Prevalence of violence victimisation and poly-victimisation among female sex workers in Haiphong, Viet Nam: A cross-sectional study.

This cross-sectional study is the first to describe the prevalence of violence and poly-victimisation among 310 female sex workers (FSWs) who were cisgender in Haiphong, Viet Nam. An adapted version of the WHO-Multi-Country Study on Violence against Women Survey Instrument was administered to assess physical, sexual, economic and emotional forms of violence perpetrated by an intimate partner, paying partner/client, and/or others (e.g. relatives, police, strangers and other FSWs) during adulthood. The ACE-Q scale was administered to assess adverse childhood experiences (ACEs) before age 18 years. Our findings showed that FSWs are exposed to high rates of multiple forms of violence by multiple perpetrators. For any male client-perpetrated violence (CPV), lifetime prevalence was 70.0%, with 12-month prevalence 61.3%. Lifetime prevalence of male intimate partner violence (IPV) was 62.1%, and the 12-month prevalence was 58.2%. Lifetime and prior 12-month prevalence of physical and/or sexual violence by other perpetrators (OPV) was 18.1% and 14.2%, respectively. Sixty-five percent of FSWs reported at least one type of ACE. Overall, 21.6 percent of FSWs reported having experienced all three forms of violence (IPV, CPV and OPV) in their lifetime. Policy and programme recommendations for screening and prevention of violence are needed in this setting.

Metabolic, renal, and hematological changes in chronic hepatitis C patients achieving rapid virologic response after 12 weeks of direct-acting antiviral treatment: A prospective cohort study.

The impact of direct-acting antivirals (DAA) therapy on lipid and glucose metabolism and kidney function in patients with hepatitis C virus (HCV) infection, along with its side effects on blood cells, remains controversial. Therefore, we conducted a study that enrolled 280 patients with HCV infection who achieved sustained virologic response after treatment with DAA therapy without ribavirin to evaluate the metabolic changes, renal function, and anemia risk based on real-world data. This study was an observational prospective study with a follow-up period of 12 weeks after the initiation of DAA therapy. Data on biochemical tests, renal function, blood counts, viral load, and host genomics were recorded before treatment and after 12 weeks of treatment with DAAs. DAA therapy reduced fibrosis-4 scores and improved liver function, with significant reductions in aspartate transaminase, alanine aminotransferase, and total bilirubin levels. However, DAA therapy slightly increased uric acid, cholesterol, and low-density lipoprotein cholesterol levels. It significantly reduced fasting blood glucose levels and hemoglobin A1C index (HbA1C) in the study group, while hemoglobin (Hb) and hematocrit (HCT) concentrations decreased significantly (4.78 ± 21.79 g/L and 0.09% ± 0.11%, respectively). The estimated glomerular filtration rate (eGFR) decreased by 12.89 ± 39.04 mL/min/1.73m2. Most variations were not related to the genotype, except for Hb, HCT, and HbA1C. Anemia incidence increased from 23.58% before treatment to 30.72% after treatment. Patients with HCV-1 genotype had a higher rate of anemia than did patients with genotype 6 (36.23% vs. 24.62%). Multivariate analysis showed that the risk of anemia was related to female sex, cirrhosis status, fibrosis-4 score, pretreatment eGFR, and pretreatment Hb level. The results of our study can provide helpful information to clinicians for the prognosis and treatment of HCV infection.

Association between recent methamphetamine use, antiretroviral therapy and HIV viral load; a mediation analysis from a cohort of HIV positive persons who inject drugs in Hai Phong, Vietnam.

