Avoidance of healthcare service use and correlates among HIV-positive patients in Vietnam: a cross-sectional study.

OBJECTIVE: The prevention of HIV/AIDS is not making sufficient progress. The slow reduction of HIV/AIDS infections needs to prioritise hesitancy towards service utilisation, including treatment duration, social support and social stigma. This study investigates HIV-positive patients' avoidance of healthcare services and its correlates. DESIGN: A cross-sectional study. SETTING: The secondary data analysis used cross-sectional data from a randomised controlled intervention, examining the effectiveness of HIV-assisted smartphone applications in the treatment of HIV/AIDS patients in the Bach Mai and Ha Dong clinics in Hanoi. METHODS: Simple random sampling was used to identify 495 eligible patients. Two-tailed χ2, Mann-Whitney, multivariate logistic and ordered logistic regression models were performed. PRIMARY AND SECONDARY OUTCOME MEASURES: The main study outcome was the patients' healthcare avoidance and frequency of healthcare avoidance. The association of individual characteristics, social and behavioural determinants of HIV patients' usage of health services was also determined based on the collected data using structured questionnaires. RESULTS: Nearly half of the participants avoid health service use (47.3%), while 30.7% rarely avoid health service use. Duration of antiretroviral therapy and initial CD4 cell count were negatively associated with avoidance of health services and frequency of health service avoidance. Similarly, those with the middle and highest income were more likely to avoid health services compared with those with the lowest income. People having health problems avoided health service use more frequently (OR 1.47, 95% CI 1.35 to 1.61). CONCLUSIONS: Our study's findings identify characteristics of significance in relation to health service avoidance and utilisation among HIV-positive patients. The results highlighted the need to improve satisfaction, adherence and utilisation of treatment. Moreover, identifying ways to address or incorporate those social determinants in new policy may also help the treatment of HIV/AIDS and strategically allocate funding in the changing financial and political climate of Vietnam. TRIAL REGISTRATION NUMBER: Thai Clinical Trials Registry TCTR20220928003.

Structural Equation Model for Social Support and Quality of Life Among Individuals With Mental Health Disorders During the COVID-19 Pandemic.

BACKGROUND: In light of the COVID-19 pandemic, the distribution of social support for mental health problems has likely become unequal. Family- and community-based social support has been recognized as a promising approach for mental disorders; however, limited global frameworks have been applied to developing countries such as Vietnam. OBJECTIVE: The aim of this study was to evaluate the quality of life and social support among patients with mental health disorders in Vietnam and to investigate the factors associated with quality of life among these patients. METHODS: A cross-sectional study was conducted on 222 psychiatric patients in Hanoi from 2020 to 2022. A structured questionnaire was developed based on four standardized scales: Mental Well-Being-5 scale, Multidimensional Scale of Perceived Social Support, EuroQoL-visual analog scale (EQ-VAS), and EuroQoL-5 dimensions-5 levels (EQ-5D-5L) scale. Tobit regression was used to identify factors associated with the EQ-5D-5L and EQ-VAS scores. Structural equation modeling was applied to verify the relationship between quality of life and social support. RESULTS: The results showed that perceived support from family scored the highest compared to support from friends and significant others. Patients with depression reported the lowest quality of life and perceived social support. Structural equation modeling showed a root mean square error of approximation of 0.055 (90% CI 0.006-0.090), comparative fit index of 0.954, Tucker-Lewis index of 0.892, and standardized root mean squared error of 0.036 (P<.001). The hypothetical model indicated statistically significant correlations between EQ-VAS score and social support (P=.004), EQ-5D-5L and mental well-being (P<.001), and social support and mental well-being (P<.001). Critical deterioration of quality of life and inconsistency in social support for patients with mental illness were also recorded. CONCLUSIONS: There is a need to enhance social support and service delivery in Vietnam, focusing on occupation and quality of life. The correlations between social support, quality of life, and mental health issues suggest the potential of a clinical-social integrated intervention model of care.

Psychological impacts of COVID-19 on Vietnamese health workers over the prolonged restricted COVID-19 responses: a cross-sectional study.

