UCLA

Background

To respond to the dual HIV and injecting drug use epidemic, Vietnam has implemented methadone maintenance treatment (MMT) nationwide since 2010 and decentralized it to primary care (i.e. commune health centers) since 2015. The study aims to explore the challenges that Vietnamese community health workers (CHW) at commune health centers encounter in providing MMT and the factors associated to these challenges.

Methods

This study had a mixed method design. We used two types of data in this study. For the sub-study 1, we used the secondary data from a quantitative survey conducted in Vinh Phuc and Phu Tho provinces among 300 CHWs who did not provide MMT at the time of the study. For the sub-studies 2 and 3, we collected quantitative and qualitative primary data from Dien Bien province. We conducted a quantitative survey among 276 CHWs including both MMT providers and non-MMT providers. From this sample, we selected 26 MMT providers with various characteristics for in-depth interviews.

Results

In the sub-study 1, the mean score of CHWs’ interaction with PWUD 36.4 (SD 8.8) on a scale of 60. The interaction between CHW not providing MMT and people who use drugs (PWUD) was negatively associated with their stigmatizing attitude towards PWUD (β = -0.84, 95% CL: -1.05; -0.63) after adjusting for their background (gender, education level, job position and years of working experience) and job-related characteristics (perceived risk and challenges when working with PWUD, job satisfaction and empathy towards PWUD). In the sub-study 2, 114 (41.3%) CHW had ever provided MMT services. Better MMT knowledge was associated with higher levels of confidence in providing MMT services among CHW who had no experience with MMT program (β=0.90, 95%CL: 0.29; 1.51), not among those who had experiences. On the other hand, technical support in working with PWUD was associated with a higher level of confidence in providing MMT services for both groups (β=0.71, 95%CL: 0.35; 1.08 and β=0.58, 95%CL: 0.19; 0.96 among CHWs who had ever and who had never worked in MMT, respectively). In sub-study 3, the perceived challenges for MMT provision included lack of confidence and motivation to provide MMT, inadequate human resource, lack of institutional support, insufficient technical support, lack of referral resources and additional support for patients, lack of policies to support the MMT program at CHCs and to protect service providers.

Conclusion

CHWs in Vietnam faced several challenges in working with PWUD and providing MMT services at primary care settings. Supportive policies and tailored interventions should be developed at different levels to ensure the quality and effectiveness of the MMT decentralization program.