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INTRODUCTION
Drug addiction has severely affected individuals, families, social
security and become the major cause of the outspread of
HIV/AIDS epidemics in many countries in the world. Over the
years, the international community has made great efforts in the
fight against drugs, HIV/AIDS and got remarkable results.
However, addiction treatment and drug relapse prevention remains
a major challenge towards many nations.
The progress of science has discovered/found the mechanism of
drug addiction which is a chronic brain disease, requiring longterm treatment. One of the treatment methods that has been applied
in many countries is the treatment of opiate addiction with
Methadone. Researches in the world has showed the effectiveness
of alternative treatment with methadone in reducing the use of
illegal drugs, prevention of HIV transmission and other bloodborne diseases and reduction of crime and family violence.
In Vietnam, Methadone treatment program was first piloted at the
Institute of Mental Health, Bach Mai Hospital from 1996 to 2002.
On the basis of the piloting results, in 2008, the Vietnamese
Government assigned the Ministry of Health to implement a
project entitled “Pilot opiate addiction treatment using methadone
in Hai Phong and Ho Chi Minh City”. With the goal to evaluate the
effectiveness of MMT model in two pilot cities, and provide
evidence to inform policy makers and provincial authorities to
implement the program, this thesis entitled "Evaluating the
effectiveness of opioid dependence treatment using MMT in Hai
Phong and Ho Chi Minh city" has two following objectives:
1. To describe the current status of illicit drug use and its
association with health, social function of drug addicts before
entering the MMT program in Hai Phong and Ho Chi Minh
City, in 2009.
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2. To evaluate the effectiveness of MMT program in Hai Phong
and Ho Chi Minh City, during 2009-2011.
New findings of the thesis:
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This thesis has attempted to fully describe the demographic
and social characteristics of drug addicts before entering an
MMT program in Hai Phong and Ho Chi Minh City in
2009.
-
This is the first research that evaluates the effectiveness of
the MMT program in community. The results focused on
the main outcomes of the model, including decreased illicit
drug use; reduced risk behaviors, reduced risk of HIV and
bloodborne diseases; improved physical health and mental
health; increased employment status, income, and socioeconomic effects; reduced crime activities and family
violence amongst drug users receiving MMT.
Layout of thesis
The thesis consists of 121 pages (excluding references,
appendices), including 4 chapters:
Introduction:
Chapter 1: Literature review:
Chapter 2: Methods:
Chapter 3: Results:
Chapter 4: Discussion:
Conclusion:
Recommendation:
2 pages
31 pages
19 pages
31 pages
35 pages
2 pages
1 page
3
Chaper 1
LITERATURE REVIEW
1.1. SOME CONCEPTS AND CLASSIFICATION OF DRUGS
1.1.1. Some concepts and definitions
1.1.1.1. Narcotic drugs
Narcotic drugs are addictive substances, psychotropic substances,
which were regulated in the the lists issued by the Government.
1.1.1.2. Substances
Substances are stimulants or neural inhibitors which can easily
cause addiction among abusers.
1.1.1.3. Psychotropic substances
Psychotropic substances are stimulants, neural inhibitors or
hallucinogenic substances, if repeated use can lead to addiction for
users.
1.1.2. Classification of opiats
Narcotic drugs are classified into 4 groups: Canabis, Cocaine,
Opioid and Synthetic drugs
1.2. CURRENT SITUATION OF DRUG USE AND HIV/AIDS
IN VIETNAM AND GLOBALLY
1.2.1.1. Drug addiction globally
According to UNODC, in the world,
cannabis has the highest
proportion with 2.82% to 5.03% of the world population got
addicted. The second one is synthetic substances; the third one is
opioid, accounting for 0.88% to 1.23% of the world population at
the aged of 15-64 (from 40.6 to 56.4 million); and the lowest
proportion is for cocaine.
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1.2.1.2. Situation of HIV/AIDS in the world
According to UNAIDS, by the end of 2011, there was about 31.4
million to 35.9 million HIV cases globally and about 0.8% of
adults aged 15-49 living with HIV.
1.2.2.1. Situation of opioid dependence in Vietnam
Opioid dependence in Vietnam is still complicated and tends to
increase. By June 2013, there were nearly about 180,000 IDUs.
Heroine was the main drug which accounted for 75% drug using
population; synthetic drugs: 10%; opium: 7%; cannabis: 1.7%; and
other substances: 6.3%.
