RESUMEN
Background HIV prevalence among men who have sex with men (MSM) and transgender women (TGW) in Vietnam is high, whereas coverage of effective HIV prevention services has been inadequate. Studies have measured MSM and TGW demand for pre-exposure prophylaxis (PrEP) services, which led to the design of the first ever PrEP program in Vietnam, Prepped for PrEP (P4P). METHODS: In March 2017, PrEP services were offered in Ho Chi Minh City as part of the P4P demonstration project, enabling same-day enrolment in three key population (KP)-led clinics and four public clinics. P4P aimed to assess acceptability and feasibility of PrEP services through calculating the rate of PrEP enrolment over time, and quarterly measures of continuation and adherence over an 18-month period. RESULTS: A total of 1069 MSM and 62 TGW were enrolled in P4P. Average monthly PrEP enrolment among MSM increased five-fold from the first 3 months (March-June 2017) to the last 3 months of active enrolment (March-June 2018), whereas for TGW, no increased trend in PrEP enrolment per quarter was seen. Self-reported PrEP adherence was >90% at all time points among MSM, but varied from 11.1% to 88.9% among TGW. PrEP continuation was calculated at months 3, 6, 9, 12, 15 and 18. For MSM, it was 88.7% at month 3, 68.8% at month 12 and 46.6% at month 18, whereas for TGW, it was 87.1%, 54.8% and 52.8%, respectively. Multivariable regression identified that MSM with lower-than-average income (adjusted odds ratio (aOR) 2.38 (95% confidence interval (CI): 1.59-3.54), P = 0.000), aged >30 years (aOR 2.03 (95% CI: 1.30-3.40), P = 0.007) and with an increasing number of sex partners (aOR: 1.06 (1.01-1.11), P = 0.011) had greater odds of remaining on PrEP. For TGW, being aged >30 years was associated with continuing on PrEP (aOR 5.62 (95% CI: 1.05-29.9), P = 0.043). CONCLUSIONS: We found PrEP to be highly acceptable among MSM and moderately acceptable among TGW. Continuation rates were relatively high for the first roll-out of PrEP; however, those aged ≤30 years were much more likely to discontinue services. Scaling-up PrEP through differentiated and community-led and engaged PrEP service delivery will be key to effectively increase access and uptake over the next 5 years.
Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Personas Transgénero , Fármacos Anti-VIH/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Humanos , Masculino , VietnamRESUMEN
OBJECTIVES: Smoking is associated with adverse health outcomes among drug users, including those in treatment. To date, however, there has been little evidence about smoking patterns among people receiving opioid-dependence treatment in developing countries. We examined self-reported nicotine dependence and associated factors in a large sample of opioid-dependent patients receiving methadone maintenance treatment (MMT) in northern Vietnam. SETTING: Five clinics in Hanoi (urban area) and Nam Dinh (rural area). PARTICIPANTS: Patients receiving MMT in the settings during the study period. PRIMARY AND SECONDARY OUTCOME MEASURES: We collected data about smoking patterns, levels of nicotine dependence and other covariates such as socioeconomic status, health status, alcohol use and drug use. The Fagerström test was used to measure nicotine dependence (FTND). Logistic regression and Tobit regression were employed to examine relationships between the smoking rate, nicotine dependence and potentially associated variables. RESULTS: Among 1016 drug users undergoing MMT (98.7% male), 87.2% were current smokers. The mean FTND score was 4.5 (SD 2.4). Longer duration of MMT (OR 0.98, 95% CI 0.96 to 0.99) and being HIV-positive (OR 0.46, 95% CI 0.24 to 0.88) were associated with lower likelihood of smoking. Being employed, older age at first drug injection and having long duration of MMT were inversely related with FTND scores. Higher age and continuing drug and alcohol use were significantly associated with higher FTND scores. CONCLUSION: Smoking prevalence is high among methadone maintenance drug users. Enhanced smoking cessation support should be integrated into MMT programmes in order to reduce risk factors for cigarette smoking and improve the health and well-being of people recovering from opiate dependence.
