Pham Linh Thi Thuy, Kitamura Akiko, Do Hoa Mai, Lai Kim Anh, Le Nhan Tuan, Nguyen Van Thi Thuy, Kato Masaya
Health Management Training Institute, Hanoi University of Public Health, Hanoi, Vietnam.
Vietnam Country Office, World Health Organization, 304 Kim Ma, Hanoi, Vietnam.
Harm Reduct J. 2017 Feb 17;14(1):12. doi: 10.1186/s12954-017-0133-6.
Vietnam has a concentrated HIV epidemic with injection drug use being the dominant mode of HIV transmission. Vietnam has rapidly expanded antiretroviral therapy (ART) and methadone maintenance therapy (MMT). This study aims to analyze ART uptake and retention among male clients receiving MMT in Vietnam in the early phase of the MMT program.
The male clients (age ≥18) who were newly enrolled in care or started ART at two HIV clinics in Hanoi (2009 to 2011) and three HIV clinics in Can Tho (2010 to 2012) were included for the analysis. The CD4 lymphocyte count at HIV care enrollment and ART initiation and retention on ART were retrospectively analyzed. The values of those receiving MMT were compared with the values of two groups: those in whom injection drug use (IDU) status was documented, but were not receiving MMT, and all male clients not receiving MMT. To analyze retention, survival analysis with log rank test and Cox proportional hazard model was used.
During the study period, 663 adult men were newly enrolled in HIV care (237 had IDU status documented) and 456 initiated ART (167 had IDU status documented). Among those who initiated ART, 28 were receiving MMT. At care enrolment, those receiving MMT had a median CD4 count of 230 (IQR 57-308) cells/mm, while men self-reporting IDU and not receiving MMT and all men not receiving MMT had a median CD4 count of 158 (IQR 50-370) cells/mm and 143 (IQR 35-366) cells/mm, respectively. At ART initiation, men receiving MMT had significantly higher CD4 count with median at 203 (IQR 64-290) cells/mm than men self-reporting IDU and not receiving MMT (80, IQR 40-220, cells/mm, p = 0.038) and all men not receiving MMT (76, IQR 20-199, cells/mm, p = 0.009). Those receiving MMT had a significantly higher retention rate than those self-reporting IDU but not receiving MMT (hazard ratio = 0.18, p = 0.019) and men not receiving MMT (hazard ratio = 0.20, p = 0.041).
Our analysis suggests that men receiving MMT in Vietnam are achieving relatively early uptake and high retention rates on ART. The findings support potential benefits of integrating MMT and ART services in Vietnam.
越南的艾滋病病毒疫情集中，注射吸毒是艾滋病病毒传播的主要方式。越南迅速扩大了抗逆转录病毒疗法（ART）和美沙酮维持治疗（MMT）。本研究旨在分析越南美沙酮维持治疗项目早期接受美沙酮维持治疗的男性患者对抗逆转录病毒疗法的接受情况和维持率。
纳入2009年至2011年在河内两家艾滋病诊所以及2010年至2012年在芹苴三家艾滋病诊所新登记接受治疗或开始接受抗逆转录病毒疗法的成年男性患者（年龄≥18岁）进行分析。对艾滋病护理登记时、开始接受抗逆转录病毒疗法时的CD4淋巴细胞计数以及抗逆转录病毒疗法的维持情况进行回顾性分析。将接受美沙酮维持治疗者的值与两组的值进行比较：一组是有注射吸毒（IDU）状态记录但未接受美沙酮维持治疗者，另一组是所有未接受美沙酮维持治疗的男性患者。为分析维持率，采用对数秩检验和Cox比例风险模型进行生存分析。
在研究期间，663名成年男性新登记接受艾滋病护理（其中237人有注射吸毒状态记录），456人开始接受抗逆转录病毒疗法（其中167人有注射吸毒状态记录）。在开始接受抗逆转录病毒疗法的患者中，28人接受美沙酮维持治疗。在护理登记时，接受美沙酮维持治疗者的CD4计数中位数为230（四分位间距57 - 308）个细胞/mm³，而自我报告有注射吸毒行为但未接受美沙酮维持治疗的男性以及所有未接受美沙酮维持治疗的男性的CD4计数中位数分别为158（四分位间距50 - 370）个细胞/mm³和143（四分位间距35 - 366）个细胞/mm³。在开始接受抗逆转录病毒疗法时，接受美沙酮维持治疗的男性的CD4计数中位数显著高于自我报告有注射吸毒行为但未接受美沙酮维持治疗的男性（80，四分位间距40 - 220个细胞/mm³，p = 0.038）和所有未接受美沙酮维持治疗的男性（76，四分位间距20 - 199个细胞/mm³，p = 0.009）。接受美沙酮维持治疗者的维持率显著高于自我报告有注射吸毒行为但未接受美沙酮维持治疗者（风险比 = 0.18，p = 0.019）和未接受美沙酮维持治疗的男性（风险比 = 0.20，p = 0.041）。
我们的分析表明，越南接受美沙酮维持治疗的男性相对较早地接受了抗逆转录病毒疗法且维持率较高。这些发现支持了在越南整合美沙酮维持治疗和抗逆转录病毒疗法服务的潜在益处。