BACKGROUND: There has been a significant increase in methamphetamine use among persons who use drugs in Vietnam in the last 5-10 years. We examined the degree to which adherence to antiretroviral therapy (ART) mediates the relationship between recent methamphetamine use and unsuppressed HIV viral load among people who inject drugs (PWID) in Hai Phong, Vietnam. METHODS: We recruited PWID from October 2016-October 2018 and enrolled HIV positive PWID into a cohort, with up to three years of total follow-up. We assessed relationships among recent methamphetamine use frequency, ART adherence and unsuppressed HIV viral load. Mediation analysis was used to estimate the total and natural direct effects of recent methamphetamine use on unsuppressed HIV viral load and the indirect effect proportion. RESULTS: We enrolled 792 HIV seropositive PWID into the cohort; approximately 75.9% reported high/perfect ART adherence at baseline and 81.3% were virally suppressed. In mediation analysis, the total effect for the association between methamphetamine use and unsuppressed HIV viral load (1000 copies/mL) was 3.94 (95% CI: 1.95, 7.96); the natural direct effect was 2.14 (95% CI: 1.29, 3.55); the proportion mediated by self-reported ART adherence was 0.444. Similar results were found when examining lower unsuppressed HIV viral load cutpoints of 250 copies/mL and 500 copies/mL. CONCLUSIONS: Methamphetamine use is associated with unsuppressed HIV viral load among PWID despite high levels of ART adherence. Further research is needed to better understand these relationships, with emphasis on potential biological pathways that may interact with ART.

Knowledge and Attitude Related to Hepatitis C among Medical Students in the Oral Direct Acting Antiviral Agents Era in Vietnam.

BACKGROUND: Medical students play important frontline roles in the prevention, early detection, and treatment of hepatitis C. This study investigated knowledge and attitudes toward hepatitis C among 5th- and 6th-year medical students and possible associated factors. METHODS: A cross-sectional survey was conducted among 2000 students from eight medical universities using a self-administered structured questionnaire. RESULTS: The mean knowledge and attitude scores for hepatitis C were 20.1 ± 4.0 (out of 26) and 10.6 ± 2.9 (out of 20), respectively. Approximately, three-quarters (74.4%) of the participants had a good knowledge score, but only a small proportion (3.1%) obtained a good attitude score. Although the participants had fairly high knowledge about the causes, consequences, and transmission routes of hepatitis C, there were important gaps in their knowledge about hepatitis C screening and treatment. In multivariate analysis, female students, 5th-year students, and students from the central provinces had significantly higher knowledge and attitude scores. There was a low positive correlation between knowledge and attitude scores. CONCLUSION: This study points out the need to update the medical training curriculum to improve the knowledge and attitude of students about hepatitis C infection.

Seroprevalence of Hepatitis B, C and D in Vietnam: A systematic review and meta-analysis.

Background: Vietnam has one of the greatest disease burdens from chronic viral hepatitis. Comprehensive prevalence data are essential to support its elimination as a public health threat. Methods: We searched Medline and Embase from 1990 to 2021 for seroprevalence data relating to Hepatitis B (HBV), C (HCV) and D (HDV) in Vietnam. We estimated pooled prevalence with a DerSimonian-Laird random-effects model and stratified study populations into i) low-risk ii) high-risk exposure and iii) liver disease. We further estimated prevalence by decade and region and rates of HIV-coinfection. Findings: We analysed 72 studies, including 120 HBV, 114 HCV and 23 HDV study populations. Pooled HBV prevalence was low in blood donors (1.86% [1.82-1.90]) but high in antenatal populations (10.8% [10.1-11.6]) and adults in the general population (10.5% [10.0-11.0]). It was similar or modestly increased in groups at highest risk of exposure, suggesting the epidemic is largely driven by chronic infections acquired in childhood. HCV pooled prevalence in the general population was lower than historical estimates: 0.26% (0.09-0.51) have active infection defined by detectable antigen or HCV RNA. In contrast, there is an extremely high prevalence of active HCV infection in people who inject drugs (PWID) (57.8% [56.5-59.1]), which has persisted through the decades despite harm-reduction interventions. HDV appears mainly confined to high-risk groups. Interpretation: Blood safety has improved, but renewed focus on HBV vaccination at birth and targeted HCV screening and treatment of PWID are urgently required to meet elimination targets. Large cross-sectional studies are needed to better characterize HDV prevalence, but mass screening may not be warranted. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Effectiveness of Interventions to Prevent Musculoskeletal Disorders among District Hospital Nurses in Vietnam.