Asunto(s)
Seropositividad para VIH/epidemiología , Trastornos Relacionados con Opioides/complicaciones , Trastornos Relacionados con Opioides/tratamiento farmacológico , Fumar/epidemiología , Tabaquismo/epidemiología , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Analgésicos Opioides/uso terapéutico , Estudios Transversales , Países en Desarrollo , Femenino , Humanos , Modelos Logísticos , Masculino , Metadona/uso terapéutico , Persona de Mediana Edad , Análisis Multivariante , Tratamiento de Sustitución de Opiáceos/métodos , Autoinforme , Factores Socioeconómicos , Vietnam/epidemiologíaRESUMEN
BACKGROUND: Ensuring high enrollment while mobilizing resources through co-payment services is critical to the success of the methadone maintenance treatment (MMT) program in Vietnam. This study assessed the willingness of patients to pay (WTP) for different MMT services delivery models and determined its associated factors. METHODS: A facility based survey was conducted among 1016 MMT patients (98.7% male, 42% aged 35 or less, and 67% living with spouse) in five MMT clinics in Hanoi and Nam Dinh province in 2013. Socioeconomic, HIV and health status, history of drug use and rehabilitation, and MMT experience were interviewed. WTP was assessed using contingent valuation method, including a set of double-bounded binary questions and a follow-up open-ended question. Point and interval data models were used to estimate maximum willingness to pay. RESULTS: 95.5% patients were willing to pay for MMT at the monthly mean price of US$ 32 (95%CI = 28-35). Higher WTP was associated with higher level of educational attainment, higher income, male sex, and had high expenses on opiates prior to MMT. Patients who reported having any problem in Pain/ Discomfort, and who did not have outpatient care last year were willing to pay less for MMT than others. CONCLUSION: High level of WTP supports the co-payment policies as a strategy to mobilize resources for the MMT program in Vietnam. However, it is necessary to ensure equalities across patient groups by acknowledging socioeconomic status of different settings and providing financial supports for disadvantaged patients with severe health status.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Deducibles y Coseguros/economía , Metadona/uso terapéutico , Tratamiento de Sustitución de Opiáceos/economía , Clase Social , Adolescente , Adulto , Estudios Transversales , Femenino , Financiación Personal , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/tratamiento farmacológico , Encuestas y Cuestionarios , Vietnam , Poblaciones Vulnerables , Adulto JovenRESUMEN
BACKGROUND: Ensuring an equal benefit across different patient groups is necessary while scaling up free-of-charge antiretroviral treatment (ART) services. This study aimed to measure the disparity in access, adherence, and outcomes of ART in Vietnam and the effects of socioeconomic status (SES) characteristics on the levels of inequality. METHODS: A cross-sectional study was conducted in 1133 PLWH in Vietnam. ART access, adherence, and treatment outcomes were self-reported using a structured questionnaire. Wealth-related inequality was calculated using a concentration index, and a decomposition analysis was used to determine the contribution of each SES variable to inequality in access, adherence, and outcomes of ART. RESULTS: Based on SES, minor inequality was found in ART access and adherence while there was considerable inequality in ART outcomes. Poor people were more likely to start treatment early, while rich people had better adherence and overall treatment outcomes. Decomposition revealed that occupation and education played important roles in inequality in ART access, adherence, and treatment outcomes. CONCLUSION: The findings suggested that health services should be integrated into the ART regimen. Furthermore, occupational orientation and training courses should be provided to reduce inequality in ART access, adherence, and treatment outcomes.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/tratamiento farmacológico , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Factores Socioeconómicos , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/psicología , Adolescente , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , VIH-1/fisiología , Humanos , Masculino , Cumplimiento de la Medicación/psicología , Persona de Mediana Edad , Aceptación de la Atención de Salud , Factores de Riesgo , Autoinforme , Clase Social , Vietnam/epidemiología , Adulto JovenRESUMEN
