title: The political and scientific challenges in evaluating compulsory drug treatment centers in Southeast Asia.
abstract: In Vietnam, like many countries in Southeast Asia, the commonly used approach of center-based compulsory drug treatment (CCT) has been criticized on human rights ground. Meanwhile, community-based voluntary methadone maintenance treatment (MMT) has been implemented for nearly a decade with promising results. Reform-minded leaders have been seeking empirical evidence of the costs and effectiveness associated with these two main treatment modalities. Conducting evaluations of these treatments, especially where randomization is not ethical, presents challenges. The aim of this paper is to discuss political challenges and methodological issues when conducting cost-effectiveness studies within the context of a non-democratic Southeast Asian country.
  
  
  
  A retrospective analysis of the political and scientific challenges that were experienced in the study design, sample size determination, government approval and ethics approvals, participant recruitment, data collection, and determination of sources, and quantification of cost and effectiveness data was undertaken. As a consequence of the non-randomized design, analysis of patient characteristics for both treatment types was undertaken to identify the magnitude of baseline group differences. Concordance between self-reported heroin use and urine drug testing was undertaken to determine the reliability of self-report data in a politically challenging environment.
  
  
  
  We demonstrate that conducting research around compulsory treatment in a non-democratic society is feasible, yet it is politically challenging and requires navigation between science and politics. We also demonstrate that engagement with the government decision makers in the research conception, implementation, and dissemination of the results increases the likelihood of research evidence being considered for change in a contentious drug policy area.
  
  
  
  Local empirical evidence on the comparative cost-effectiveness of CCT and MMT in a Southeast Asian setting is critical to consideration of more holistic, humane, and effective drug-dependence treatment approaches, but the garnering of such evidence is very challenging.
authors.affiliation: The National Drug and Alcohol Research Centre/UNSW Australia, Sydney, Australia. huongthuhanoi@gmail.com.
authors.forename: Thu
authors.identifier: 0000-0003-4463-9781
authors.initials: T
authors.lastname: Vuong
authors.affiliation: FHI360 Vietnam, Hanoi, Vietnam.
authors.forename: Nhu
authors.initials: N
authors.lastname: Nguyen
authors.affiliation: Hanoi Medical University, Hanoi, Vietnam.
authors.forename: Giang
authors.initials: G
authors.lastname: Le
authors.affiliation: The National Drug and Alcohol Research Centre/UNSW Australia, Sydney, Australia.
authors.forename: Marian
authors.initials: M
authors.lastname: Shanahan
authors.affiliation: The National Drug and Alcohol Research Centre/UNSW Australia, Sydney, Australia.|University of Adelaide, Adelaide, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Ali
authors.affiliation: The National Drug and Alcohol Research Centre/UNSW Australia, Sydney, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Ritter
mesh_terms: D000328:Adult; D001210:Asia, Southeastern; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000191:economics* / Q000379:methods; D011057:Politics; D015397:Program Evaluation / Q000379:methods*; D015203:Reproducibility of Results; D012107:Research Design; D012189:Retrospective Studies; D016320:Substance Abuse Treatment Centers / Q000191:economics* / Q000331:legislation & jurisprudence / Q000379:methods; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D016896:Treatment Outcome
chemical_list: D008691:Methadone
keywords: Compulsory treatment; Cost-effectiveness; Heroin use; Methadone treatment; Southeast Asia