Commune Health Workers' Methadone Maintenance Treatment (MMT) Knowledge and Perceived Difficulties Providing Decentralized MMT Services in Vietnam

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 β=−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.

Examining common mental health disorders in people living with HIV on methadone maintenance therapy in Hanoi, Vietnam

“…This cross-sectional study documents the syndemic of HIV, substance use, and mental health disorders among MMT patients in Vietnam where the relationship between substance use behaviors and methadone compliance among PLH with CMD on MMT is complex. However, as Vietnam continues to expand MMT and integrate MMT and HIV care [41][42][43], prioritizing the mental health needs of this doubly vulnerable population is warranted and could lead to improved treatment outcomes and a reduction in risky behaviors. Integrated care programs will need to account for social, physical and economic barriers to care, such as patient perceptions of stigma towards HIV, injection drug use and limited availability and affordability of mental health care services [41,43,44].…”

HIV- and Drug Use–Related Stigma and Service Provision Among Community Health Workers in Vietnam

“…Confidence in HIV/drug-related service provision was measured by a six-item scale developed specifically for this study based on a qualitative work exploring health providers' perception and experiences of treating PWUD (McLaughlin, McKenna, Leslie, Moore, & Robinson, 2006). The scale has been used previously among CHW in Vietnam (Lin, Nguyen, & Li, 2018). The participants were asked to rate their level of confidence on the following areas: (1) getting in touch with PLH and/or PWUD in the community, (2) providing consultation for PLH and/or PWUD, (3) engaging PLH and/or PWUD to different treatment program, (4) helping PLH and/or PWUD adhere to the treatment, (5) motivating PLH and/or PWUD to make positive behavior change, and (6) providing long-term follow-up and care for PLH and/or PWUD.…”

“…Stigma in health care settings remains a major barrier to HIV and drug-related service provision (Tran et al, 2016). In particular, community health workers (CHW), who are on the front line of HIV and drug control in Vietnam, have significant prejudicial beliefs and attitudes towards PLH and PWUD (Lin, Nguyen, & Li, 2018). The purpose of this study was to decompose the stigma due to HIV infection and drug use status among CHW in Vietnam.…”

Facing drug addiction: Vietnam’s struggle with opioids

“…Despite the success of the pilot methadone maintenance treatment program started in 2008, there are many challenges ahead in expansion and maintenance of the program including the capacity of treatment programs and facilities, budget for the program, and knowledge and skill of the staffs at treatment facilities (Lin et al, 2018;Nguyen et al, 2012). The transition from donor-funded outpatient clinics to public health clinics has resulted not only in patients facing treatment disruptions but also with other problems such as fewer supportive services, more stigma and discrimination, and staff who lack training and experience to advise and persuade patients to continue participating in the treatment program.…”