BACKGROUND: The rapid expansion of methadone maintenance treatment (MMT) services has significantly improved health status and quality of life of patients. However, little is known about its impacts on addiction-related stigma and associated factors. METHODS: A cross-sectional survey was conducted in 2013 in Vietnam's capital, Hanoi, and Nam Dinh province among 1016 methadone maintenance patients; 26.6 % at provincial AIDS centers (PAC) and 73.4 % at district health centers (DHC), respectively. Drug addiction history and related stigma, health status, MMT-related covariates, and sociodemographic characteristics were interviewed. RESULTS: More than one-sixth of the sample reported experiencing felt or enacted stigma, including Blame or Judgement (17.2 %), Shame (19.9 %), or Others' fear of HIV transmission (17.1 %). These proportions were higher in PACs than in DHCs, which are integrated with other HIV or general health care services. Very few patients reported being discriminated at the workplace (2.5 %) or at health care services (1.7 %); however, 15.6 % of patients at PACs and 10.6 % of patients at DHCs reported discrimination in their communities. Drug users taking MMT for longer periods were less likely to report felt stigma. Other factors associated with stigma against MMT patients included the lack of comprehensive services, higher education, presence of pain/discomfort, and anxiety/depression, self-reported HIV positive, and number of previous drug rehabilitation episodes. CONCLUSION: The study shows a high level of stigma against MMT patients and emphasizes the necessity to integrate MMT with comprehensive health and support services. Mass communication campaigns to reduce stigma against people with drug addiction and HIV/AIDS, as well as vocational trainings and jobs referrals for MMT patients, are needed to maximize the benefits of MMT programs in Vietnam.
Asunto(s)
Consumidores de Drogas/psicología , Metadona/uso terapéutico , Tratamiento de Sustitución de Opiáceos , Estigma Social , Trastornos Relacionados con Sustancias/psicología , Adulto , Estudios Transversales , Consumidores de Drogas/estadística & datos numéricos , Femenino , Infecciones por VIH/psicología , Administración de los Servicios de Salud , Humanos , Masculino , Modelos Organizacionales , Investigación Cualitativa , Trastornos Relacionados con Sustancias/rehabilitación , VietnamRESUMEN
BACKGROUND: Vietnam is among those countries with the highest drinking prevalence. In this study, we examined the prevalence of alcohol use disorders (AUDs) and its associations with HIV risky behaviors, health care utilization, and health-related quality of life (HRQOL) among clients using voluntary HIV testing and counseling services (VCT). METHODS: A cross-sectional survey of 365 VCT clients (71% male; mean age 34) was conducted in Hanoi and Nam Dinh province. AUD and HRQOL were measured using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), and EuroQol-five dimensions-five levels (EQ-5D-5L). Risky sexual behaviors, concurrent opioid use, and inpatient and outpatient service use were self-reported. RESULTS: 67.2% clients were lifetime ever drinkers of those 62.9% were hazardous drinkers and 82.0% were binge drinkers. There were 48.8% respondents who had ≥2 sex partners over the past year and 55.4, 38.3, and 46.1% did not use condom in the last sex with primary/casual/commercial sex partners, respectively. Multivariate models show that AUD was significantly associated with risky sexual behaviors, using inpatient care and lower HRQOL among VCT clients. CONCLUSIONS: AUD was prevalent, was associated with increased risks of HIV infection, and diminished health status among VCT clients. It may be efficient to screen for AUD and refer at-risk clients to appropriate AUD counseling and treatment along with HIV-related services.
