Challenges of methadone maintenance treatment decentralisation from Vietnamese primary care providers' perspectives
Corresponding Author
Diep Bich Nguyen
Center for Training and Research on Substance Abuse and HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
Department of Epidemiology, Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
Correspondence
Diep Bich Nguyen, Center for Training and Research on Substance Abuse and HIV/AIDS, Hanoi Medical University. Room 211B, E3 Building, Hanoi Medical University, No. 1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam.
Email: [email protected]
Search for more papers by this authorTrang Thu Nguyen
Center for Training and Research on Substance Abuse and HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
Search for more papers by this authorChunqing Lin
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles, USA
Search for more papers by this authorThuy Thi Thanh Dinh
Center for Training and Research on Substance Abuse and HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
Search for more papers by this authorGiang Minh Le
Center for Training and Research on Substance Abuse and HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
Department of Epidemiology, Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
Search for more papers by this authorLi Li
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles, USA
Search for more papers by this authorCorresponding Author
Diep Bich Nguyen
Center for Training and Research on Substance Abuse and HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
Department of Epidemiology, Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
Correspondence
Diep Bich Nguyen, Center for Training and Research on Substance Abuse and HIV/AIDS, Hanoi Medical University. Room 211B, E3 Building, Hanoi Medical University, No. 1 Ton That Tung Street, Dong Da District, Hanoi, Vietnam.
Email: [email protected]
Search for more papers by this authorTrang Thu Nguyen
Center for Training and Research on Substance Abuse and HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
Search for more papers by this authorChunqing Lin
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles, USA
Search for more papers by this authorThuy Thi Thanh Dinh
Center for Training and Research on Substance Abuse and HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
Search for more papers by this authorGiang Minh Le
Center for Training and Research on Substance Abuse and HIV/AIDS, Hanoi Medical University, Hanoi, Vietnam
Department of Epidemiology, Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
Search for more papers by this authorLi Li
Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles, USA
Search for more papers by this authorAbstract
Introduction
Decentralising methadone maintenance treatment to primary care improves patients' access to care and their drug and HIV treatment outcomes. However, primary care providers (PCP), especially those working in limited-resource settings, are facing great challenges to provide quality methadone treatment. This study explores the challenges perceived by PCP providing methadone treatment at commune health centres in a mountainous region in Vietnam.
Method
We conducted in-depth interviews with 26 PCP who worked as program managers, physicians, counsellors, pharmacists and medication dispensing staff at the methadone programs of eight commune health centres in Dien Bien, Vietnam, in November and December 2019. We used the health-care system framework in developing the interview guides and in summarising data themes.
Results
Participants identified major challenges in providing methadone treatment in commune health centres at the individual, clinic and environmental levels. Individual-level challenges included a lack of confidence and motivation in providing methadone treatment. Clinic-level factors included inadequate human resources, lack of institutional support, insufficient technical support, lack of referral resources and additional support for patients. Environment-level factors comprised a lack of reasonable policies on financial support for providers at commune health centres for providing methadone treatment, lack of regulations and mechanisms to ensure providers' safety in case of potential violence by patients and to share responsibility for overdose during treatment.
Discussion and Conclusion
PCP in Vietnam faced multi-level challenges in providing quality methadone treatment. Supportive policies and additional resources are needed to ensure the effectiveness of the decentralisation program.
CONFLICT OF INTEREST STATEMENT
The authors have no conflict of interest.
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