1.2.2.2. Situation of HIV epidemics in Vietnam
By December 2013, Vietnam had 212,714 people living with HIV,
of these, 62,437 patients had AIDS and the total number of deaths
from HIV/AIDS cases was 63,716. About half the number of people
living with HIV was IDUs.
1.3. DETOXIFICATION TREATMENT
Detoxification treatment is a combination of medical and
psychological therapy in order to achieve goals of: (1) To reduce or
stop using drugs; (2) To prevent harm related to drug use; (3) To
recover and improve quality of life of drug user.
1.3.2. Maintenance therapy relapse prevention support
1.3.2.3. Treatment with agonist:
a) Methadone:
Methadone is an opioid agonist. In substitution treatment,
methadone captured μ receptor and block the effects of other
opioids, only drink drug one time/day. With stable doses, patients
can work and live normally.
b) Levo-Alpha acetyl-Methadol:
LAAM is used as the second-line regimen for opioid dependence
treatment, in case patient failed with Methadone or Buprenorphine.
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c) Buprenorphine:
Buprenorphine used to treat opioid dependence. Buprenorphine is a
partial agonist of μ receptor and have antagonist activity at kappa
opioid receptors.
d) Levo-Alpha acetyl-Methadol:
LAAM is used as the second-line regimen for opioid dependence
treatment, in case patient failed with Methadone or Buprenorphine.
1.4. METHADONE MAINTENANCE TREATMENT
1.4.1. Methadone is a drug addiction treatment
Drug addiction is a chronic brain disease, easy to relapse.
Therefore, long-term treatment, long-life treatment. Methadone is
considered as a drug for the most common treatment of opioid
addiction.
1.4.2. The process of substitution treatment with methadone at
some country in the world.
Substitution treatment with methadone was first implemented in
Canada in 1959 and later expanded, so far 80 countries have
applied . In the United States, by 2010, there were more than 267
thousand people were treated with methadone. In Australia,
methadone therapy has been implemented since 1969. Especially
from the early 1980s, with the outbreak of HIV, the number of
patients participate in methadone treatment has increased rapidly.
By now, Australia has 35,850 people were under treatment. In
European countries such as Sweden, the UK and the Netherlands,
methadone treatment has been implemented from 1960s. In Asia,
methadone treatment is available in many countries. China
implemented the treatment from 2004 and by the end of 2010,
there were 140,000 people enrolled in treatment. Hong Kong has
implemented it since 1974, with coverage of about 95% drug users.
1.4.3. Effectiveness of MMT
MMT has been proved as the most effective therapy for addiction
treatment. The results of many research have showed the
advantages of MMT: reducing illicit drug use; reducing needle
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sharing; reducing transmission rate of HIV and other blood-borne
diseases; reducing criminal activity; economically efficient:
reducing costs for addicts; creating jobs, increasing incomes,
fostering community reintegration, improving social functions;
improving the health status; reducing deaths from drug overdoses
and suicide.
1.4.4. MMT in Vietnam
There were only one research study on MMT in Vietnam,
conducted in Institute of mental Health, Bach Mai Hospital, when
the Ministry of Health start the project "Pilot treatment of opiate
addiction with methadone in Ho Chi Minh City and Hai Phong
city". Another research conducted in Ha Noi (on 68 IDUs) and Hai
Phong (on 74 IDUs) from 1996 to 2002
Chapter 2
PARTICIPANTS AND METHODS
2.1. PARTICIPANTS, STUDY SITES AND STUDY PERIOD
2.1.1. Participants
2.1.1.1. Participants quantitative
965 drug addicts enrolled in the “Pilot treatment of opiate addiction
with methadone”.
2.1.1.3. Participants quanlitative
64 people are invited to participate in the study, including:
- 18 staffs working at 6 methadone treatment centres.
- 16 representatives of the departments.
- 30 family members of some patients on methadone treatment.
2.1.2. Materials
- Self-reported questionnaires; medical records, blood test and
urine test; reports from MMT facility.
- Questionnaires, opinion polls patients.
- Medical records of patients treated with methadone.
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- Books, reports, organizational processes, deployment
models.
2.1.3 Study sites
The study was conducted in six methadone treatment facilities of
two cities: Hai Phong (Le Chan, Ngo Quyen, Thuy Nguyen) and
Ho Chi Minh City (District 4, District 6, Binh Thanh).