OBJECTIVE: We assessed the psychological impact posed by COVID-19 and its associated factors on the healthcare workforce nationwide during the peak of Vietnam's fourth outbreak. DESIGN: A cross-sectional study. SETTING: Our study was conducted in 61 provinces of Vietnam. METHODS: A total of 2814 healthcare professionals in 61/63 provinces of Vietnam. An online questionnaire using Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale-4 (PSS-4) and Generalised Anxiety Disorder-7 (GAD-7) scales was distributed randomly to a subgroup of 503 respondents. PRIMARY AND SECONDARY OUTCOME MEASURES: To determine the impact of COVID-19 on the psychological of health workers, we conducted analyses to test a primary hypothesis related to participants based on three main scales including PHQ-9, PSS-4 and GAD-7 scales. RESULTS: Nearly half (49.7%) of healthcare workers experienced mild depression symptoms, 34.0% underwent moderate anxiety symptoms and 49.3% reported high-stress levels. Respondents who had a monthly income below 5 million VND (~US$212) and had more than 3 days of duty per week had a higher score on the anxiety scales. Compared with medical doctors, nurses/midwives had lower PHQ-9 (Coef=-2.53; 95% CI=-3.71 to -1.36) and GAD-7 scores (Coef=-2.36; 95% CI=-3.56 L to -1.16). Increased workload and work time was the harmful factor that increase the PHQ-9, GAD-7 or PSS-4 scores. More than half (53.9%) of respondents stated no demand for mental healthcare services. CONCLUSIONS: Health workers who gained less financial rewards are reported to have higher levels of mental distress than others, implying the need for a raise in basic salary as well as compensation and encouragement schemes. To tackle hesitancy in seeking mental help, integrating online mental health therapy with e-health consultations via social media can be strategically implemented to augment service delivery, and simultaneously enhance the standard of mental health services.

Characterizing the Development of Research Landscapes in Substance Use and HIV/AIDS During 1990 to 2021.

Mitigating the impacts of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and substance use requires comprehensive and systematic thinking in designing interventions and developing policies. This study describes the growth of research publications from 1991 to 2021 in the Web of Science database and points out current research landscapes in the fields of HIV/AIDS and substance use. Latent Dirichlet Allocation was used for classifying 21 359 papers into corresponding topics. The most common topics were HIV transmission, HIV infection, quality of life and mental health of substance users, and the biomedical effect of substance use. Emerging research landscapes include vulnerabilities of people who inject drugs to HIV transmission and related health problems. This study found a lack of research on health services, interdisciplinary and inter-sectoral in combination with clinical evaluation and treatment services. Future investment and implementation of HIV/AIDS and substance use programs should focus on research of health services and clinical evaluation, especially context-specific interventions.

Crucial choices in a global health crisis: Revealing the demand and willingness to pay for a hypothetical monkeypox vaccine - the PREVENT study.

Background: The latent monkeypox outbreak has become the most emergent public health challenge globally. This study was conducted to assess the acceptability, and willingness to take and pay for a hypothetical Monkeypox vaccine among the Vietnamese general public as well as investigate preference for individual vaccine attributes. Methods: An online cross-sectional study was conducted using snowball sampling among 842 respondents in Vietnam in 2022. A Discrete choice experiment (DCE) on preference for six major attributes of vaccine: effectiveness, immunity duration, side effects, mortality rate, restriction, and the cost was applied. Results: Fear of the impact of monkeypox on public health and the economy, vaccine service satisfaction and responsibility to the community were the most weighted factors in the decision to take a hypothetical monkeypox vaccine. Two-thirds of participants were willing to take the vaccine, while insufficient information on monkeypox and the vaccine were the main reasons for vaccine hesitancy. For vaccine attributes, the mortality rate after seven days of vaccination was the most weighted while cost was the least influential attribute. Factors associated with willingness to take and to pay for the monkeypox vaccine included knowledge of transmission, geographical location, service satisfaction, and risk of infection, while financial burden and fear of vaccine were major drivers of hesitancy. Conclusion: Our findings underline an urgent need for effective information dissemination through social media and counseling. The implementation of nationwide monkeypox vaccination requires prioritization and support for high-risk groups as well as consideration for the country's financial resources.

Improving the diagnostic accuracy for major depressive disorder using machine learning algorithms integrating clinical and near-infrared spectroscopy data.

