Case study: Methadone maintenance treatment in Hanoi, Vietnam

Jardine, Melissa; Nguyen, Van Anh Thi; Khuat, Thu Hong

doi:10.1186/1477-7517-9-26

Cited by 10 publications

(14 citation statements)

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“…Our quantitative analysis extends previous qualitative literature suggesting interference between detention and MMT in Asia [102,103,119]. A recent 12 United Nation Joint Agency Statement called for an end to compulsory detention, as mandatory detention centres do not provide an effective environment for treatment of drug dependence and constantly violate internationally recognised human right standards [120].…”

Section: Discussionsupporting

confidence: 68%

Methadone Maintenance Treatment Participant Retention and Behavioural Effectiveness in China: A Systematic Review and Meta-Analysis

et al. 2013

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BackgroundMethadone maintenance treatment (MMT) has been scaled up by the Chinese government alongside persistent compulsory drug user detention, but the extent to which detention interferes with MMT is unknown. The study systematically reviews Chinese MMT retention rates, reasons for drop out, and behavioural changes.MethodChinese and English databases of literature are searched for studies reporting retention rates, drug use and sexual behaviours among MMT participants in China between 2004 and 2013. The estimates are summarized through a systematic review and meta-analysis.ResultsA total of 74 studies representing 43,263 individuals are included in this analysis. About a third of MMT participants drop out during the first three months of treatment (retention rate 69.0% (95% CI 57.7-78.4%)). Police arrest and detention in compulsory rehabilitation was the most common cause of drop out, accounting for 22.2% of all those not retained. Among retained participants, changing unsafe drug use behaviours was more effective than changing unsafe sexual behaviours. At 12 months following MMT initiation, 24.6% (15.7-33.5%) of MMT participants had a positive urine test, 9.3% (4.7-17.8%) injected drugs and only 1.1% (0.4-3.0%) sold sex for drugs. These correspond to 0.002 (<0.001-0.011), 0.045 (0.004-0.114) and 0.209 (0.076-0.580) times lower odds than baseline. However, MMT participants did not have substantial changes in condom use rates.ConclusionMMT is effective in drug users in China but participant retention is poor, substantially related to compulsory detention. Reforming the compulsory drug user detention system may improve MMT retention and effectiveness.

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Section: Discussionsupporting

confidence: 68%

Methadone Maintenance Treatment Participant Retention and Behavioural Effectiveness in China: A Systematic Review and Meta-Analysis

et al. 2013

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“…Perhaps more important, however, is the building of better partnerships between police and public health authorities. Recent programs of this sort in Southeast Asia show promise for better these groups in combating HIV (Beyrer, 2012; Chheng et al, 2012; Jardine et al, 2012; Sharma and Chatterjee, 2012). While the potential success of similar efforts in Ukraine remains unknown, these approaches are promising and should be piloted for study and eventual large-scale implementation in the region.…”

Section: Discussionmentioning

confidence: 99%

High rates of police detention among recently released HIV-infected prisoners in Ukraine: Implications for health outcomes

Izenberg¹,

Bachireddy²,

Soule³

et al. 2013

Drug and Alcohol Dependence

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Background Ukraine’s HIV epidemic, primarily affecting people who inject drugs (PWID), is expanding and transitioning despite free opioid substitution therapy (OST) and antiretroviral therapy (ART), two effective ways to reduce HIV transmission. Police detention not resulting in imprisonment, defined as police harassment, of PWID is common, but its prevalence and impact on health is not known. Method HIV-infected individuals (N=97) released from prison within one year were recruited and surveyed in two HIV-endemic Ukrainian cities about post-release police detention experiences. Data on the frequency of police detention, related adverse events, and impact on OST and ART continuity were collected, and correlates of detention were examined using logistic regression. Results Detention responses were available for 94 (96.9%) participants, of which 55 (58.5%) reported police detentions (mean=9.4 per person-year). For those detained while prescribed OST (N=28) and ART (N=27), medication interruption was common (67.9% and 70.4%, respectively); 23 of 27 participants prescribed OST (85.2%) were detained en route to/from OST treatment. Significant independent correlates of detention without charges included post-release ART prescription (AOR 4.98, p=0.021), current high-risk injection practices (AOR 5.03, p=0.011), male gender (AOR 10.88, p=0.010), and lower lifetime months of imprisonment (AOR 0.99, p=0.031). Conclusions HIV-infected individuals recently released from prison in Ukraine experience frequent police detentions, resulting in withdrawal symptoms, confiscation of syringes, and interruptions of essential medications, including ART and OST. Structural changes are urgently needed to reduce police detentions in order to control HIV transmission and improve both individual and public health.

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“…Yet the negative perceptions of community on drug users and regulations on drug rehabilitation make patients hesitant and fear to participate in any community-based treatment services, including MMT. They are often at risk of being sent to compulsory treatment if considered being bad users [26]. …”

Section: Discussionmentioning

confidence: 99%

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

Nguyen

Nguyễn

Pham

et al. 2012

Advances in Preventive Medicine

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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.

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Case study: Methadone maintenance treatment in Hanoi, Vietnam

Cited by 10 publications

References 0 publications

Methadone Maintenance Treatment Participant Retention and Behavioural Effectiveness in China: A Systematic Review and Meta-Analysis

Methadone Maintenance Treatment Participant Retention and Behavioural Effectiveness in China: A Systematic Review and Meta-Analysis

High rates of police detention among recently released HIV-infected prisoners in Ukraine: Implications for health outcomes

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

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