Asunto(s)
Alcoholismo/complicaciones , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Estado de Salud , Adulto , Consumo Excesivo de Bebidas Alcohólicas/complicaciones , Consumo Excesivo de Bebidas Alcohólicas/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/diagnóstico , Encuestas de Atención de la Salud , Humanos , Masculino , Trastornos Relacionados con Opioides/complicaciones , Trastornos Relacionados con Opioides/epidemiología , Calidad de Vida , Riesgo , Asunción de Riesgos , Clase Social , Sexo Inseguro/estadística & datos numéricos , Vietnam/epidemiologíaRESUMEN
BACKGROUND: Integrating HIV/AIDS and methadone maintenance treatment (MMT) services with existing health care delivery system is critical in sustaining efforts to fight HIV/AIDS in large injection-driven epidemics. However, efficiency of different integrative service models is unknown. This study assessed behavioral and health-related quality-of-life (HRQOL) outcomes of MMT in four service delivery models and explored factors associated with these outcomes of interest. METHODS: A cross-sectional survey was conducted in two HIV epicenters in Vietnam: Hanoi and Nam Dinh Province. All patients in five selected MMT clinics were invited to participate, and 1016 were interviewed (80-90% response rate). RESULTS: Respondents had a mean age of 35.8, taken MMT for average 16.5 months and 3.3% on MMT for 36-60 months. The MMT integrated with rural district health center (DHC) has the highest prevalence of concurrent drug use (11.3%). The percentage of condom use (last sexual intercourse) with primary and casual partners was lowest in the MMT at urban DHCs. Patients at the rural DHC reported very high proportions of pain/discomfort (37.8%), anxiety/depression (43.1%), and mobility (13.3%). In regression models, poorer HRQOL outcomes were found in MMT models in the rural areas or without general health care, and among those patients who were HIV positive, reported concurrent drug use, and had higher numbers of previous drug rehabilitation episodes. Mobility and anxiety/depression are factors that increased the likelihood of concurrent drug use among MMT patients. CONCLUSIONS: Outcomes of MMT were diverse across different integrative service models. Policies on rapid expansion of the MMT program in Vietnam should also emphasize on the integration with comprehensive health care services including psychological supports for patients.
Asunto(s)
Metadona/uso terapéutico , Narcóticos/uso terapéutico , Tratamiento de Sustitución de Opiáceos/psicología , Trastornos Relacionados con Opioides/psicología , Trastornos Relacionados con Opioides/rehabilitación , Calidad de Vida , Adulto , Estudios Transversales , Atención a la Salud/organización & administración , Femenino , Seropositividad para VIH/epidemiología , Humanos , Masculino , Modelos Organizacionales , Población Rural , Factores Socioeconómicos , Resultado del Tratamiento , Sexo Inseguro , Población Urbana , Vietnam/epidemiologíaRESUMEN
BACKGROUND: Co-payment for methadone maintenance treatment (MMT) services is a strategy to ensure the financial sustainability of the HIV/AIDS programs in Vietnam. In this study, we examined health services utilization and expenditure among MMT patients, and further explored factors associated with catastrophic health expenditure among affected households. METHODS: A multi-site cross-sectional study was conducted among 1016 patients in two epicentres: Hanoi and Nam Dinh province in 2013. RESULTS: Overall, 8.2% and 28.7% respondents used inpatient and outpatient health care services in the past 12 months apart from receiving MMT. There were 12.8% respondents experiencing catastrophic health expenditure given MMT is provided free-of-charge, otherwise 63.5% patients would suffer from health care costs. MMT integrated with general health or HIV services may encourage health care services utilization of patients. Patients, who were single, lived in the rural, had inpatient care and reported problems in Mobility were more likely to experience catastrophic health expenditure than other patient groups. CONCLUSIONS: The health care costs are still financially burden to many drug users and remained over the course of MMT that implies the necessity of continuous supports from the program. Scaling-up and decentralizing integrated MMT clinics together with economic empowerments for treated drug users and their families should be prioritized in Vietnam.