BACKGROUND: Given that major depressive disorder (MDD) is both biologically and clinically heterogeneous, a diagnostic system integrating neurobiological markers and clinical characteristics would allow for better diagnostic accuracy and, consequently, treatment efficacy. OBJECTIVE: Our study aimed to evaluate the discriminative and predictive ability of unimodal, bimodal, and multimodal approaches in a total of seven machine learning (ML) models-clinical, demographic, functional near-infrared spectroscopy (fNIRS), combinations of two unimodal models, as well as a combination of all three-for MDD. METHODS: We recruited 65 adults with MDD and 68 matched healthy controls, who provided both sociodemographic and clinical information, and completed the HAM-D questionnaire. They were also subject to fNIRS measurement when participating in the verbal fluency task. Using the nested cross validation procedure, the classification performance of each ML model was evaluated based on the area under the receiver operating characteristic curve (ROC), balanced accuracy, sensitivity, and specificity. RESULTS: The multimodal ML model was able to distinguish between depressed patients and healthy controls with the highest balanced accuracy of 87.98 ± 8.84% (AUC = 0.92; 95% CI (0.84-0.99) when compared with the uni- and bi-modal models. CONCLUSIONS: Our multimodal ML model demonstrated the highest diagnostic accuracy for MDD. This reinforces the biological and clinical heterogeneity of MDD and highlights the potential of this model to improve MDD diagnosis rates. Furthermore, this model is cost-effective and clinically applicable enough to be established as a robust diagnostic system for MDD based on patients' biosignatures.

Prefrontal Cortical Activation While Doing Mindfulness Task: a Pilot Functional Near-Infrared Spectroscopy Study.

Mindfulness interventions are increasingly used in clinical settings. Neurophysiological mechanisms underlying mindfulness offer objective evidence that can help us evaluate the efficacy of mindfulness. Recent advances in technology have facilitated the use of functional Near-Infrared Spectroscopy (fNIRS) as a light weight, portable, and relatively lower cost neuroimaging device as compared to functional Magnetic Resonance Imaging (fMRI). In contrast to numerous fMRI studies, there are scanty investigations using fNIRS to study mindfulness. Hence, this study was done to investigate the feasibility of using a continuous-wave multichannel fNIRS system to study cerebral cortex activations on a mindfulness task versus a baseline task. NIRS data from 14 healthy Asian subjects were collected. A statistical parametric mapping toolbox specific for statistical analysis of NIRS signal called NIRS_SPM was used to study the activations. The results from group analysis performed on the contrast of the mindfulness versus baseline tasks showed foci of activations on the left and central parts of the prefrontal cortex. The findings are consistent with prevailing fMRI studies and show promise of using fNIRS system for studying real-time neurophysiological cortical activations during mindfulness practice.

Evidence of COVID-19 Impacts on Occupations During the First Vietnamese National Lockdown.

Background: Although "social isolation" protects the life and health of Vietnamese citizens from the adverse effects of the COVID-19 pandemic, it also triggers massive reductions in the economic activities of the country. Objective: our study aimed to identify negative impacts of COVID-19 on occupations of Vietnamese people during the first national lockdown, including the quality and quantity of jobs as well as adverse problems at work due to COVID-19. Methods: A cross-sectional study using web-based platforms was conducted during the first time of social isolation in Vietnam at the beginning of April 2020. We utilized a respondent-driven sampling technique to select 1423 respondents from 63 cities and provinces over Vietnam. Exploratory factor analysis (EFA) was used to define sub-domains of perceived impacts of COVID-19 on occupations. Findings: Approximately two-thirds of respondents reported decreases in their income (61.6%), and 28.2% reported that their income deficit was 40% and above. The percentage of female individuals having decreased revenue due to COVID-19 was higher than that of male respondents (65.2% and 54.7%, respectively). "Worry that colleagues exposed to COVID-19 patients" and "Being alienated because employment-related to COVID-19" accounted for the highest score in each factor. Compared to healthcare workers, being self-employed/unemployed/retired were less likely to suffer from "Increased workload and conflicts due to COVID-19" and "Disclosure and discrimination related to COVID-19 work exposure." Conclusion: Our study revealed a drastic reduction in both the quality and quantity of working, as well as the increased fear and stigmatization of exposure to COVID-19 at workplaces. Health protection and economic support are immediate targets that should be focused on when implementing policies and regulations.

Psychological distress among mountainous farmers in Vietnam: a cross-sectional study of prevalence and associated factors.