Background: Nurses are one of the population groups with the highest prevalence of musculoskeletal disorders (MSDs). Preventive measures in Vietnamese hospitals on the job have not been proposed to study their effectiveness due to barriers related to the lack of knowledge about MSDs by health care administrators and the lack of human resources with expertise in MSD management in hospitals. Objectives: This study is aimed at evaluating the effectiveness of basic interventions (education, physical exercise) to prevent MSDs among district hospital nurses in Vietnam. Material and Methods. A quasi-experimental study was carried out before/after over a period of one year among two groups of nurses, one receiving the intervention (n = 162) and the other the control group (n = 128). The intervention includes 3 components: training on MSDs, ergonomics training, and instructions for physical exercise. The pre- and postintervention assessment tools included the Modified Nordic, Quality of Life Enjoyment and Satisfaction Short-Form (Q-LES-Q-SF), and the Kessler Psychological Distress Questionnaire (K6). A generalized estimating equation analysis was performed to assess the difference between the two groups at two points in time (before and after the intervention) on some indicators (prevalence of MSDs in the last 12 months and 7 days, score for quality of life and psychological distress). Results: There was a significant difference of the test on the prevalence of MSDs in the last 7 days between the 2 groups before and after the intervention with the p value = 0.016. This difference occurred in 4 anatomical sites: neck, shoulder/upper arm, wrists/hand, and lower back, with p values being 0.013, 0.011, 0.038, and 0.009, respectively. Conclusions: The intervention measures are probably effective in reducing the prevalence of MSDs at 4 anatomical sites in the last 7 days. More in-depth studies are needed with a combination of measures over a longer period of time to obtain stronger evidence of interventions.

Knowledge, Attitudes and Practices toward Hepatitis B Virus Infection among Students of Medicine in Vietnam.

BACKGROUND: Building capacity in hepatitis B virus prevention and management for medical students and health professionals is one of the pillars of the national viral hepatitis control strategy. METHODS: A cross-sectional study was conducted at eight medical universities from the northern, central and southern regions of the country between May and November 2020 using a systematic random sampling technique. RESULTS: Among 2000 participants, 84.2% reported they had been tested for hepatitis B and 83.9% had received the hepatitis B vaccine. The mean knowledge, attitude, practice score was 40.2 out of 54 (74.4%) with only 19.9% of the study participants obtaining a good score. In multivariate analysis, fifth year students, students from central universities, students who had tested positive for hepatitis B and students who had received hepatitis B vaccine or had encountered patients with chronic hepatitis B had significantly higher knowledge score (p < 0.05). The study showed lack of trust in the hepatitis B vaccine safety and lack of confidence in providing counselling, testing and management of patients with chronic hepatitis B. CONCLUSION: Findings from our research emphasized an immediate need to improve the medical schools' training curriculum in Vietnam to enable students' readiness in hepatitis B prevention and management.

Blood Lead Levels and Associated Sociodemographic Factors among Children Aged 3 to 14 Years Living near Zinc and Lead Mines in Two Provinces in Vietnam.

Lead poisoning in children is a major public health concern worldwide, especially in developing countries. We conducted a cross-sectional study on 403 children aged from 3 to 14 years living nearly zinc-lead mining areas in two provinces in Vietnam (Bac Kan and Thai Nguyen) from 06/2016 to 10/2016 to identify risk factors for lead contamination. Results. The proportion of children with blood lead levels (BLLs) ≥ 10 µg/dL was 80.51% in Bac Kan and 50% in Thai Nguyen; the mean blood lead level for children was 14.41 ± 9.42 µg/dL. In linear regression analyses, the body mass index was negatively associated with elevated BLLs with r = -0.404, p < 0.05 (95% CI: -0.801, -0.006). In multivariable regression analysis, several risk factors were associated with lead contamination including male sex (aOR = 2.44, 95% CI: 1.13-5.24, p = 0.02), play areas in Bac Kan (aOR = 2.3 (1.02-5.17), p = 0.04), proximity of children's home of less than 2 kilometers from the mine (aOR = 2.90 (1.54-5.44), p = 0.001), and inattentive symptoms in Thai Nguyen (aOR = 7.85, 95% CI 3.49-17.69, p = 0.001). Environmental factors, including lead concentrations in the soil and ambient air samples in both locations, are many times higher than Vietnamese standards.

Impacts and interactions of COVID-19 response involvement, health-related behaviours, health literacy on anxiety, depression and health-related quality of life among healthcare workers: a cross-sectional study.

