Methadone Maintenance Therapy in Vietnam: An Overview and Scaling-Up Plan

Abstract

Vietnam is among the countries with the highest rate of HIV transmission through injecting drug users. HIV prevalence among injecting drug users is 20% and up to 50% in many provinces. An estimated number of drug users in the country by the end of 2011 were 171,000 in which the most common is heroin (85%). Detoxification at home, community, and in rehabilitation centers have been the main modalities for managing heroin addiction until Methadone Maintenance Treatment (MMT) was piloted in 2008. Recent reports have demonstrated positive treatment outcomes. Incidence of HIV was found remarkably low among patients on MMT. Treatment has significantly improved the quality of life as well as stability for society. The government has granted the Ministry of Health (MoH) to expand Methadone treatment to at least 30 provinces to provide treatment for more than 80,000 drug users by 2015. The Vietnam Administration for HIV/AIDS Control (VAAC) and MOH have outlined the role and responsibility of key departments at the central and local levels in implementing and maintaining MMT treatment. This paper will describe the achievements of the MMT pilot program and the scaling-up plan as well as strategies to ensure quality and sustainability and to overcome the challenges in the coming years.

The effectiveness of compulsory drug treatment: A systematic review

“…4,5 China, Vietnam and Malaysia, for example, all previously scaled up compulsory drug detention centers, but are increasingly moving towards voluntary methadone maintenance and needle and syringe distribution systems to reduce the risk of blood-borne disease transmission from PWID sharing injecting equipment. 51–57 Emerging evidence suggests that expanded OST dispensation in these settings has been effective in reducing drug use. 54,56–58 This scale up of evidence-based biomedical and harm reduction interventions is occurring despite China’s previous investment in a compulsory treatment infrastructure; as such, tensions remain between voluntary, public health-oriented approaches and compulsory detainment, 59 as they do in settings that include both compulsory and voluntary approaches, such as Mexico.…”

Compulsory drug detention centers in East and Southeast Asia

“…Along with a review of these laws and policies, greater financial investment in harm reduction compared to supply and demand reduction will need to take place. An additional challenge for most of the affected countries is the limited in-country technical capacity in substance use prevention, treatment, care and support for which capacity building in a broad range of areas will need to take place to transition treatment into voluntary community based settings (Nguyen, Nguyen, Pham, Vu, & Mulvey, 2012). A significant barrier to progress is the difficulty in convincing policy makers of the need for the immediate closure of the CDDCs in the absence of adequate resources and facilities providing evidence-based treatment in the community and the continued focus on abstinence-based model of treatment as compared to harm reduction approaches in many of these affected countries.…”

Willingness to pay for methadone maintenance treatment in Vietnamese epicentres of injection-drug-driven HIV infection

“…14,23,24 Interviewers then summarized the government's plan for scaling up MMT. 11,25 Although MMT was free as of 2012, interviewers concluded the summary by asserting that, because of decreasing international funding, it will be difficult for the government to expand treatment coverage. Double-bounded dichotomouschoice questions backed by an openended question were used to elicit willingness to pay for MMT.…”