BACKGROUND: Psychological distress has been known as a major health problem among farmers across the world. In Vietnam, approximately 50% of farmers have lived in rural and mountainous areas. Yet, little has been known about how psychological distress impacts mountainous farmers' health. OBJECTIVES: This study aimed to examine the prevalence and risk factors related to psychological distress among mountainous farmers in Vietnam. DESIGN AND SETTING: A cross-sectional study was performed from August to September 2018 in Moc Chau district, Vietnam. A structured questionnaire and face-to-face interviews were used for data collection. PARTICIPANTS: A random sample of 197 farmers aged at least 18 years, spoke Vietnamese, was not suffering from severe diseases and residing in Moc Chau at the time of the survey were recruited. PRIMARY AND SECONDARY OUTCOME MEASURES: The Kessler Psychological Distress Scale (K6) was employed to measure psychological distress. The tobit and logistic regressions were applied to indicate associated factors. RESULTS: The prevalence of psychological distress was 38.2% (95% CI 31.3% to 45.5%). Having a greater comorbidities (OR=6.17; 95% CI 1.44 to 26.43), drinking alcohol (OR=3.86; 95% CI 1.02 to 14.59) and obtaining health information from health workers (OR=3.77; 95% CI 1.22 to 11.66) were positively associated with the prevalence of psychological distress. By contrast, being overweight (OR=0.29; 95% CI 0.09 to 0.93), adopting books as the primary source of health information (OR=0.11; 95% CI 0.01 to 0.8), and receiving a higher number of home visits by community health workers (CHWs) (OR=0.38; 95% CI 0.14 to 0.99) were negatively associated with the prevalence of psychological distress. CONCLUSION: This study highlighted a high prevalence of psychological distress among mountainous farmers. Providing routine psychological and physical health screening, developing CHWs to provide clinical support and raising health awareness are critical implications for reducing psychological distress in this population.

The operational readiness capacities of the grassroots health system in responses to epidemics: Implications for COVID-19 control in Vietnam.

BACKGROUND: There is a paucity of data on the operational readiness capacities of the grassroots health system in Vietnam while it plays a vital role as a first-line defense against health emergencies, including the coronavirus disease (COVID-19). This study, therefore, aims to assess the operational readiness capacities of the grassroots health system in response to epidemics and provides implications for controlling COVID-19 in Vietnam. METHODS: An online cross-sectional study using the respondent-driven sampling technique was conducted with 6029 health professionals and medical students in Vietnam from December 2019 to February 2020. The operational readiness capacities of the health system were assessed by the sufficiency of health professionals, administrative and logistics staffs, equipment and facilities, and general capacity of health professionals. Kruskal-Wallis test, Fisher exact test and χ2 test were employed to identify the differences among variables. Tobit and censored regression models were operated to determine associated factors. RESULTS: The operational readiness capacities of the grassroots health system for four assessed criteria were at moderate levels, ranging from 6.3 to 6.8 over 10. In Vietnam, the grassroots health system in rural areas, in the South, and at the district level were more likely to be vulnerable compared to their counterparts. CONCLUSIONS: According to empirical data, this study reveals the vulnerability of the grassroots health system in Vietnam and provides the rationality of prompt and vigorous actions of the Vietnamese Government against COVID-19. Findings also offer useful insights for effective strategies to strengthen the grassroots health system in the long term. In the short term, practicing precautionary measures and mobilizing human resources, as well as medical equipment, are needed to successfully contain COVID-19 in Vietnam.

The disappearance of white matter in an adult-onset disease: a case report.

BACKGROUND: Vanishing white matter disease (VWMD) is one of the most prevalent hereditary white matter diseases in childhood, but it is increasingly recognised in adulthood with high phenotypic variation and severity. CASE PRESENTATION: We report a case of an adult female presenting with emotional lability and cognitive impairment, in addition to progressive dystonia, ataxia, postural instability and recurrent falls. Magnetic resonance imaging (MRI) of the brain and genetic testing confirmed the diagnosis of VWMD. CONCLUSIONS: VWMD has a broad clinical presentation in adulthood, and the age at onset of symptoms is one of its most important prognostic factors. It is crucial to recognize the pathognomonic MRI patterns and consider VWMD as a differential diagnosis when assessing patients presenting with psychiatric, cognitive and non-specific neurological symptoms.

Establishing activity centers for elderly people in metropolitan areas of Vietnam: preference and willingness-to-pay.

