Mobilization for HIV Voluntary Counseling and Testing Services in Vietnam: Clients' Risk Behaviors, Attitudes and Willingness to Pay.

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.

Motivation for smoking cessation among drug-using smokers under methadone maintenance treatment in Vietnam.

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.

Factors associated with nicotine dependence during methadone maintenance treatment: findings from a multisite survey in Vietnam.

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.

Prevalence of cigarette smoking and associated factors in a large sample of HIV-positive patients receiving antiretroviral therapy in Vietnam.

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.

HIV infection, risk factors, and preventive services utilization among female sex workers in the Mekong Delta Region of Vietnam.

BACKGROUND: Risk behaviors among female sex workers (FSW) are considerable drivers of HIV infections in Vietnam, especially transmission between high-risk and low-risk groups. We assessed HIV prevalence and its correlates among FSWs, and the use of preventive services among this community in the Mekong Delta region, southern Vietnam. METHODS: A cross-sectional survey of 1,999 FSWs was carried out in five provinces including Ben Tre, Hau Giang, Kien Giang, Tien Giang, and Vinh Long between June, 2006 and June, 2007. We interviewed participants face-to-face in order to elicit information about their lives and potential risk factors, and we tested their sera to determine their HIV status. We then performed multivariate logistic regression analyses to investigate factors associated with HIV infection. RESULTS: Seventeen percent of the participating FSWs were street-based sex workers (SSWs) and the rest (83%) were entertainment establishment-based sex workers (ESWs). Unprotected sex with regular and casual clients in the past month was frequent among study participants (40.5% and 33.5% respectively). However, few respondents (1.3%) had ever injected drugs. Only 2.1% (95% confidence interval (CI): 1.6%-2.8%) of FSWs were found to be infected with HIV. HIV prevalence among SSWs was greater than among ESWs (3.8% vs. 1.8%, p = 0.02, respectively). Increased risk for HIV infection was significantly associated with the number of clients per month (adjusted odd ratio (aOR) = 2.65, 95% CI: 1.26-5.59). CONCLUSIONS: Interventions to reduce unsafe sex and drug injection, and to increase uptake of HIV testing among FSWs are necessary. Differences in HIV prevalence and its correlates by type of sex work emphasize the importance of constrained contexts in shaping risk behaviors among FSWs; that should be considered in designing HIV prevention programs.

HIV voluntary testing and perceived risk among female sex workers in the Mekong Delta region of Vietnam.

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.

Patient satisfaction with HIV/AIDS care and treatment in the decentralization of services delivery in Vietnam.

OBJECTIVE: We evaluated the patient satisfaction with HIV/AIDS care and treatment and its determinants across levels of health service administration in Vietnam. METHODS: We interviewed 1016 patients at 7 hospitals and health centers in three epicenters, including Hanoi, Hai Phong, and Ho Chi Minh City. The Satisfaction with HIV/AIDS Treatment Interview Scale (SATIS) was developed, and 3 dimensions were constructed using factor analysis, namely "Quality and Convenience"; "Availability and Responsiveness"; and "Competence of health care workers". RESULTS: In a band score of (0; 10), the mean scores of all domains were large; it was the highest in "Competence of health workers" (9.34±0.84), and the lowest in "Quality and Convenience" (9.03±1.04). The percentages of respondents completely satisfied with overall service quality and treatment outcomes were 42.4% and 18.8%, respectively. In multivariate analysis, factors related to higher satisfaction included female sex, older age, and living with spouses or partners. Meanwhile, lower satisfaction was found among patients who were attending provincial and district clinics; in the richest group; had higher CD4 count; and drug users. CONCLUSION: This study highlights the importance of improving the quality of HIV/AIDS services at the provincial and district clinics. Potential strategies include capacity building for health workers, integrative service delivery, engagements of family members in treatment supports, and additional attention and comprehensive care for drug users with HIV/AIDS.