PMID- 26471235 OWN - NLM STAT- MEDLINE DCOM- 20160610 LR - 20240520 IS - 1477-7517 (Electronic) IS - 1477-7517 (Linking) VI - 12 DP - 2015 Oct 16 TI - Impact of a methadone maintenance therapy pilot in Vietnam and its role in a scaled-up response. PG - 39 LID - 10.1186/s12954-015-0075-9 [doi] LID - 39 AB - BACKGROUND: As a dual response to the HIV epidemic and the high level of injecting drug use in Vietnam, the Ministry of Health (MOH) initiated a pilot methadone maintenance therapy (MMT) program in Hai Phong and Ho Chi Minh City (HCMC) in early 2009. The objectives of the pilot were to provide evidence on whether MMT could be successfully implemented in Vietnam and scaled up to other localities. METHODS: A prospective study was conducted among 965 opiate drug users admitted to the pilot. Data on demographic characteristics, sexual behaviors, substance use behaviors (including heroin use), and blood-borne virus infection (HIV, hepatitis B, and hepatitis C) were collected at treatment initiation and then again at 3-, 6-, 9-, 12-, 18-, and 24-month intervals thereafter. RESULTS: Twenty-four months after treatment initiation, heroin use as measured by urine test or self-report had reduced from 100 % of participants at both sites to 14.6 % in Hai Phong and 22.9 % in HCMC. When adjusted for multiple factors in Generalized Estimating Equations (GEE) logistic regression modeling, independent predictors of continued heroin use after 24 months of MMT in HCMC were the following: poor methadone adherence (adjusted odds ratio (AOR) = 3.7, 95 % confidence interval (CI) 1.8-7.8); currently on antiretroviral treatment (ART) (AOR = 1.8, 95 % CI 1.4-2.4); currently on TB treatment (AOR = 2.2, 95 % CI 1.4-3.4); currently experiencing family conflict (AOR = 1.6, 95 % CI 1.1-2.4); and currently employed (AOR = 0.8, 95 % CI 0.6-1.0). For Hai Phong participants, predictors were the following: currently on ART (AOR = 2.0, 95 % CI = 1.4-3.0); currently experiencing family conflict (AOR = 2.0, 95 % CI = 1.0-3.9); and moderate adherence to methadone (AOR = 2.1, 95 % CI = 1.2-1.9). In Hai Phong, the percentage of participants who were employed had also increased by end of study from 35.0 to 52.8 %, while in HCMC the level remained relatively unchanged, between 52.2 and 55.1 %. DISCUSSION: Study findings were used in multiple fora to convince policymakers and the public on the significant and vital role MMT can play in reducing heroin use and improving quality of life for individuals and families. Four years after this study was completed, Vietnam had expanded MMT to 162 clinics in 44 provinces serving 32,000 patients. FAU - Hoang, Tran Vu AU - Hoang TV AD - Partners in Health Research, 47 Yen Phu Street, Tay Ho District, Hanoi, Vietnam. Hoang@phr.com.vn. FAU - Ha, Tran Thi Thanh AU - Ha TT AD - FHI 360, 7th floor, Hanoi Tourist Building, 8 Ly Thuong Kiet Street, Hanoi, Vietnam. hatranthanh@yahoo.com. FAU - Hoang, Tran Minh AU - Hoang TM AD - Hanoi Medical University, No. 1, Ton That Tung Street, Hanoi, Vietnam. tranminhhoang123@gmail.com. FAU - Nhu, Nguyen To AU - Nhu NT AD - FHI 360, 7th floor, Hanoi Tourist Building, 8 Ly Thuong Kiet Street, Hanoi, Vietnam. tonhu@fhi360.org. FAU - Quoc, Nguyen Cuong AU - Quoc NC AD - FHI 360, 7th floor, Hanoi Tourist Building, 8 Ly Thuong Kiet Street, Hanoi, Vietnam. Quoc@fhi360.org. FAU - Tam, Nguyen thi Minh AU - Tam Nt AD - Vietnam Administration for AIDS Control, Vietnam Ministry of Health, 5th floor, 138a Giang Vo Street, Ba Dinh District, Hanoi, Vietnam. minhtam71@yahoo.com. FAU - Mills, Stephen AU - Mills S AD - FHI 360, 19th Floor, Sindhorn Building, Wittayu Road, Bangkok, Thailand. Smills@fhi360.org. LA - eng GR - 486-A-00-06-00009-00/PEPFAR/United States GR - 486-A-11-00011/PEPFAR/United States PT - Journal Article PT - Observational Study PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20151016 PL - England TA - Harm Reduct J JT - Harm reduction journal JID - 101153624 RN - 0 (Narcotics) RN - UC6VBE7V1Z (Methadone) SB - IM MH - Adult MH - Cohort Studies MH - Female MH - Follow-Up Studies MH - HIV Infections/prevention & control MH - Heroin Dependence/*rehabilitation MH - Humans MH - Male MH - Methadone/*therapeutic use MH - Narcotics/therapeutic use MH - Opiate Substitution Treatment/*statistics & numerical data MH - Pilot Projects MH - Prospective Studies MH - Quality of Life MH - Substance Abuse, Intravenous/*rehabilitation MH - Vietnam MH - Young Adult PMC - PMC4608299 EDAT- 2015/10/17 06:00 MHDA- 2016/06/11 06:00 PMCR- 2015/10/16 CRDT- 2015/10/17 06:00 PHST- 2015/06/11 00:00 [received] PHST- 2015/08/23 00:00 [accepted] PHST- 2015/10/17 06:00 [entrez] PHST- 2015/10/17 06:00 [pubmed] PHST- 2016/06/11 06:00 [medline] PHST- 2015/10/16 00:00 [pmc-release] AID - 10.1186/s12954-015-0075-9 [pii] AID - 75 [pii] AID - 10.1186/s12954-015-0075-9 [doi] PST - epublish SO - Harm Reduct J. 2015 Oct 16;12:39. doi: 10.1186/s12954-015-0075-9.