PURPOSE AND AIM: The activity center (AC), an effective model for health support and health-related quality of life improvements for older people, has been operating for many years worldwide. This study aimed to assess the necessity of and preference for attending AC and its desired functions and facilities in elderly people in Vietnam. SUBJECTS AND METHODS: A cross-sectional study was conducted at parks and senior clubs, with 121 participants from 6 February to 20 April 2017, in Hanoi. The health status, preference, and willingness-to-pay for AC use of respondents were assessed. RESULTS: Over 75% of respondents agreed to establish an AC for older people. Among them, approximately 71.7% were willing to pay a monthly fee for this center. Elderly individuals who obtain regular physical examination when feeling pain/discomfort and who were participating in clubs for elder people were more likely to agree to establish and pay for an AC. Meanwhile, women who have to take care of grandchildren, people who were saving money and people who had children working in organizations or who were freelancers were less likely to agree to establish and pay for AC. CONCLUSION: The results suggest the feasibility of establishment of ACs in Vietnam, with a high proportion of participants agreeing to such establishing and willing to pay for the AC.

Assessment of nutritional status in older diabetic outpatients and related factors in Hanoi, Vietnam.

Purpose: Nutritional status is an important element for the wellness among older diabetic outpatients. This study aimed to assess the nutritional status of the older diabetic outpatient by using the Mini-Nutrition Assessment Short Form (MNA-SF) tool, and describe the relationship among related factors in older diabetic outpatients in the National Geriatric Hospital, Hanoi, Vietnam. Patients and methods: A cross-sectional study was conducted from June to September 2015 in the National Geriatric Hospital. A total of 158 diabetic patients aged ≥60 years at the Outpatient Department were included in this study. Patients were interviewed face-to-face to evaluate their nutritional status by using the MNA-SF. Socio-demographic, diabetic treatment information, frailty, exhaustion, cognitive function, hand grip strength and 4 m walk test were collected. Multivariate regression was used to determine factors associated with nutritional status. Results: The mean age was 69.52 (SD=6.758) with 31% patients malnourished and at risk of malnutrition. A significant association was found between the nutritional status and exhaustion, cognitive impairment, and frailty. In multiple logistic regression, the study found that risk of malnutrition was associated with frailty (OR=8.45; 95%CI=1.91-37.39) and cognitive impairment (OR=2.21; 95%CI=1.01-4.84). Conclusion: The results suggest that frailty was significantly associated with risk of malnutrition in older diabetic outpatients. Thus, early screening by nutritional assessment, and other interventions might improve the nutritional status of older outpatients with diabetes to prevent this complication and its effects.

Changes in Substance Abuse and HIV Risk Behaviors over 12-Month Methadone Maintenance Treatment among Vietnamese Patients in Mountainous Provinces.

Methadone maintenance treatment (MMT) programs have been used worldwide to reduce the number of drug users and for HIV prevention; however, evidence of their effectiveness in mountainous areas is limited. This study aimed to identify changes in substance abuse and sexual practices among MMT patients after treatment in three Vietnamese mountainous provinces. A survey on risk behaviors was conducted among 300 drug users in six MMT clinics prior to and following one year of MMT. Cramér's effect size of changes was extrapolated to justify the magnitude of the intervention's effectiveness. A generalized estimation equation was used to find the factors associated with respondents' substance use and sexual risk behavior. While drug-related risk behaviors were significantly reduced, alcohol and sex-related behaviors remained risk factors for HIV in this group. Additionally, condom use was common among participants at both time points, but not among those having sex with sex workers. Socio-economic characteristics of ethnic, education, occupation, as well as drug use history influenced the possibility of engaging in drug use and/or sexual risk behavior following treatment. Further emphasis on managing these among MMT patients is required, potentially by providing integrated services including smoking and drinking counseling and condom use promotion in accordance with MMT.

Rubella Vaccination Coverage Among Women of Childbearing Age in Vietnam.

