1
|
Giang LM, Trang NT, Thuy DT, Nguyen HH, Diep NB, Van HTH, Truc TT, Reback CJ, Li M, Van Dung D, Shoptaw S. Using ADAPT-ITT framework to tailor evidence-based interventions for addressing methamphetamine use among methadone patients in Vietnam. Drug Alcohol Rev 2023; 42:1667-1679. [PMID: 37614129 PMCID: PMC10848814 DOI: 10.1111/dar.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Methamphetamine use threatens positive treatment outcomes in substance use and HIV, for people with opioid use disorders (POUD) in many countries. This paper describes the adaptation of four evidence-based interventions (EBI) (motivational interviewing, contingency management, Matrix group model and SMS text messaging) for treating methamphetamine use among POUD receiving methadone maintenance therapy in Vietnam. METHODS Following the ADAPT-ITT (Assessment-Decision-Administration-Production-Topical experts-Training-Testing) framework, we conducted 16 focus group discussions with POUD (n = 25) and providers (n = 22) at four methadone clinics in two largest cities (Hanoi in the North, Ho Chi Minh City in the South) to assess patterns of methamphetamine use and to get feedback on proposed EBIs. The proposed EBIs were properly adapted and used to train providers in two of the four methadone clinics. The revised EBIs were tested over 12 weeks among 42 POUD on methadone who use methamphetamine. Post-intervention feedback served to fine-tune the revised EBIs. RESULTS Insights about patterns of methamphetamine use suggested that EBIs should focus on different triggers to methamphetamine use among POUD receiving methadone treatment in the two cities. All EBIs should emphasise family-related topics to build a strong motivation for treatment. Participants suggested when, where and how each EBI should be delivered. Most participants were satisfied with the adapted EBIs. Limited human resources at methadone clinics might hinder implementation of the adapted EBIs. DISCUSSION AND CONCLUSIONS We successfully completed the adaptation of EBIs for POUD who use methamphetamine on methadone in Vietnam. The pilot testing of the adapted EBIs demonstrated feasibility and acceptability. TRIAL REGISTRATION NCT04706624. Registered 13 January 2021. https://clinicaltrials.gov/ct2/show/NCT04706624.
Collapse
Affiliation(s)
- Le Minh Giang
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Thu Trang
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Dinh Thanh Thuy
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Hoa H. Nguyen
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Bich Diep
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | | | - Thai Thanh Truc
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Cathy J. Reback
- Friends Research Institute, Friends Community Center, Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, California, USA
| | - Michael Li
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, California, USA
| | - Do Van Dung
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Steve Shoptaw
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, California, USA
| |
Collapse
|
2
|
Giang LM, Trang NT, Diep NB, Thuy DTD, Thuy DT, Hoe HD, Van HTH, Truc TT, Nguyen HH, Lai NL, Linh PTD, Vi VTT, Reback CJ, Leibowitz A, Li L, Lin C, Li M, Do Van Dung, Shoptaw S. An adaptive design to screen, treat, and retain people with opioid use disorders who use methamphetamine in methadone clinics (STAR-OM): study protocol of a clinical trial. Trials 2022; 23:342. [PMID: 35461300 PMCID: PMC9034071 DOI: 10.1186/s13063-022-06278-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methamphetamine use could jeopardize the current efforts to address opioid use disorder and HIV infection. Evidence-based behavioral interventions (EBI) are effective in reducing methamphetamine use. However, evidence on optimal combinations of EBI is limited. This protocol presents a type-1 effectiveness-implementation hybrid design to evaluate the effectiveness, cost-effectiveness of adaptive methamphetamine use interventions, and their implementation barriers in Vietnam. METHOD Design: Participants will be first randomized into two frontline interventions for 12 weeks. They will then be placed or randomized to three adaptive strategies for another 12 weeks. An economic evaluation and an ethnographic evaluation will be conducted alongside the interventions. PARTICIPANTS We will recruit 600 participants in 20 methadone clinics. ELIGIBILITY CRITERIA (1) age 16+; (2) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores ≥ 10 for methamphetamine use or confirmed methamphetamine use with urine drug screening; (3) willing to provide three pieces of contact information; and (4) having a cell phone. OUTCOMES Outcomes are measured at 13, 26, and 49 weeks and throughout the interventions. Primary outcomes include the (1) increase in HIV viral suppression, (2) reduction in HIV risk behaviors, and (3) reduction in methamphetamine use. COVID-19 response: We developed a response plan for interruptions caused by COVID-19 lockdowns to ensure data quality and intervention fidelity. DISCUSSION This study will provide important evidence for scale-up of EBIs for methamphetamine use among methadone patients in limited-resource settings. As the EBIs will be delivered by methadone providers, they can be readily implemented if the trial demonstrates effectiveness and cost-effectiveness. TRIAL REGISTRATION ClinicalTrials.gov NCT04706624. Registered on 13 January 2021. https://clinicaltrials.gov/ct2/show/NCT04706624.
