An intervention pilot to facilitate harm reduction service decentralization in Vietnam

IF 3.7 2区医学 Q1 PSYCHOLOGY, CLINICAL Journal of Substance Abuse Treatment Pub Date : 2023-01-01 DOI:10.1016/j.jsat.2022.108927

Chunqing Lin , Li Li , Anh Tuan Le , Hoang My Lien Tran , Thanh Duyen Pham , Anh Tuan Nguyen

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Abstract

Introduction

Harm reduction services, including methadone maintenance therapy (MMT), have been decentralized to Vietnam's community health care settings. This study aims to pilot test an intervention to facilitate decentralized harm reduction service delivery in Vietnam.

Methods

The research team conducted an intervention pilot between August 2020 and May 2021 with six community MMT distribution sites in Thai Nguyen Province of Vietnam. We recruited five commune health workers (CHW) from each center (N = 30). In-person intervention training included content to correct misconceptions about harm reduction and reduce stigmatizing attitudes toward patients who use drugs and teach CHWs to self-examine and improve their service provision process. The study team developed a web-based platform to streamline CHW's patient monitoring and referral efforts. The team assessed intervention outcomes at baseline, 3-, and 6-months. CHWs in the intervention group provided acceptability ratings and feedback on the intervention at 6-months.

Results

CHWs in both intervention and control groups had similar background characteristics and outcome measures at baseline. CHWs in the intervention group, compared to those in the control group, showed a significantly higher level of improvement in adherence to service delivery protocol at 3-months. CHW in the intervention group had a significantly lower level of management-related stress compared to the control group at 6-months, although the intervention effect measured by the difference in change from baseline was not statistically significant. CHWs who participated in the final focus group reported high acceptability of the intervention.

Conclusion

This intervention pilot demonstrated acceptability and promising outcomes on community-based harm reduction service delivery. Similar intervention strategies can be applied to enhance the decentralization of other chronic disease treatment services.

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促进越南减少伤害服务权力下放的干预试点

减少危害服务，包括美沙酮维持治疗(MMT)，已经分散到越南的社区卫生保健机构。本研究旨在试点测试一种干预措施，以促进越南分散的减少危害服务的提供。研究小组于2020年8月至2021年5月在越南太原省的6个社区MMT分发点进行了干预试点。我们从每个中心招募5名社区卫生工作者(CHW) (N = 30)。现场干预培训的内容包括纠正对减少危害的误解和减少对吸毒患者的污名化态度，以及教卫生工作者自我检查和改进服务提供过程。研究小组开发了一个基于网络的平台，以简化CHW的患者监测和转诊工作。研究小组在基线、3个月和6个月时评估了干预结果。干预组的卫生保健员在6个月时对干预进行了可接受性评分和反馈。结果干预组和对照组在基线时具有相似的背景特征和结局指标。与对照组相比，干预组的卫生保健员在3个月时对服务提供方案的依从性有显著提高。干预组CHW在6个月时的管理相关压力水平明显低于对照组，但以基线变化差异衡量的干预效果无统计学意义。参加最后焦点小组的卫生保健员对干预的可接受性很高。结论该干预试点在社区减少危害服务提供方面具有可接受性和良好的效果。类似的干预战略可用于加强其他慢性病治疗服务的权力下放。

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来源期刊

Journal of Substance Abuse Treatment Multiple-

CiteScore

7.60

自引率

10.30%

发文量

220

期刊介绍： The Journal of Substance Abuse Treatment (JSAT) features original reviews, training and educational articles, special commentary, and especially research articles that are meaningful to the treatment of alcohol, heroin, marijuana, and other drugs of dependence. JSAT is directed toward treatment practitioners from all disciplines (medicine, nursing, social work, psychology, and counseling) in both private and public sectors, including those involved in schools, health centers, community agencies, correctional facilities, and individual practices. The editors emphasize that JSAT articles should address techniques and treatment approaches that can be used directly by contemporary practitioners.