Vuong Thu, Nguyen Nhu, Le Giang, Shanahan Marian, Ali Robert, Ritter Alison
The National Drug and Alcohol Research Centre/UNSW Australia, Sydney, Australia.
FHI360 Vietnam, Hanoi, Vietnam.
Harm Reduct J. 2017 Jan 11;14(1):2. doi: 10.1186/s12954-016-0130-1.
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.
在越南，与东南亚许多国家一样，基于中心的强制戒毒治疗（CCT）这一常用方法受到了人权方面的批评。与此同时，基于社区的自愿美沙酮维持治疗（MMT）已实施近十年，效果良好。有改革意识的领导人一直在寻求这两种主要治疗方式相关成本和效果的实证证据。对这些治疗进行评估，尤其是在随机化不符合伦理的情况下，存在挑战。本文旨在探讨在一个非民主的东南亚国家背景下进行成本效益研究时的政治挑战和方法问题。
对在研究设计、样本量确定、政府批准和伦理批准、参与者招募、数据收集、来源确定以及成本和效果数据量化等过程中遇到的政治和科学挑战进行回顾性分析。由于采用非随机设计，对两种治疗类型的患者特征进行分析，以确定基线组差异的程度。对自我报告的海洛因使用情况与尿液药物检测结果进行一致性分析，以确定在政治具有挑战性的环境中自我报告数据的可靠性。
我们证明，在非民主社会围绕强制治疗开展研究是可行的，但在政治上具有挑战性，需要在科学与政治之间进行权衡。我们还证明，在研究构思、实施和结果传播过程中与政府决策者进行接触，会增加在有争议的毒品政策领域将研究证据考虑用于政策变革的可能性。
在东南亚背景下，关于CCT和MMT相对成本效益的本地实证证据对于考虑更全面、人道和有效的药物依赖治疗方法至关重要，但获取此类证据极具挑战性。