Collapse
Affiliation(s)
- Le Minh Giang
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Thu Trang
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam.
| | - Nguyen Bich Diep
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Dao Thi Dieu Thuy
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Dinh Thanh Thuy
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Han Dinh Hoe
- Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam
| | | | - Thai Thanh Truc
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hoa H Nguyen
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Ly Lai
- South Vietnam HIV and Addiction Technology Transfer Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Pham Thi Dan Linh
- South Vietnam HIV and Addiction Technology Transfer Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Vu Thi Tuong Vi
- South Vietnam HIV and Addiction Technology Transfer Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Cathy J Reback
- Friends Research Institute, Friends Community Center, Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, USA
| | - Arleen Leibowitz
- Department of Public Policy, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, USA
| | - Li Li
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, USA
| | - Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, Jane & Terry Semel Institute for Neuroscience & Human Behavior, University of California, Los Angeles, Los Angeles, USA
| | - Michael Li
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, Los Angeles, USA
| | - Do Van Dung
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Steve Shoptaw
- Center for Behavioral and Addiction Medicine, Department of Family Medicine, University of California, Los Angeles, Los Angeles, USA
| |
Collapse
|
3
|
Edsall A, Hoffman KA, Thuy DT, Mai PP, Hang NT, Khuyen TT, Trang NT, Kunkel LE, Giang LM, Korthuis PT. Use of methamphetamine and alcohol among people with opioid use disorder and HIV in Vietnam: a qualitative study. BMC Public Health 2021; 21:1718. [PMID: 34548042 PMCID: PMC8456677 DOI: 10.1186/s12889-021-11783-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heroin use continues to drive HIV transmission in Vietnam, but methamphetamine and alcohol use are growing rapidly and, as in other countries, polysubstance use is widespread. The objective of this study was to understand the interplay between heroin, methamphetamine, and alcohol use among people with opioid use disorder (OUD) and HIV in Vietnam. METHODS We conducted 44 in-depth, face-to-face qualitative interviews with people with OUD and HIV who participated in the BRAVO trial of buprenorphine versus methadone in five Vietnam HIV clinics. Interviews probed participants' experiences of heroin, methamphetamine, and alcohol use and their interplay with HIV/OUD treatment. Interviews were professionally transcribed and analyzed using a thematic analysis approach. RESULTS Of 44 participants interviewed 42 were male, on average 38.8 years of age, with 30 reporting a history of methamphetamine use and 33 reporting a history of alcohol use. Several themes emerged: 1) Methamphetamine and alcohol were perceived to have lower addiction potential than heroin 2) Social settings were key facilitators of alcohol and methamphetamine use 3) Some participants, but not all, used methamphetamine to help quit heroin 4) Consuming alcohol blunted the effects of heroin, while paradoxically serving as a catalyst for heroin use 5) Use of methamphetamine was perceived by many participants to be incompatible with treatment for HIV. CONCLUSIONS Participant experiences reflected a significant impact of polysubstance use on treatment of HIV and OUD. Patterns of polysubstance use are subject to common preconceptions of alcohol and methamphetamine as having a low addictive potential, and these substances are deeply enmeshed in the social life of many people with OUD in Vietnam. Interventions to address complex social norms and potential harms of polysubstance use are urgently needed as the population of people receiving medication for OUD (MOUD) increases in Vietnam and globally. TRIAL REGISTRATION BRAVO - NCT01936857 , September 2013.
Collapse
Affiliation(s)
- Andrew Edsall
- Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Kim A Hoffman
- Oregon Health & Science University - Portland State University School of Public Health, 840 SW Gaines St, Room 230, Portland, OR, 97239, USA
| | - Dinh Thanh Thuy
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - Pham Phuong Mai
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - Nguyen Thu Hang
- Oregon Health & Science University - Portland State University School of Public Health, 840 SW Gaines St, Room 230, Portland, OR, 97239, USA
| | - Tong Thi Khuyen
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - Nguyen Thu Trang
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - Lynn E Kunkel
- Oregon Health & Science University - Portland State University School of Public Health, 840 SW Gaines St, Room 230, Portland, OR, 97239, USA
| | - Le Minh Giang
- Hanoi Medical University, 1 Tôn Thất Tùng, Kim Liên, Đống Đa, Hà Nội, 116001, Vietnam
| | - P Todd Korthuis
- Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- Oregon Health & Science University - Portland State University School of Public Health, 840 SW Gaines St, Room 230, Portland, OR, 97239, USA
- Department of Medicine, Section of Addiction Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| |
Collapse
|
4
|
