Intervention to Facilitate MMT/HIV Service Decentralization in Vietnam

University of California, Los Angeles (UCLA)

Status: Completed

Conditions: Opioid-use Disorder

Treatments: Behavioral: Service decentralization facilitation intervention

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT04798534

R34DA043783 (U.S. NIH Grant/Contract)

R34DA04378

Details and patient eligibility

About

Vietnam is currently decentralizing its methadone maintenance therapy (MMT) dispensing network to its local commune health centers (CHC), which provides a window of opportunity to study decentralization of harm reduction and HIV-related healthcare services into community-based healthcare settings. Commune health workers (CHW) in Vietnam have widespread misconceptions about harm reduction and perceived significant challenges associated with treating people who use drugs. Intervention effort is needed to address these issues to ensure a smooth implementation of the decentralized service model. This study is to pilot testing an intervention with a primary focus on process optimization in six CHC-based MMT distribution sites with 30 CHW and 90 MMT patients. The six CHC in Thai Nguyen Province of Vietnam will be randomized to either an intervention condition or a control condition. The intervention will be executed through a combination of in-person training and mobile phone application utilization. The intervention outcomes on CHW and MMT clients will be evaluated at baseline, 3-, and 6-months.

Full description

The intervention pilot will be conducted in six commune health center (CHC)-based methadone maintenance therapy (MMT) distribution sites in Thai Nguyen Province of Vietnam. Five commune health workers (CHW) and 15 MMT clients will be recruited from each of the CHC (total n = 30 CHW and 90 MMT clients). The six CHC will be matched into pairs based on the current number of CHW and MMT patient load; and within each pair, the two CHC will be randomized into either a control condition or an intervention condition. The intervention contents will include the promotion of streamlined procedure, skill training, problem solving, knowledge acquisition, networking and support, and information sharing. The intervention will be delivered through a combination of service provider in-person training and mobile phone application utilization. Provider-level outcomes (e.g., CHW's MMT/HIV service provision) and client-level outcomes (e.g., treatment progress) will be measured at baseline, 3-, and 6-month follow-ups.

Enrollment: 120 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

MMT patients (n=90):

Inclusion criteria:

• Age 18 or over
• Currently seeking MMT services in one of the participating commune health centers
• Voluntary informed consent

Exclusion criteria:

• Having psychosis or neurological damage, or cannot understand the study purposes as judged by the recruiter in consultation with a clinic supervisor.
• Inability to give informed consent

CHW (n=30):

Inclusion criteria:

• Age 18 or over
• Currently working in one of the participating commune health centers and have direct contact with MMT clients
• Providing informed consent

Exclusion criteria:

• Inability to provide informed consent

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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120 participants in 2 patient groups

Intervention group

Experimental group

Description:

CHW in the intervention arm will receive intervention through a combination of in-person training sessions and internet support. MMT patients in the intervention arm can use a specially designed online platform to communicate with their CHW.

Treatment:

Behavioral: Service decentralization facilitation intervention

Control group

No Intervention group

Description:

The control group CHW will perform business as usual. Both control group CHW and MMT patients do not have access to the online platform.