Asunto(s)
Analgésicos Opioides/economía , Costos de los Medicamentos , Consumidores de Drogas , Gastos en Salud , Reembolso de Seguro de Salud/economía , Metadona/economía , Tratamiento de Sustitución de Opiáceos/economía , Trastornos Relacionados con Opioides/economía , Trastornos Relacionados con Opioides/rehabilitación , Adolescente , Adulto , Analgésicos Opioides/administración & dosificación , Estudios Transversales , Consumidores de Drogas/legislación & jurisprudencia , Consumidores de Drogas/psicología , Femenino , Recursos en Salud/economía , Humanos , Reembolso de Seguro de Salud/legislación & jurisprudencia , Masculino , Metadona/administración & dosificación , Trastornos Relacionados con Opioides/diagnóstico , Trastornos Relacionados con Opioides/psicología , Vietnam , Adulto JovenRESUMEN
A total of 2768 MSM participated in a survey in southern Vietnam. Univariate and multivariate logistic regression analyses were performed to determine predictors of HIV infection. The prevalence of HIV among MSM was 2.6 %. HIV infection was more likely in MSM who were older, had a religion, had engaged in anal sex with a foreigner in the past 12 months, previously or currently used recreational drugs, perceived themselves as likely or very likely to be infected with HIV, and/or were syphilis seropositive. MSM who had ever married, were exclusively or frequently receptive, sometimes consumed alcohol before sex, and/or frequently used condoms during anal sex in the past 3 months were less likely to be infected with HIV. Recreational drug use is strongly associated with HIV infection among MSM in southern Vietnam. HIV interventions among MSM should incorporate health promotion, condom promotion, harm reduction, sexually transmitted infection treatment, and address risk behaviors.
Asunto(s)
Alcoholismo/epidemiología , Condones/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Homosexualidad Masculina/estadística & datos numéricos , Drogas Ilícitas , Conducta Sexual/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adolescente , Adulto , Estudios Transversales , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Masculino , Prevalencia , Asunción de Riesgos , Enfermedades de Transmisión Sexual/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Encuestas y Cuestionarios , Vietnam/epidemiología , Adulto JovenRESUMEN
A multi-site survey was conducted on a sample of 365 clients to assess their willingness to pay for HIV voluntary counseling and testing (VCT) services in Ha Noi and Nam Dinh province, two epicenters of Vietnam. By using contingent valuation technique, the results showed that most of respondents (95.1 %) were willing to pay averagely 155 (95 % CI 132-177) thousands Vietnam Dong (~US $7.75, 2013) for a VCT service. Clients who were female, had middle income level, and current opioid users were willing to pay less; meanwhile clients who had university level of education were willing to pay more for a VCT service. The results highlighted the high rate of willingness to pay for the service at a high amount by VCT clients. These findings contribute to the implementation of co-payment scheme for VCT services toward the financial sustainability of HIV/AIDS programs in Vietnam.
Asunto(s)
Serodiagnóstico del SIDA/economía , Consejo/economía , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Costos de la Atención en Salud/estadística & datos numéricos , Aceptación de la Atención de Salud , Serodiagnóstico del SIDA/estadística & datos numéricos , Consejo/estadística & datos numéricos , Escolaridad , Femenino , Infecciones por VIH/psicología , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Trastornos Relacionados con Opioides , Asunción de Riesgos , Clase Social , Encuestas y Cuestionarios , VietnamRESUMEN
BACKGROUND: Smoking cessation treatment service is concerned to be a critical element in methadone maintenance treatment (MMT) in order to diminish the effect of smoke on health outcomes. To implement the smoking cessation services in Vietnam, we examined the stages of change to quit and determined associated factors among MMT patients. METHODS: We conducted a cross-sectional survey with 1016 MMT patients in five clinics in Hanoi and Nam Dinh province, of those, 932 (91.7%) were ever-smokers. Patients were classified into four groups: "pre-contemplation," "contemplation," "preparation," and "action and maintenance" by using the transtheoretical model. Multivariate logistic regression was applied to determine the associated factor for intention and action to quit smoking. RESULTS: Overall, 96% were not actively trying to quit or maintain abstinence. Age older than 45, HIV-positive status, and residence in Hanoi were negatively associated with intention to quit. Meanwhile, higher levels of nicotine dependence and number of years of smoking negatively associated with quitting and abstinence. CONCLUSIONS: The study indicated the high rate of MMT smokers being in pre-contemplation stage but low proportion of quitting and maintaining abstinence. It emphasizes the importance of availability and accessibility of information about smoking cessation therapies and services. Integrating cessation programs into health-care services should be considered to provide tailored interventions for different patient groups.