Korthuis PT, King C, Cook RR, Khuyen TT, Kunkel LE, Bart G, Nguyen T, Thuy DT, Bielavitz S, Nguyen DB, Tam NTM, Giang LM. HIV clinic-based buprenorphine plus naloxone versus referral for methadone maintenance therapy for treatment of opioid use disorder in HIV clinics in Vietnam (BRAVO): an open-label, randomised, non-inferiority trial. Lancet HIV 2021; 8:e67-e76. [PMID: 33539760 DOI: 10.1016/s2352-3018(20)30302-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND UNAIDS recommends integrating methadone or buprenorphine treatment of opioid use disorder with HIV care to improve HIV outcomes, but buprenorphine adoption remains limited in many countries. We aimed to assess whether HIV clinic-based buprenorphine plus naloxone treatment for opioid use disorder was non-inferior to referral for methadone maintenance therapy in achieving HIV viral suppression in Vietnam. METHODS In an open-label, non-inferiority trial (BRAVO), we randomly assigned people with HIV and opioid use disorder (1:1) by computer-generated random number sequence, in blocks of ten and stratified by site, to receive HIV clinic-based buprenorphine plus naloxone treatment or referral for methadone maintenance therapy in six HIV clinics in Vietnam. The primary outcome was HIV viral suppression at 12 months (HIV-1 RNA ≤200 copies per mL on PCR) by intention to treat (absolute risk difference [RD] margin ≤13%), compared by use of generalised estimating equations. Research staff actively queried treatment-emergent adverse events during quarterly study visits and passively collected adverse events reported during HIV clinic visits. This study is registered with ClinicalTrials.gov, NCT01936857, and is completed. FINDINGS Between July 27, 2015, and Feb 12, 2018, we enrolled 281 patients. At baseline, 272 (97%) participants were male, mean age was 38·3 years (SD 6·1), and mean CD4 count was 405 cells per μL (SD 224). Viral suppression improved between baseline and 12 months for both HIV clinic-based buprenorphine plus naloxone (from 97 [69%] of 140 patients to 74 [81%] of 91 patients) and referral for methadone maintenance therapy (from 92 [66%] of 140 to 99 [93%] of 107). Buprenorphine plus naloxone did not demonstrate non-inferiority to methadone maintenance therapy in achieving viral suppression at 12 months (RD -0·11, 95% CI -0·20 to -0·02). Retention on medication at 12 months was lower for buprenorphine plus naloxone than for methadone maintenance therapy (40% vs 65%; RD -0·53, 95% CI -0·75 to -0·31). Participants assigned to buprenorphine plus naloxone more frequently experienced serious adverse events (ten [7%] of 141 vs four of 140 [3%] assigned to methadone maintenance therapy) and deaths (seven of 141 [5%] vs three of 141 [2%]). Serious adverse events and deaths typically occurred in people no longer taking ART or opioid use disorder medications. INTERPRETATION Although integrated buprenorphine and HIV care may potentially increase access to treatment for opioid use disorder, scale-up in middle-income countries might require enhanced support for buprenorphine adherence to improve HIV viral suppression. The strength of our study as a multisite randomised trial was offset by low retention of patients on buprenorphine. FUNDING National Institute on Drug Abuse (US National Institutes of Health).
Collapse
Affiliation(s)
- P Todd Korthuis
- Addiction Medicine Program, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA.
| | - Caroline King
- Addiction Medicine Program, Oregon Health & Science University, Portland, OR, USA
| | - Ryan R Cook
- Addiction Medicine Program, Oregon Health & Science University, Portland, OR, USA
| | | | - Lynn E Kunkel
- Addiction Medicine Program, Oregon Health & Science University, Portland, OR, USA
| | - Gavin Bart
- Hennepin Healthcare, Minneapolis, MN, USA
| | - Thuan Nguyen
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | | | - Sarann Bielavitz
- Addiction Medicine Program, Oregon Health & Science University, Portland, OR, USA
| | | | - Nguyen Thi Minh Tam
- Vietnam Administration for HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | | |
Collapse
|
5
|
Takahashi S, Thuy DT, Sato H, Kubota Y, Sun XZ, Chandrasekharan NV. Effects of the restriction of food and water intake on the distribution and retention of radioiodine in mice. J Radiat Res 2000; 41:313-320. [PMID: 11210832 DOI: 10.1269/jrr.41.313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The effects of the restriction of food and water intakes on gastrointestinal absorption, distribution to organs and excretion of 131I were investigated in C3H/He mice. The animals were divided into four groups and administered orally 37 kBq carrier-free Na 131I in 0.25 ml normal saline. One group of animals was given food and water ad libitum throughout the experimental period. Food and water to the remaining groups were restricted before and/or after the administration of 131I. The animals in each group were sacrificed 4 h and 24 h after administration, and the activity of 131I in thyroid, blood, liver, kidney, gastrointestinal tract, urine, feces, and carcass was measured. There was a significant increase in the retention of 131I in the thyroid and the concentration of 131I in the blood due to the restriction of food and water after the administration of 131I. In contrast, a significant decrease in the urinary excretion was observed in these animals. In those animals, which fasted before administration only, the retention of 131I in the thyroid and other organs were decreased. Therefore, for an accurate diagnosis and effective therapy with radioiodine as well as effective radiation protection, the intake of food and water should be taken into account.
Collapse
Affiliation(s)
- S Takahashi
- 4th Research Group, National Institute of Radiological Sciences, 9-1, Anagawa-4-chome, Inage-ku, Chiba-shi, Chiba 263-8555, Japan.
| | | | | | | | | | | |
Collapse
|