ethics, human rights, meaningful involvement of affected communities, and client safety, as well as good governance, transparency, and accountability. The transition also represents an opportunity to review the roles and responsibilities of various agencies across the public health and public security sectors in order to balance the workload and ensure positive results. The need to accelerate national-level transitions to voluntary community-based drug dependence treatment and support services is compelling--on economic, medical, sustainable community development, and ethical grounds--as extensively documented in the literature. In this context, the expert working group fully endorses initiation of a transition towards voluntary evidence- and community-based drug dependence treatment and support services across the region, as well as the steady scale-down of compulsory centers for drug users.Components of voluntary community-based drug dependence treatment and support services are being implemented in Cambodia, China, Indonesia, Malaysia, and Thailand. However, significant technical and financial support will be required to be allocated from national budgets and by international development agencies in order to complete the transition and reduce the reliance on detention of people who use drugs in Asia.
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Affiliation(s)
| | | | - Apinun Aramrattana
- Department of Family Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Alex Wodak
- Alcohol and Drug Service, St Vincent's Hospital, Sydney, Australia.
| | - Nicholas Thomson
- University of Melbourne's School of Population and Global Health, Melbourne, Australia.
- John Hopkins Bloomberg School of Public Health, Baltimore, United States.
| | - Robert Ali
- Australian National Advisory Council on Alcohol & Drugs (ANACAD), Adelaide, Australia.
| | - Gino Vumbaca
- Australian National Council on Drugs (ANCD), Canberra, Australia.
| | - Gloria Lai
- International Drug Policy Consortium, Bangkok, Thailand.
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