Asunto(s)
Metadona/uso terapéutico , Motivación , Tratamiento de Sustitución de Opiáceos/psicología , Cese del Hábito de Fumar/psicología , Trastornos Relacionados con Sustancias/terapia , Tabaquismo/terapia , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/psicología , Tabaquismo/complicaciones , Tabaquismo/psicología , VietnamRESUMEN
BACKGROUND: Patient satisfaction is an important component of quality in healthcare delivery. To inform the expansion of Methadone Maintenance Treatment (MMT) services in Vietnam, we examined the satisfaction of patients with regards to different services delivery models and identified its associated factors. METHODS: We interviewed 1,016 MMT patients at 5 clinics in Hanoi and Nam Dinh province. The modified SATIS instrument, a 10-item scale, was used to measure three dimensions: "Services quality and convenience", "Health workers' capacity and responsiveness" and "Inter-professional care". RESULTS: The average score was high across three SATIS dimensions. However, only one third of patients completely satisfied with general health services and treatment outcomes. Older age, higher education, having any problem in self-care and anxiety/depression were negatively associated with patient's satisfaction. Meanwhile, patients receiving MMT at clinics, where more comprehensive HIV and general health care services were available, were more likely to report a complete satisfaction. CONCLUSION: Patients were highly satisfied with MMT services in Vietnam. However, treatment for drug users should go beyond methadone maintenance to address complicated health demands of drug users. Integrating MMT with comprehensive HIV and general health services together with improving the capacity of health workers and efficiency of services organisation to provide interconnected health care for drug users are critical for improving the outcomes of the MMT program.
Asunto(s)
Metadona/uso terapéutico , Tratamiento de Sustitución de Opiáceos/psicología , Satisfacción del Paciente , Adulto , Instituciones de Atención Ambulatoria , Estudios Transversales , Prestación Integrada de Atención de Salud/métodos , Consumidores de Drogas/psicología , Femenino , Infecciones por VIH/complicaciones , Humanos , Masculino , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/tratamiento farmacológico , Trastornos Relacionados con Sustancias/psicología , VietnamRESUMEN
BACKGROUND: Integrating and decentralizing services are essential to increase the accessibility and provide comprehensive care for methadone patients. Moreover, they assure the sustainability of a HIV/AIDS prevention program by reducing the implementation cost. This study aimed to measure the preference of patients enrolling in a MMT program for integrated and decentralized MMT clinics and then further examine related factors. METHODS: A cross-sectional study was conducted among 510 patients receiving methadone at 3 clinics in Hanoi. Structured questionnaires were used to collect data about the preference for integrated and decentralized MMT services. Covariates including socio-economic status; health-related quality of life (using EQ-5D-5 L instrument) and HIV status; history of drug use along with MMT treatment; and exposure to the discrimination within family and community were also investigated. Multivariate logistic regression with polynomial fractions was used to identify the determinants of preference for integrative and decentralized models. RESULTS: Of 510 patients enrolled, 66.7 and 60.8 % preferred integrated and decentralized models, respectively. The main reason for preferring the integrative model was the convenience of use of various services (53.2 %), while more privacy (43.5 %) was the primary reason to select stand-alone model. People preferred the decentralized model primarily because of travel cost reduction (95.0 %), while the main reason for not selecting the model was increased privacy (7.7 %). After adjusting for covariates, factors influencing the preference for integrative model were poor socioeconomic status, anxiety/depression, history of drug rehabilitation, and ever disclosed health status; while exposure to community discrimination inversely associated with this preference. In addition, people who were self-employed, had a longer duration of MMT, and use current MMT with comprehensive HIV services were less likely to select decentralized model. CONCLUSION: In conclusion, the study confirmed the high preference of MMT patients for the integrative and decentralized MMT service delivery models. The convenience of healthcare services utilization and reduction of geographical barriers were the main reasons to use those models within drug use populations in Vietnam. Countering community stigma and encouraging communication between patients and their societies needed to be considered when implementing those models.
