Finding what works: identification of implementation strategies for the integration of methadone maintenance therapy and HIV services in Vietnam.
BACKGROUND
Integration of methadone maintenance therapy (MMT) and HIV services is an evidence-based intervention (EBI) that benefits HIV care and reduces costs. While MMT/HIV integration is recommended by the World Health Organization and the Centers for Disease Control and Prevention, it is not widely implemented, due to organizational and operational barriers. Our study applied an innovative process to identify implementation strategies to address these barriers.


METHODS
Our process was adapted from the Expert Recommendations for Implementing Change (ERIC) protocol and consisted of two main phases. In Phase 1, we conducted 16 in-depth interviews with stakeholders and developed matrices to display barriers to integration. In Phase 2, we selected implementation strategies that addressed the barriers identified in Phase 1 and conducted a poll to vote on the most important and feasible strategies among a panel with expertise in cultural context and implementation science.


RESULTS
Barriers fell into two broad categories: policy and programmatic. At the policy level, barriers included lack of a national mandate, different structures (MMT vs. HIV clinic) for cost reimbursement and staff salaries, and resistance on the part of staff to take on additional tasks without compensation. Programmatic barriers included the need for cross-training in MMT and HIV tasks, staff accountability, and commitment from local leaders. In Phase 2, we focused on programmatic challenges. Based on voting results and iterative dialogue with our expert panel, we selected several implementation strategies in the domains of technical assistance, staff accountability, and local commitment that targeted these barriers.


CONCLUSIONS
Key programmatic barriers to MMT/HIV integration in Vietnam may be addressed through implementation strategies that focus on technical assistance, staff accountability, and local commitment. Our process of identifying implementation strategies was simple, low cost, and potentially replicable to other settings.
Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA. vgo@email.unc.edu.
Vivian F
VF
Go
Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
Giuliana J
GJ
Morales
Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
Nguyen Tuyet
NT
Mai
Prevention Research Center in St. Louis, Brown School, Washington University, St. Louis, MO, USA.|Division of Public Health Sciences and Alvin J. Siteman Cancer Center, School of Medicine, Washington University, St. Louis, MO, USA.
Ross C
RC
Brownson
Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
Tran Viet
TV
Ha
Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.|Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Current affiliation: Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
William C
WC
Miller
D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006284:Health Plan Implementation / Q000379:methods*; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000150:complications / Q000534:rehabilitation*; D014744:Vietnam
D008691:Methadone
Implementation research; Implementation science; Implementation strategies; MMT/HIV integration; People who inject drugs; Vietnam