title: Impact of a methadone maintenance therapy pilot in Vietnam and its role in a scaled-up response.
abstract: BACKGROUND
  As a dual response to the HIV epidemic and the high level of injecting drug use in Vietnam, the Ministry of Health (MOH) initiated a pilot methadone maintenance therapy (MMT) program in Hai Phong and Ho Chi Minh City (HCMC) in early 2009. The objectives of the pilot were to provide evidence on whether MMT could be successfully implemented in Vietnam and scaled up to other localities.
  
  
  METHODS
  A prospective study was conducted among 965 opiate drug users admitted to the pilot. Data on demographic characteristics, sexual behaviors, substance use behaviors (including heroin use), and blood-borne virus infection (HIV, hepatitis B, and hepatitis C) were collected at treatment initiation and then again at 3-, 6-, 9-, 12-, 18-, and 24-month intervals thereafter.
  
  
  RESULTS
  Twenty-four months after treatment initiation, heroin use as measured by urine test or self-report had reduced from 100 % of participants at both sites to 14.6 % in Hai Phong and 22.9 % in HCMC. When adjusted for multiple factors in Generalized Estimating Equations (GEE) logistic regression modeling, independent predictors of continued heroin use after 24 months of MMT in HCMC were the following: poor methadone adherence (adjusted odds ratio (AOR) = 3.7, 95 % confidence interval (CI) 1.8-7.8); currently on antiretroviral treatment (ART) (AOR = 1.8, 95 % CI 1.4-2.4); currently on TB treatment (AOR = 2.2, 95 % CI 1.4-3.4); currently experiencing family conflict (AOR = 1.6, 95 % CI 1.1-2.4); and currently employed (AOR = 0.8, 95 % CI 0.6-1.0). For Hai Phong participants, predictors were the following: currently on ART (AOR = 2.0, 95 % CI = 1.4-3.0); currently experiencing family conflict (AOR = 2.0, 95 % CI = 1.0-3.9); and moderate adherence to methadone (AOR = 2.1, 95 % CI = 1.2-1.9). In Hai Phong, the percentage of participants who were employed had also increased by end of study from 35.0 to 52.8 %, while in HCMC the level remained relatively unchanged, between 52.2 and 55.1 %.
  
  
  CONCLUSIONS
  Study findings were used in multiple fora to convince policymakers and the public on the significant and vital role MMT can play in reducing heroin use and improving quality of life for individuals and families. Four years after this study was completed, Vietnam had expanded MMT to 162 clinics in 44 provinces serving 32,000 patients.
authors.affiliation: Partners in Health Research, 47 Yen Phu Street, Tay Ho District, Hanoi, Vietnam. Hoang@phr.com.vn.
authors.forename: Tran Vu
authors.initials: TV
authors.lastname: Hoang
authors.affiliation: FHI 360, 7th floor, Hanoi Tourist Building, 8 Ly Thuong Kiet Street, Hanoi, Vietnam. hatranthanh@yahoo.com.
authors.forename: Tran Thi Thanh
authors.initials: TT
authors.lastname: Ha
authors.affiliation: Hanoi Medical University, No. 1, Ton That Tung Street, Hanoi, Vietnam. tranminhhoang123@gmail.com.
authors.forename: Tran Minh
authors.initials: TM
authors.lastname: Hoang
authors.affiliation: FHI 360, 7th floor, Hanoi Tourist Building, 8 Ly Thuong Kiet Street, Hanoi, Vietnam. tonhu@fhi360.org.
authors.forename: Nguyen To
authors.initials: NT
authors.lastname: Nhu
authors.affiliation: FHI 360, 7th floor, Hanoi Tourist Building, 8 Ly Thuong Kiet Street, Hanoi, Vietnam. Quoc@fhi360.org.
authors.forename: Nguyen Cuong
authors.initials: NC
authors.lastname: Quoc
authors.affiliation: Vietnam Administration for AIDS Control, Vietnam Ministry of Health, 5th floor, 138a Giang Vo Street, Ba Dinh District, Hanoi, Vietnam. minhtam71@yahoo.com.
authors.forename: Nguyen thi Minh
authors.initials: Nt
authors.lastname: Tam
authors.affiliation: FHI 360, 19th Floor, Sindhorn Building, Wittayu Road, Bangkok, Thailand. Smills@fhi360.org.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mills
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D015819:Substance Abuse, Intravenous / Q000534:rehabilitation*; D014744:Vietnam; D055815:Young Adult
chemical_list: D009294:Narcotics; D008691:Methadone