2.1.4. Study period
The study period: from January 2009 to November 2011, indicated
two periods:
- The first one: Situation evaluation (from 01/2009 to 11/2011)
- The second: Intervention study (from 11/2009 to 11/2011).
2.2. Methods
2.2.1. Design
- Cross-sectional study, integrating quantitative and qualitative
research;
- Intervention study without control group.
2.2.2. Cross-sectional study
2.2.2.1. Sample size and sampling cross-sectional
All patients enrolled in MMT pilot program in Hai Phong and Ho
Chi Minh City were selected. We invited 970 patients to participate
in the study, 5 patients refused to participate. In total, 965 patients
agreed to participate in the study (Hai Phong City: 467 patients, Ho
Chi Minh City: 498 patients).
- Sample size and sampling of qualitative research:
+ Select 64 participants.
+ 02 times to take the vote of patients participating in methadone
treatment model. Total votes are 600 votes / 1 x 2 times = 1200
votes.
2.2.3. Intervention study:
2.2.3.1. Sample size and sampling intervention study
Intervention studies were conducted on patients who agreed to
participate in the research. A total of 965 patients were involved in
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the study at baseline. The drop-out rate at 12 months were 113, and
at 24 months were 101 (214 patients were not follow-up in total),
751 patients remained in the study.
2.6. RESEARCH ETHICS
Ethical approval was granted by the Hanoi School of Public
Healths’ Ethics Board.
Consent forms to participate in the study were collected from
participants before they are screened and chosen. The study
participants were enlisted for free testing. Study results will be
used for counselling and supporting for themselves in the treatment
process.
2.7. LIMITED RESEARCH
- Intervention study without control group.
- Short duration of model testing (2 years).
- Representativeness of objects who are addicted to opiates
participating in this study is not high. Due to the piloting phase, the
Judge priortised long-term addicts using intravenous drugs,
regularly relapse and actively work for HIV/AIDS prevention and
control.
- In the study of this thesis, evaluation components on
organization, model implementation and economic efficiency have
not been mentioned remarkably, therefore, it requires further
studies.
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CHAPTER 3
RESULTS
3.1. DESCRIBE DRUG USE PATTERNS AND FACTORS
ASSOCIATED WITH HEALTH, SOCIAL STATUS OF
DRUG DENPENDENCE.
3.1.1. Socioeconomic characteristic of participants
- Most of participants (94.9%) were male. Only 5.1% were female
(Ho Chi Minh City: 8.0% and Hai Phong: 1.9%).
- Mean ages of participants were 31.5 ± 0.2. Of these, 30-39 age
group were accounted for the highest (44.3%), followed by were
25-29 age group (32.0%), 20-24 age group (9.8%) and under 20
age group were the lowest (1.6%).
- Patients who passed the secondary school and high school were at
the same percentage (45.5% and 44.0%). The percentage of
patients who passed primary education or below were only 10.5%.
- Patients who have jobs and income were accounted for 64.0%
and 87.9%.
3.1.2. PATTERNS OF DRUG USE BEFORE TREATMENT
3.1.2.1. Patterns of drug use in participants
The duration of drug use from 5 – 10 years was accounted for the
highest percentage (46.2%), followed by 1-5 years (36.4%), above
10 years (16.6%), and below 1 year was the lowest (0.8%).
Table 3.6. Drugs commonly used
Drugs
commonly used
Hai Phong Ho
Chi General
city
Minh
city
(n=965)
(n=498)
(n=467)
TS
%
TS
%
TS
%
Heroin
375
80,3
434
87,1
809
83,8
Opium
117
25,1
27
5,4
144
14,9
10
Synthetic
Drugs
47
10,1
64
12,9
111
11.5
Marijuana
41
8,8
104
20,9
145
15,0
Pharmaceutical
44
drugs
9,4
148
29,7
192
19,9
Table 3.7. Route of drug use
Hai Phong
Ho Chi Minh Total
Route of drug
(n=467)
City (n=498)
(n=965)
use
TS
%
TS
%
TS
%
Oral
38
8,1
114
22,9
152
15,8
Inhale
39
8,4
13
2,6
52
5,4
Smoke
408
87,4
469
94,2
877
90,9
Subcutaneous
3
0,6
4
0,8
7
0,7
Injection
375
80,3
423
84,9
798
82,7
3.1.2.2. Relapse of participants after treatment
Most of the participants (97.9%) have been involved in
detoxification drug at least once but failed. Only 2.1% have never
been involved in any drug rehabilitation.