Despite the availability of effective and safe rubella vaccines for women of childbearing age, prevention and control of congenital rubella syndrome in children remains challenging in Vietnam. In order to examine this issue, we conducted a cross-sectional study, examining the current coverage of rubella vaccination before pregnancy among 807 pregnant women and women with children under 12 months of age in urban and rural districts, Dong Da and Ba Vi, in Hanoi, Vietnam. In this population, we observed an alarming non-compliance rate with rubella vaccination before pregnancy in both localities. Among the 82.0% of participants who remained unvaccinated against this contagious viral infection, 95.8% of them were in Ba Vi district, compared to 68.0% in Dong Da district (p < 0.001). Besides the differences in age, number of children, education levels, primary occupations and monthly incomes among the participants between the two districts, other reasons for noncompliance with rubella vaccination includeddisinterest in rubella vaccination, the high cost and long distance to vaccination sites as well as unawareness of vaccination locations. In addition to addressing the unique socio-economicchallenges behind one's accessibility to vaccination services in urban and rural areas, our study supports a continued effort in ensuring proper access to and education about pre-pregnancy vaccines and vaccination among women of childbearing age in order to achieve and sustain sufficient immunization coverage of rubella and other vaccine-preventable diseases in both settings.

Acceptability of and willingness to pay for using a smartphone-based vaccination application in a Vietnamese cohort.

BACKGROUND: The increasing accessibility of smartphone in Vietnam shows potential in using smartphone applications for vaccination management to improve compliance. However, the acceptability and financial feasibility of using this application in Vietnam have not yet been understood. This study measured the general perception of and willingness to pay (WTP) for using smartphone-based vaccination management applications and their associated factors in Vietnam. SUBJECTS AND METHODS: A cross-sectional study was conducted between March and April 2016 in an urban vaccination clinic at the Hanoi Medical University in Vietnam. Convenience sampling was used to recruit 429 adult participants who had received vaccinations or whose children were vaccinated. Sociodemographic characteristics and the acceptability of and WTP for using smartphone-based vaccination management applications were evaluated. RESULTS: Among participants who used smartphone applications, 5% were aware of existing vaccination management applications, of whom 57.9% had previously used the applications. About 69.6% of participants believed that the applications were necessary, 93.7% of them were also willing to use the applications, and 79.1% were willing to pay 92.7 thousand Vietnamese dong (VND) for the applications on average. Participants who were older, unemployed, earned more household income, and having knowledge about functions and benefits of vaccination were less likely to use the vaccination applications. Participants who brought their children to get vaccinated at younger age and with higher level of education were willing to pay more for vaccination applications. CONCLUSION: High levels of acceptability of, willingness to use, and WTP for smartphone-based vaccination management applications among Vietnamese participants are reported. Increased education and awareness about the benefits of vaccination and vaccination management applications through community health workers might increase the feasibility of implementing such applications and perception toward their usage among young adult smartphone users. In addition, building a stronger relationship with health care providers at hospitals might improve the application's visibility and adoption.

Methadone Maintenance Treatment Reduces the Vulnerability of Drug Users on HIV/AIDS in Vietnamese Remote Settings: Assessing the Changes in HIV Knowledge, Perceived Risk, and Testing Uptake after a 12-Month Follow-Up.

Methadone Maintenance Treatment (MMT) program has been considered a medium through which human immunodeficiency virus (HIV) risks assessment and prevention on drug use/HIV-infected population can be effectively conducted. Studies concerning the implementation of such idea on patients in remote, under-developed areas, however, have been limited. Having the clinics established in three mountainous provinces of Vietnam, this study aimed to evaluate the changes in knowledge of HIV, perceived risk, and HIV testing uptake of the patients. A longitudinal study was conducted at six MMT clinics in three provinces with a pre- and post-assessments among 300 patients. Outcomes of interest were compared between baseline and after 12 months. The magnitude of changes was extrapolated. The proportion of participants reporting that their HIV knowledge was not good fell by 4.4% (61.3% at the baseline vs. 56.8% at 12 months). The significant improvement seen was in the knowledge that needle sharing was a mode of transmission (82.7% vs. 89.6%). Nevertheless, the majority of participants reportedly considered mosquitoes/insect and eating with the HIV-infected patient were the route of transmission at both time points (84.7% vs. 89.1%, 92.2% vs. 93.3%, respectively). This study found a limited improvement in HIV knowledge and testing uptake among MMT patients following a 12-month period. It also highlighted some shortcomings in the knowledge, attitudes and practices (KAP) of these patients, in particular, incorrect identification of HIV transmission routes, among patients both at program initiation and follow-up. The findings lent support to the argument for enhancing education and counseling efforts at MMT clinics regarding HIV, as well as for improving access to preventive and health care services through the integration of MMT/HIV services.