Asunto(s)
Reducción del Daño , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Metadona/uso terapéutico , Tratamiento de Sustitución de Opiáceos/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/rehabilitación , Adulto , Comorbilidad , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Masculino , Narcóticos/uso terapéutico , Calidad de Vida , Factores Socioeconómicos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Encuestas y Cuestionarios , Vietnam/epidemiologíaRESUMEN
BACKGROUND: Smoking cessation is emerging as an important component in current HIV care to reduce smoking-related adverse health outcomes. This study aimed to examine motivation to quit and its associated factors in a sample of 409 HIV-positive smokers in Vietnam. METHODS: A cross-sectional survey was conducted from January to September 2013 in Hanoi (the capital) and Nam Dinh (a rural city). Motivation to quit was measured by a 4-point single item, and was dichotomized as having any motivation versus no motivation. Smoking history, nicotine dependence (Fagerstrom Test of Nicotine Dependence), and other covariates were self-reported by participants. Multivariate logistic regression was performed to identify correlates of motivation to quit. RESULTS: The sample was mostly male (97%). Mean age was 36 years (SD = 5.8). Approximately 37% and 69% of the sample were hazardous drinkers and ever drug users, respectively. The mean duration of HIV infection and ART treatment were 6 years (SD = 3.6) and 5 years (SD = 2.2), respectively. Overall, 59% of the sample was motivated to quit. Factors significantly associated with motivation to quit were income, pain, currently taking Methadone, and the interaction between binge drinking and lifetime drug use. Individuals with the highest income level (OR = 2.2, 95% CI = 1.3-3.6), moderate income level (OR = 1.8, 95% CI = 1.1-3.1), and currently feeling pain (OR = 1.6, 95% CI = 1.0-2.5) were more likely to be motivated to quit. Conversely, taking Methadone was associated with a lower likelihood of motivation to quit (OR = 0.4, 95% CI = 0.2-0.9). Also, those who reported binge drinking only (OR = 0.5, 95% CI = 0.3-0.9), lifetime drug use only (OR = 0.3, 95% CI = 0.1, 0.7), or both substance uses (OR = 0.4, 95% CI = 0.2, 0.8) were less motivated to quit smoking. CONCLUSION: Smoking cessation treatment should be integrated into HIV care in Vietnam, and should be tailored to meet specific needs for individuals with different attitudes on smoking, low income, and polysubstance use.
Asunto(s)
Seropositividad para VIH , Motivación , Cese del Hábito de Fumar/psicología , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Pobreza , Cese del Hábito de Fumar/estadística & datos numéricos , VietnamRESUMEN
BACKGROUND: Cigarette smoking presents a salient risk for HIV-positive populations. This study is among the first to examine smoking prevalence, nicotine dependence, and associated factors in a large sample of HIV-positive patients receiving antiretroviral therapy (ART) in Vietnam. METHODS: A cross-sectional study of 1133 HIV-positive people was conducted from January to September 2013 at 8 ART clinics in Hanoi (the capital) and Nam Dinh (a rural area). Smoking history and nicotine dependence (Fagerstrom Test of Nicotine Dependence-FTND) were assessed by participant self-report. Logistic regression and Tobit linear regression were performed to identify factors significantly associated with smoking outcomes. RESULTS: Prevalence of current, former, and never smokers in the sample was 36.1%, 9.5%, and 54.4%, respectively. The current smoking proportion was higher in males (59.7%) than females (2.6%). The mean FTND score was 3.6 (SD = 2.1). Males were more likely to currently smoke than females (OR = 23.4, 95% CI = 11.6-47.3). Individuals with problem drinking (OR = 1.8, 95% CI = 1.1-2.9) and ever drug use (OR = 3.7, 95%CI = 2.5-5.7) were more likely to be current smokers. Older age and currently feeling pain were associated with lower nicotine dependence. Conversely, receiving care in Nam Dinh, greater alcohol consumption, ever drug use, and a longer smoking duration were associated with greater nicotine dependence. CONCLUSIONS: Given the high prevalence of smoking among HIV-positive patients, smoking screening and cessation support should be offered at ART clinics in Vietnam. Risk factors (i.e., substance use) linked with smoking behavior should be considered in prevention programs.