OBJECTIVES: We examined impacts and interactions of COVID-19 response involvement, health-related behaviours and health literacy (HL) on anxiety, depression, and health-related quality of life (HRQoL) among healthcare workers (HCWs). DESIGN: A cross-sectional study was conducted. Data were collected 6 April to 19 April 2020 using online-based, self-administered questionnaires. SETTING: 19 hospitals and health centres in Vietnam. PARTICIPANTS: 7 124 HCWs aged 21-60 years. RESULTS: The COVID-19 response-involved HCWs had higher anxiety likelihood (OR (95% CI)=4.41 (3.53 to 5.51)), higher depression likelihood (OR(95% CI)=3.31 (2.71 to 4.05)) and lower HRQoL score (coefficient, b(95% CI)=-2.14 (-2.89 to -1.38)), compared with uninvolved HCWs. Overall, HCWs who smoked or drank at unchanged/increased levels had higher likelihood of anxiety, depression and lower HRQoL scores; those with unchanged/healthier eating, unchanged/more physical activity and higher HL scores had lower likelihood of anxiety, depression and higher HRQoL scores. In comparison to uninvolved HCWs who smoked or drank at never/stopped/reduced levels, involved HCWs with unchanged/increased smoking or drinking had lower anxiety likelihood (OR(95% CI)=0.34 (0.14 to 0.83)) or (OR(95% CI)=0.26 (0.11 to 0.60)), and lower depression likelihood (OR(95% CI)=0.33 (0.15 to 0.74)) or (OR(95% CI)=0.24 (0.11 to 0.53)), respectively. In comparison with uninvolved HCWs who exercised at never/stopped/reduced levels, or with those in the lowest HL quartile, involved HCWs with unchanged/increased exercise or with one-quartile HL increment reported lower anxiety likelihood (OR(95% CI)=0.50 (0.31 to 0.81)) or (OR(95% CI)=0.57 (0.45 to 0.71)), lower depression likelihood (OR(95% CI)=0.40 (0.27 to 0.61)) or (OR(95% CI)=0.63 (0.52 to 0.76)), and higher HRQoL scores (b(95% CI)=2.08 (0.58 to 3.58)), or (b(95% CI)=1.10 (0.42 to 1.78)), respectively. CONCLUSIONS: Physical activity and higher HL were found to protect against anxiety and depression and were associated with higher HRQoL. Unexpectedly, smoking and drinking were also found to be coping behaviours. It is important to have strategic approaches that protect HCWs' mental health and HRQoL.

Towards HCV elimination among people who inject drugs in Hai Phong, Vietnam: study protocol for an effectiveness-implementation trial evaluating an integrated model of HCV care (DRIVE-C: DRug use & Infections in ViEtnam-hepatitis C).

INTRODUCTION: In Vietnam, people who inject drugs (PWID), who are the major population infected by hepatitis C virus (HCV), remain largely undiagnosed and unlinked to HCV prevention and care despite recommended universal hepatitis C treatment. The data on the outcomes of HCV treatment among PWID also remain limited in resource-limited settings. The DRug use & Infections in ViEtnam-hepatitis C (DRIVE-C) study examines the effectiveness of a model of hepatitis C screening and integrated care targeting PWID that largely uses community-based organisations (CBO) in Hai Phong, Vietnam. In a wider perspective, this model may have the potential to eliminate HCV among PWID in this city. METHODS AND ANALYSIS: The model of care comprises large community-based mass screening, simplified treatment with direct-acting antivirals (DAAs) and major involvement of CBO for PWID reaching out, linkage to care, treatment adherence and prevention of reinfection. The effectiveness of DAA care strategy among PWID, the potential obstacles to widespread implementation and its impact at population level will be assessed. A cost-effectiveness analysis is planned to further inform policy-makers. The enrolment target is 1050 PWID, recruited from the DRIVE study in Hai Phong. After initiation of pan-genotypic treatment consisting of sofosbuvir and daclatasvir administrated for 12 weeks, with ribavirin added in cases of cirrhosis, participants are followed-up for 48 weeks. The primary outcome is the proportion of patients with sustained virological response at week 48, that will be compared with a theoretical expected rate of 70%. ETHICS AND DISSEMINATION: The study was approved by Haiphong University of Medicine and Pharmacy's Ethics Review Board and the Vietnamese Ministry of Health. The sponsor and the investigators are committed to conducting this study in accordance with ethics principles contained in the World Medical Association's Declaration of Helsinki (Ethical Principles for Medical Research Involving Human Subjects). Informed consent is obtained before study enrolment. The data are anonymised and stored in a secure database. The study is ongoing. Results will be presented at international conferences and submitted to international peer-review journals. TRIAL REGISTRATION NUMBER: NCT03537196.

