Community Capacity Building for HIV and Addiction Service Integration: An Intervention Trial in Vietnam

Abstract

Scientific findings and policy guidelines recommend integrating HIV and drug addiction prevention and care into community-based settings. Systematic capacity-building efforts are warranted to provide technical support for community health workers and improve their confidence in the integrated service provision. An intervention trial was conducted between 2018 and 2019 with 120 community health workers (CHW) from 60 communes in Vietnam’s four provinces. The 60 intervention CHW received in-person training to enhance their HIV/addiction-related service knowledge and skills. Online support groups were established between trained CHW and local HIV and addiction specialists. The intervention outcomes were assessed using mixed-effects regression models with the data collected at baseline and every 3 months for 1 year. Adjusted analyses showed that intervention CHW reported a significant increase in the interaction with other treatment providers than the control group at 6 months and remained at the 12-month follow-up. The difference in the improvement of confidence in HIV/addiction-related service delivery between the intervention and control groups was significant at 6-month but became insignificant at the 12-month. Male CHW were more confident in providing services than female CHW at baseline, and gender differences in the changing patterns were observed over time. This capacity-building intervention demonstrated promising outcomes on CHW inter-agency collaborations and confidence in service delivery. Gender divides in healthcare professionals should be attended to in future studies.

Integration measurement and its applications in low- and middle-income country health systems: a scoping review

“…Professional integration is defined as, “inter-professional partnerships based on shared competences, roles, responsibilities and accountability to deliver a comprehensive continuum of care to a defined population” in the RMIC [ 25 ]. Six papers were deemed to measure professional integration alone [ 85 – 90 ]. These papers emphasize measurement constructs of communication and collaboration across providers, leadership, and collaboration.…”

“…All papers measuring professional integration were quantitative and utilized surveys of providers [ 85 – 88 , 90 ]; one paper also included government officials and patients in the study population [ 89 ]. Constructs or indicators used to measure professional integration were similar across included papers and emphasized communication across medical professionals for referrals or treatment across levels of the health system [ 86 , 89 ], leadership and decision making [ 88 ], teamwork [ 85 – 87 ], provider communication for coordination of care [ 87 – 89 ], and provider collaborative capacity [ 90 ]. For example, Li et al .…”

Integrating HIV and substance misuse services: a person-centred approach grounded in human rights

“…There are accounts of how CHWs in some settings have significantly increased their interaction with other providers, as well as improved their confidence in providing HIV/addiction-related health services. 90 However, task-shifting must not become 'task-dumping' and models of care should respect all those involved. 91 An alternative integration design is based on community outreach centres or mobile drop-in clinics, offering services such as HCV testing, immunizations, rehabilitation, mental health services, care coordination, and syringe exchange programmes.…”

“…67 There is also a need for greater gender and cultural concordance between providers and people seeking care to better ensure approachable and culturally appropriate care environments. 90,101 Besides the barrier of stigma, physical barriers play an important role in access to HIV and SUD care. Distance to care influences transportation costs, and adequate sick-leave policies can negatively impact patients' ability to seek care.…”

“…96 Training to increase care in communities: A clustered RCT study conducted across four provinces in Vietnam (Bac Giang, Hai Duong, Nam Dinh, and Nghe An) provided 60 CHWs in the intervention group with in-person and online training to enhance their HIV/addiction-related service knowledge and skills for a length of 12 months. 90 Capacity building of CHWs with training intervention was considered effective as CHWs in the intervention group reported significant increase in their interaction with other providers as well as improved their confidence in providing HIV/addiction-related health services.…”