Craving was the most reason for relapse (69.8%), followed by the
enticement of friends (55.3%), depression, disappointed (45.9%)
and other reasons (5.0%).
The percentage of patients who had been shocked by overdose was
16.8%.
3.1.3. Blood test results before MMT
HIV prevalence in patients before methadone treatment was
28.4%, of these, patients in Ho Chi Minh city had a higher positive
rate (30.1%), in Haiphong, the rate was 26.6%.
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Table 3.14. Prevalance of hepatitis B virus (HBV) and hepatitis
C (HCV) infection before MMT
Ho
Chi
Hai Phong
Total
Minh
Blood test
(n=467)
(n=965)
(n=498)
N
%
n
%
n
%
HBV positive
55
11,8
103 20,7 158
16,4
HCV positive
200
42,8
349
70,1
549
56,9
3.1.4. Perceived risk of HIV transmission
3.1.4.1. Needle sharing
The rate of needle sharing was 4.1%.
3.1.5. Illegal activites before MMT
There were 40.8% of the patients reported that they had illegal
activities in the past.
3.1.6. Health problems of patients before MMT
The results indicated that the proportion of patients with mental
health problems was 73.5%.
Health ordinary highest proportion (50.1%), satisfaction (29.6%),
non satisfied (18.1%), very satisfied (1.9%) and very dissatisfied
(0.3%)
3.1.7. Access and utilization of health care before MMT
Voluntary counseling and testing was accounted for the highest
percentage (64.5%), ARV services (12.8%), tuberculosis (4.0%),
OI (3.1%) and psychiatry treatment (0.1%).
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3.2 THE EFFECTIVENESS OF MMT PROGRAM IN HAI
PHONG AND HO CHI MINH CITY, IN 2009. (2009 –
2011)
3.2.2. Patients’ satisfaction with MMT program
Analysis of results from vote polls in 6 methadone treatment
facility showed that 90% of patients were satisfied with the
specific process of the model.
3.2.4. Reduced drug use, risk behaviors and HIV, hepatitis B
virus (HBV), hepatitis C virus (HCV) transmission of MMT
patients
Figure 3.2. The prevalence of patients having positive with
heroin urine test (n=751)
The percentage of patients having positive with heroin urine test
decreased from 100% (before treatment) to 17.2% (after 12
months) and 12.4% (after 24 months), efficiency index were 87.6%
(χ2=123,29, p<0,001).
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Figure 3.3. Percentage of patients injecting drug (n=751)
The percentage of patients Injecting drug decreased from 83.2%
(before treatment) to 8.2% (after 12 months) and 6.7% (after 24
months), efficiency index were 91,9% (χ2=1306,15, p<0,001).
Figure 3.5. Percentage of patients consistent condmom use
The percentage of consistent condom use increased from 86.2%
(before treatment) to 100% (after 12 and 24 months), efficiency
index were 16.0 % (p <0.05).
- The percentage of HIV-infected before treatment and after
treatment was not different (p> 0.05), the rate at baseline was
28.2%; 28.2% after 12 months and 28,4% after 24 months. After
02 years of treatment, we found only 1 new HIV positive case.
- The percentage of patients infected with hepatitis B before
treatment was 16.1%/751 patients; after 12 months and after 24
months this percentage also increased a little but itwas not
statistically significance (p> 0.05). The study on 751 patients
showed that after 12 months, having 3 new infections and after 24
months, having 9 new infections
- The percentage of patients infected with hepatitis C (before
treatment) was increased from 58.5% to 59% (after 12 months) and
61.4% (after 24 months). However, the difference between pre-
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treatment and post-treatment was not statistically significant (p>
0.05). The study on 751 patients showed that after 12 months,
having 4 new infected HCV and after 24 months, having 22 new
infected with HCV.
3.2.5. Effectiveness on health and social functions of patients
- The percentage of patients having illegal activities decreased
from 39.1% (before treatment) to 2.7% (after 12 months) and 1.6%
(after 24 months). The difference between pre-treatment and posttreatment was statistically significant (p <0.001); efficiency index
were 93.1% and 95.9%.
- The percentage of patients having domestic violence decreased
from 86.8% (before treatment) to 4.8% (after 12 months) and 2.3%
(after 24 months). The difference between pre-treatment and posttreatment was statistically significant (p <0.001); efficiency index
were 94.6.2% and 98.1%.