Daily heroin injection and psychiatric disorders: A cross-sectional survey among People Who Inject Drugs (PWID) in Haiphong, Vietnam.

BACKGROUND: Psychiatric comorbidities are frequent among people who inject drugs, they are associated with a poorer prognosis and need to be addressed. Their interaction with daily heroin injection requires clarification. METHODS: A cross-sectional survey was conducted among PWID recruited in the city of Haiphong, Vietnam, by respondent-driven sampling. The inclusion criteria were age 18 or older and current injection drug use, verified by skin marks and positive urine tests for heroin or methamphetamine. Data on socio-demographic characteristics, drug use, sexual behaviour and access to treatment were collected using face-to-face questionnaires by trained interviewers. PWID were screened by trained psychiatrists for depression, psychotic disorder and suicidality, using the MINI questionnaire. RESULTS: 418 participants were included in the analyses. All were injected heroin users, 21 % were diagnosed with a current major depressive disorder, 15 % with a current psychotic disorder and 12 % presented a suicide risk. In the bivariate analyses, regular meth use, cannabis use and ketamine use were positively associated with presenting at least one psychiatric condition while daily heroin injection and being currently treated with methadone were negatively associated. In the multivariate model, poly-substance use was positively associated with depression (methamphetamine and drinking in addition to heroin) and psychotic disorder (methamphetamine and/or hazardous drinking in addition to heroin) while daily heroin injection and current methadone treatment were negatively and independently associated with depression and psychotic syndrome. CONCLUSIONS: Our survey confirms the burden of methamphetamine use and the protective effect of methadone but also a possible protective effect of daily heroin injection.

Quality of life among district hospital nurses with multisite musculoskeletal symptoms in Vietnam.

BACKGROUND: Nurses are one of the population groups with the highest prevalence of musculoskeletal disorders (MSDs). At many sites, musculoskeletal symptoms (MS) represent a major health-care burden, adversely affecting nurses' quality of life and giving rise to mental health issues. OBJECTIVES: This study measured the prevalence of multi-body-site (two or more anatomical sites) musculoskeletal symptoms (MMS), and the association between MMS, a number of demographic and work characteristics, psychological distress, and the quality of life among district hospital nurses. MATERIAL AND METHODS: A cross-sectional study was performed with 1179 nurses in Haiphong City using three questionnaires: the Modified Nordic; Quality of Life Enjoyment and Satisfaction Short Form (Q-LES-Q-SF); and the Kessler Psychological Distress Questionnaire (K6). RESULTS: Women have a higher MMS prevalence than men (57.1% in women vs 37.6% in men, P < .001). Having a higher number of anatomical sites of MS appears to be associated with a worse quality of life among nurses. Linear regression analysis found a number of other factors negatively associated with the nurses' quality of life: gender (female), age (50-60 years old vs 19-29 years old), and psychological distress. CONCLUSIONS: This study shows a high prevalence of MMS and the relationship between, on the one hand, MMS, gender, age, as well as psychological distress and, on the other hand, the quality of life among nurses in Vietnam. Further in-depth studies are needed to investigate the causal relationships between these indicators.

Prevalence and Characteristics of Multisite Musculoskeletal Symptoms among District Hospital Nurses in Haiphong, Vietnam.