Asunto(s)
Infecciones por VIH/epidemiología , Fumar/epidemiología , Adulto , Fármacos Anti-VIH/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Prevalencia , Factores Socioeconómicos , VietnamRESUMEN
INTRODUCTION: HIV voluntary counseling and testing (VCT) comprise an effective preventive measure and an entry point to care and support services. We sought to assess VCT uptake and HIV-related knowledge and perceived risk among female sex workers (FSWs) in five provinces of the Mekong Delta region. METHODS: A cross-sectional survey was carried out in 1998 FSWs, including both street-based sex workers (SSWs) and entertainment-based sex workers (ESWs). RESULTS: High proportions of FSWs were aware that using condoms (94.6%), and clean needles (34.1%) are preventive measures that reduce the risk of HIV transmission. Some FSWs reported avoiding public toilet use (8.6%), physical contacts (16.1%), or sharing meals (10.9%) with people living with HIV/AIDS, and preventing mosquito bites (20.8%). Twenty-nine percent (29.0%) of FSWs perceived themselves as being at risk of HIV infection. Only 32.7% had ever tested for HIV, of whom 54% were voluntary for testing. FSWs who ever injected drugs (OR = 0.03, p=0.05), had drug-injecting clients (OR = 0.07, p<0.01), and had inconsistent condom use with husbands or lovers (OR = 0.10, p=0.01) were less likely to have a voluntary test. Inconsistent condom use with clients (OR = 13.86, p<0.01), and receiving HIV information from radio (OR = 13.28, p<0.05) and communication campaigns (OR = 6.69, p<0.05), increased the likelihood of VCT uptake. CONCLUSION: Inadequate knowledge and some misconceptions about HIV transmission routes and preventive measures, low perceived risk of HIV infection, and low VCT uptake were observed among FSWs in the Mekong Delta region. Interventions to improve their knowledge and self-efficacy, reduce risky behaviors, and encourage VCT uptake and early access to health care services are necessary to prevent HIV transmission in this region.
Asunto(s)
Serodiagnóstico del SIDA , Actitud Frente a la Salud , Trabajadores Sexuales/psicología , Sexo Inseguro/psicología , Serodiagnóstico del SIDA/tendencias , Adolescente , Adulto , Condones/estadística & datos numéricos , Estudios Transversales , Escolaridad , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Asunción de Riesgos , Trabajadores Sexuales/estadística & datos numéricos , Vietnam/epidemiología , Programas Voluntarios/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: The prevalence of HIV and sexually transmitted infections among men who have sex with men (MSM) has increased substantially in Vietnam. This study aimed to estimate the prevalence of HIV, syphilis, urethral gonorrhoea, and urethral chlamydia, and determined correlates of HIV infection among MSM in An Giang, Vietnam. METHODS: A group of 381 MSM were recruited in a community-based cross-sectional survey between August and December 2009. Face-to-face interviews were conducted for collecting data on sociodemographics, behaviors, and access to HIV prevention programs. Serological tests for HIV and syphilis and polymerase chain reaction for gonorrhoea/chlamydia were performed. Multivariate regression analyses were used to investigate the correlates of HIV infection. RESULTS: The prevalence of HIV, syphilis, gonorrhoea, chlamydia, and gonorrhoea/chlamydia were 6.3%, 1.3%, 1.8%, 3.2%, and 4.7%, respectively. HIV prevalence among 63 injecting MSM was significantly higher than that of 318 noninjectors (20.6% vs. 3.5%, P < 0.001). Approximately 40.4% identified as heterosexual and 42.8% had ever had sex with females. The rate of unprotected anal intercourse with another male in the last month was substantially high (75.3%). Injecting drugs (adjusted prevalence ratio [aPR] = 2.88, 95% confidence interval [CI]: 1.12-7.42), being transgender (aPR = 4.27, 95% CI, 1.17-15.57), and unprotected sex with a female sex worker (aPR = 4.88, 95% CI: 1.91-12.50) were significantly associated with HIV infection. The infection risk increased with age to a peak of 25 years and then decreased. CONCLUSIONS: Although prevalence levels are lower in An Giang, Vietnam than in some other comparable locations, HIV/sexually transmitted infections prevention, and sexual health promotion targeting MSM are highly important in this location.