Figure 3.6. The percentage of patients having job (n = 751)
The proportion of patients having job increased from 55.7%
(before treatment) to 62% (after 12 months) and 75.9% (after 24
months), efficiency index were 11.3% and 36.3% (χ2=70,25, p
<0,001).
The percentage of patients suffering mental health problems
decreased from 61.7% (before treatment) to 34.6% (after 12
months) and 38.7% (after 24 months), efficiency index were
43.9.% and 37.3% (χ2=128,68; p <0.001). About the depression
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of IDUs being treated with methadone are average overall
score of Kessler (depression scale level), the results reduce
from an average level of risk to non risk after 12 months of
treatment.
The percentage of patients having better quality of life increased
from 15% (before treatment) to 52.5% (after 12 months) and 55%
(after 24 months), efficiency index were 250% and 267,3%
(χ2=88,16; p<0,001).
The percentage of patients being satisfied with their health
increased from 80.9% (before treatment) to 94% (after 12 months)
and 94.1% (after 24 months), efficiency index were 16.2% and
16.3% (χ2=88,16; p <0.005).
The percentage of patients accessing to health services, such as
harm reduction interventions, behavior change communication, …
relatively high, incresed from 75.8% (before treatment) to 76.9%
(after 12 months) and 81.2% (after 24 months).
3.2.6. Economic efficiency
3.2.4.1. Cost per day/patient
At baseline, the average cost per day/patient was high (over
241,000 VND). The average cost rapidly decreased to 42,700 VND
and 27,000 VND in the next 2 quarters; the average cost per
day/patient was approximately 21,700 VND with 57% of the
design capacity of model.
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Figure 3.12. Distribution of total cost of 6 MMT facilities
With the current organizational structure, the cost per day /
person treatment for methadone treatment facility with
the size of 150 patients would be 20,750 dong ($ 1.26)
(exchange rate at the first quarter / 2009: 1 USD = 16,450
dong), the cost of treatment for one year will be $460.
Similarly, with the current organizational structure,
methadone treatment facility with a capacity of 250
patients, the cost per day / person only 15,500 dong. With
plans for a streamlined, cost per day / person of model
Methadone can reached only 12,500 dong ($ 0.76) in the
methadone treatment scale treatment of 400 patients (cost
of one patient for one year will be $277).
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Chapter 4
DISCUSSION
4.1. DESCRIBE DRUG USE PATTERNS AND FACTORS
ASSOCIATED WITH HEALTH AND SOCIAL
STATUS OF DRUG DENPENDENCE BEFORE
PARTICIPATING IN MMT PROGRAM IN HAI
PHONG AND HO CHI MINH CITY (2009)
4.1.1. The general situation of two cities
In terms of age: As reported by the Ministry of Public Security at
2012, drug addicts in the country tends to rejuvenate, aged under
30 years old accounted for 50.2% rate, but according to this results
of this study, the majority of IDUs are 30 years old or above
(56.5%).
Results of research on educational attainment shows that drug
addicts have varied levels, the proportion of patient completing
secondary school level was the highest in sample (45.5%),
followed by high school or higher (44.0%), the lowest percentage
was primary school or below (10.5%).
4.1.2. Patterns of drug use before treatment
About the period of using drug, the study showed that, the duration
of drug use from 5 – 10 years accounted for the highest percentage
(46.2%), followed by 1-5 years (36.4%), above 10 years (16.6%),
and below 1 years was the lowest (0.8%). The findings of Truong
Tan Minh et al (2008) indicated that the patients having duration of
drug use less than 5 years accounted for the highest percentage
(48.0%). The most popular drugs was heroin (83.8%), the
percentage of opium users accounted for 14.9%
4.1.3. The current situation of patients’ relapse
The findings of the study showed that majority of patients (97.9%)
had been involved in detoxification program at least once but
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failed. Most of patients had a very short duration (< 1 year) from
involving detoxification program to relapse (51,4%). This result
was consistent with the report of the Ministry of Labour, Invalids
and Social Affairs and the Ministry of Public Security on the work
of drug addiction detoxification.
4.1.4. Blood test results of patients before MMT
The findings indicated that the prevalence of HIV in patients
before treatment was 28.4%,
The prevalence of HBV and HCV in patients before treatment was
16.4 % and 56.9 %, respectively. Among those, reports in Bac
Kan, Hoa Binh and Tuyen Quang (2011) also showed a very high
prevalence of HCV, and HBV infection rates was several times
lower than HCV in IDUs. The proportion of patients with positive
HCV was very high: 83.6 % at Hoa Binh, 82.4 % at Bac Kan and
56 % at Tuyen Quang.