BACKGROUND: Musculoskeletal disorders (MSDs) are commonly observed among workers around the world. These diseases not only affect the health of workers, their quality of life, and their performance, but the effects of such diseases also represent a great burden for the health and social systems. These issues are even more prevalent in developing countries, and nurses are no exception. Many studies worldwide have shown a high prevalence of work-related MSDs in each body position among nurses. However, there are very few studies that have mentioned multisite musculoskeletal symptoms (MMS). OBJECTIVES: To describe the prevalence and characteristics of MMS among district hospital nurses in Haiphong, Vietnam. Material and Methods. A cross-sectional study was carried out on 1179 nurses working in all 15 district hospitals using the Modified Nordic Questionnaire at 9 anatomical sites on the body (neck, shoulder/upper arm, elbow/forearm, wrist/hand, upper back, lower back, hip/thigh, knee/lower leg, and ankle/foot). The following main indicators were calculated: the prevalence of musculoskeletal symptoms (MS) (at least 1 of 9 sites), MMS (two or more sites), and widespread musculoskeletal symptoms (WMS) (MS of the upper limb, the lower limb, and the back or the neck). RESULTS: The prevalence of MS during the past 12 months and symptoms lasting for at least 30 days was 60.6% and 17.2% in men and 77.6% and 21.5% in women, respectively. The lower back, neck, upper back, and shoulder/upper arm were the most common sites affected. In terms of MMS, the prevalence was 37.6% in men and 57.1% in women during the past 12 months while 8.6% of men and 11.3% of women reported that symptoms lasted for at least 30 days. The prevalence of MMS tended to increase with age, seniority, having a history of musculoskeletal diseases, and in nurses working in district hospitals located in urban areas. Nearly 90% of MMS concerned two or three anatomical regions during the past 12 months, and almost 80% of MMS lasting at least 30 days involved two or three anatomical regions. The prevalence of WMS was 10.4% in men and 18.6% in women during the past 12 months and 0.9% in men and 2.1% in women lasting at least 30 days. CONCLUSIONS: This study showed the high prevalence of MMS and WMS among nursing staff. Further and more extensive research is needed to improve our understanding of multisite musculoskeletal symptoms and act as the foundation for developing preventive measures for nurses.

Psychiatric Comorbidities among People Who Inject Drugs in Hai Phong, Vietnam: The Need for Screening and Innovative Interventions.

The objective of this study is to describe psychiatric comorbidities, associated factors, and access to psychiatric assessment and care in a cohort of people who inject drugs (PWID) in Hai Phong, Vietnam. Mental health was assessed after 12 months' follow-up using the Mini International Neuropsychiatric Interview questionnaire (MINI 5.0.0). PWID medical history, drug use, and sociodemographic and clinical characteristics were also collected. Among 188 PWID who participated in the assessment, 48 (25.5%) had at least one psychiatric disorder and 19 (10.1%) had 2 or more psychiatric disorders. The most common current psychiatric disorders were major depressive episode (12.2%) and psychotic disorder (4.8%), reaching 10.1% for the latter when lifetime prevalence was considered. Females were more likely than males to have at least one psychiatric disorder, a major depressive disorder, or an anxiety disorder. Methamphetamine use was associated with an increased risk of presenting a lifetime psychotic syndrome. Problematic alcohol consumption was associated with an increased risk of having at least one psychiatric disorder. Psychiatric comorbidities are frequent among PWID in Vietnam. These results highlight the need for routine assessment and innovative interventions to address mental health needs among PWID. Community-based interventions targeting mental health prevention and care should be strongly supported.

Intravenous heroin use in Haiphong, Vietnam: Need for comprehensive care including methamphetamine use-related interventions.

BACKGROUND: The aim of this study was to describe patterns among people who inject drugs (PWID), risk-related behaviours and access to methadone treatment, in order to design a large-scale intervention aiming to end the HIV epidemic in Haiphong, Vietnam. METHODS: A respondent-driven sampling (RDS) survey was first conducted to identify profiles of drug use and HIV risk-related behaviour among PWID. A sample of PWID was then included in a one-year cohort study to describe access to methadone treatment and associated factors. RESULTS: Among the 603 patients enrolled in the RDS survey, 10% were female, all were injecting heroin and 24% were using methamphetamine, including 3 (0.5%) through injection. Different profiles of risk-related behaviours were identified, including one entailing high-risk sexual behaviour (n=37) and another involving drug-related high-risk practices (n=22). High-risk sexual activity was related to binge drinking and methamphetamine use. Among subjects with low sexual risk, sexual intercourse with a main partner with unknown serostatus was often unprotected. Among the 250 PWID included in the cohort, 55.2% initiated methadone treatment during the follow-up (versus 4.4% at RDS); methamphetamine use significantly increased. The factors associated with not being treated with methadone after 52 weeks were fewer injections per month and being a methamphetamine user at RDS. CONCLUSION: Heroin is still the main drug injected in Haiphong. Methamphetamine use is increasing markedly and is associated with delay in methadone initiation. Drug-related risks are low but sexual risk behaviours are still present. Comprehensive approaches are needed in the short term.