4.1.6. Illegal activites of patients before treatment
Drug use also causes loss of social order and safety, was the source
of many types of criminal offenses. The proportion of patients who
had illegal activites was 40.8%, the proportion of patients had
previous criminal was 13.0%, the proportion of patients had
previous conviction was 20, 6%, the proportion of patients had
domestic violence was 90.4%.
4.1.7. Employment status of patients before treatment
Patients who have jobs and income were accounted for 64.0% and
87.9%, respectively. The findings of Lai Kim Anh and coworker
(2006-2007) in Can Tho showed that 71% IDUs were
unemployment; this rate on study of Pham Thi Dao (2008-2009) in
Da Nang was 48%.
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4.2. THE EFFECTIVENESS OF MMT PROGRAM IN HAI
PHONG AND HO CHI MINH CITY. (2009 – 2011)
4.2.1. Drop-out rate at 12 and 24 months after treatment
At baseline, a total of 965 patients enrolled in the study; 852
patients after 12 months (the drop-out rate was 11.7%) and 751
patients after 24 months (the drop-out rate was 22.2%)
4.2.2. The effectiveness of MMT program
4.2.2.2. Reducing prevalence of drug use, risk behaviors and
HIV, HBV, HCV infection among MMT patients
The study results indicated that methadone can reduce the use of
illegal drugs: the percentage of positive with heroin urine test were
decreased from 100% (before treatment) to 17.2% (after 12
months) and 12.4% (after 24 months) (with p<0.001), the
efficiency index were 84% and 87.6% (for after 12 months and 24
months, respectively).
Results of the study was also consistent with findings of other
studies that methadone treatment reduced the daily drug use:
findings from the Institute of Mental Health, Bach Mai hospital,
and findings from Simpson DD, Sells SB reported that the illicit
drug use at 02 months before treatment was 100%, after 01 years
of substitution therapy for opioid addiction with methadone, the
ratio decreased to 36%, and after 03 years of treatment, this rate
decreased to 22%.
The results showed that the prevalence of patients injecting
decreased from 83.2% (before treatment) to 8.2% (after 12 months)
and 6.7% (after 24 months). The difference between before
treatment after treatment with 12 months and 24 months was
statistically significant with p <0.001, IE reached 91% after 12
months and 91.9% after 24 months.
The effectiveness of methadone treatment in the prevention of HIV
transmission: before treatment, the prevalence was 28.2%;
28.2%after 12 months and 28.4% after 24 months (p> 0.05), in 02
years of methadone treatment, among patients enrolled in MMT
20
program, only 01 new HIV case was found, compared with the rate
of new infections in the community in similar period, therefore
MMT showed to be very effective intervention to prevent HIV
infection in Vietnam.
Although the rate increased slightly after treatment, MMT
prevented numerous blood transmitted diseases, such as Hepatitis
B, Hepatitis C... The proportion of patients with hepatitis B has
increased from 16.4% before participating MMT program to 17.3%
after 24 months, but the difference was unstatistical significance
with p>0.05.
4.2.2.3 Effectiveness of MMT on health and accessing health
and social support services of patients
Participating MMT program helped addicts improving their health,
nutritional status, and improve relationships with family.
4.2.2.4. Reduce illegal activities of patients
MMT was contributed to psychological adjustment of patients,
helping patients having the opportunity to improve their life,
reintegrate into the community and participate in the usual social
activities, reducing stigma and discrimination in the workplace as
recommended by UNAIDS.
4.2.2.5. Increasing the opportunities to be employment
Participant of methadone treatment have more opportunities to find
employment as well as employment again. Findings of the study
also showed that the proportion of patients with post-treatment
employment has increased. That is accord the study conducted by
Simpson DD, Sells SB showed that the proportion of employed
after treatment increased by 33% compared to a previous year
before treament, and, this percentage increased to nearly 60% after
03 years.
4.2.2.6 Economic effiency of MMT program
With the current organizational structure, the cost per day/person
for treatment with methadone (with capacity of 250 patients) will
be 15,500 VND, the cost of treatment for one year will be 227460USD/person. Total cost of operation for methadone treatment
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