Integrated respondent-driven sampling and peer support for persons who inject drugs in Haiphong, Vietnam: a case study with implications for interventions.

Combined prevention for HIV among persons who inject drugs (PWID) has led to greatly reduced HIV transmission among PWID in many high-income settings, but these successes have not yet been replicated in resource-limited settings. Haiphong, Vietnam experienced a large HIV epidemic among PWID, with 68% prevalence in 2006. Haiphong has implemented needle/syringe programs, methadone maintenance treatment (MMT), and anti-retroviral treatment (ART), but there is an urgent need to identify high-risk PWID and link them to services. We examined integration of respondent-driven sampling (RDS) and strong peer support groups as a mechanism for identifying high-risk PWID and linking them to services. The peer support staff performed the key tasks that required building and maintaining trust with the participants, including recruiting the RDS seeds, greeting and registering participants at the research site, taking electronic copies of participant fingerprints (to prevent multiple participation in the study), and conducting urinalyses. A 6-month cohort study with 250 participants followed the RDS cross-sectional study. The peer support staff maintained contact with these participants, tracking them if they missed appointments, and providing assistance in accessing methadone and ART. The RDS recruitment was quite rapid, with 603 participants recruited in three weeks. HIV prevalence was 25%, Hepatitis C (HCV) prevalence 67%, and participants reported an average of 2.7 heroin injections per day. Retention in the cohort study was high, with 86% of participants re-interviewed at 6-month follow-up. Assistance in accessing services led to half of the participants in need of methadone enrolled in methadone clinics, and half of HIV-positive participants in need of ART enrolled in HIV clinics by the 6-month follow-up. This study suggests that integrating large-scale RDS and strong peer support may provide a method for rapidly linking high-risk PWID to combined prevention and care, and greatly reducing HIV transmission among PWID in resource-limited settings.

[Management of sexually transmitted infections by private pharmacies in Hanoi]. / Prise en charge des infections sexuellement transmissibles dans les pharmacies privées à Hanoi.

AIM: This cross-sectional study comprising quantitative and qualitative analysis of clinical practices was designed to evaluate the quality and relevance of management of sexually transmitted infections (STI) based on a syndrome approach by private pharmacies in Hanoi in 2010 compared to a similar study conducted in 2000. METHODS: One investigator played the role of a customer presenting signs of STI. He visited 60 randomly selected private pharmacies in Hanoi and noted the treatments, questions and advice provided by pharmacists. RESULTS: The results show that pharmacists proposed a treatment for 87% of cases of urethral discharge and 30% of cases of genital ulcers. The patient was not asked any questions in 55% of cases. None of the prescriptions complied with national guidelines. Only 8.3% of pharmacists/shop assistants asked the "patient" questions concerning the spouse/partner and 20% provided advice (the use of condoms in 26.6% of cases and a screening test for HIV in only one case). Pharmacists/shop assistants recommended consulting a doctor in only 43.3% of cases or a specialized STI clinic in only 16.7% of cases. CONCLUSION: The behaviour of private pharmacists/shop assistants in Hanoi have not changed over the last ten years (2000-2010). They readily treat STI inappropriately and provide little advice concerning prevention, screening and treatment. In the age of the HIV pandemic and microbial resistance to antibiotics, patients with STI should be advised to seek management by competent public services.

Validation of the Karasek-Job Content Questionnaire to measure job strain in Vietnam.

The objective of this study was to validate the Karasek-Job Content Questionnaire in Vietnamese. A translation/back-translation of the questionnaire was performed prior to its administration to 344 health personnel in Vietnam. Several psychometric properties of the Vietnamese version of the Karasek-Job Content Questionnaire were assessed. A valid Vietnamese version of the Karasek-Job Content Questionnaire was produced, composed of five subscales based on the original theoretical model: Psychological demands, Social support at work, Decision latitude-Autonomy, Decision latitude-Authority, and Skill discretion. Internal consistency and reliability coefficients for each subscale of the questionnaire were satisfactory. The correlations with depression and work absence indicators were weak but statistically significant, as expected. The Vietnamese version of the Karasek-Job Content Questionnaire will help Vietnamese researchers and clinicians appropriately evaluate and document the job strain of workers in Vietnamese workplaces.