School of Medicine, The University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15213, USA.
Epidemiology Department, University of North Carolina At Chapel Hill Gillings School of Global Public Health, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
Harm Reduct J. 2021 Apr 23;18(1):45. doi: 10.1186/s12954-021-00495-3.
Injection drug use drives HIV transmission in Southeast Asia, where around a quarter of users are living with HIV. Vietnam developed Methadone Maintenance Therapy (MMT) programs to reduce unsafe drug abuse. Common mental health disorders (CMD), including depression, anxiety and post-traumatic stress disorder (PTSD), can worsen MMT outcomes and are highly prevalent among people living with HIV (PLH). We aimed to characterize HIV and CMD among MMT patients and assess the impact of HIV and CMD on MMT engagement outcomes in Hanoi, Vietnam.
This cross-sectional study was conducted at an urban MMT clinic in Hanoi. Participants were screened for CMD with the relevant sections of the Mini International Neuropsychiatric Interview (MINI). Tabular comparisons and regression models were used to understand the association of HIV and CMD with substance use and methadone compliance.
Of the 400 MMT participants, 22% were living with HIV, 11% a CMD, 27% reported injection drug use, and 27% reported methadone noncompliance. Around 17% of those with HIV also had a CMD. Reporting non injection and injection drug use were each higher among those with CMD regardless of HIV status. In addition, reporting any drug use was much higher among those with both HIV and CMD than among those with neither (73% vs 31%, p value 0.001). While methadone noncompliance was lower among PLH than among those without HIV (16.3% vs 30.1%, p value 0.010), noncompliance was higher among those with CMD than among those without (40.5% vs 25.6%, p value 0.045). Among those without HIV, noncompliance was higher among those with CMD than among those without, but among those with HIV, the opposite relationship was observed.
There is complex overlap between substance use and methadone noncompliance among MMT patients living with HIV, CMD or both. In this population, we found a high prevalence of CMD and substance use among PLH, and a high prevalence of substance use and methadone noncompliance among those with CMD. Prioritizing provision of mental health care services to MMT patients living with HIV can help improve engagement with substance use disorder treatment and reduce the risk of HIV transmission.
在东南亚，注射吸毒是 HIV 传播的主要途径，而大约四分之一的吸毒者携带 HIV。越南制定了美沙酮维持治疗（MMT）计划，以减少不安全的药物滥用。常见的精神健康障碍（CMD），包括抑郁、焦虑和创伤后应激障碍（PTSD），会使 MMT 治疗效果恶化，而 HIV 感染者（PLH）中此类疾病的发病率很高。我们旨在描述 MMT 患者中的 HIV 和 CMD 情况，并评估 HIV 和 CMD 对越南河内 MMT 参与结果的影响。
本横断面研究在河内的一个城市 MMT 诊所进行。参与者接受了 Mini International Neuropsychiatric Interview（MINI）的相关部分，以筛查 CMD。使用表格比较和回归模型来了解 HIV 和 CMD 与物质使用和美沙酮依从性的关系。
在 400 名 MMT 参与者中，22%携带 HIV，11%患有 CMD，27%报告使用注射药物，27%报告美沙酮不依从。约 17%的 HIV 感染者同时患有 CMD。无论 HIV 状况如何，患有 CMD 的人报告非注射和注射药物使用的比例均较高。此外，同时患有 HIV 和 CMD 的人报告任何药物使用的比例明显高于既没有 HIV 也没有 CMD 的人（73%比 31%，p 值 0.001）。虽然 PLH 的美沙酮不依从率低于没有 HIV 的人（16.3%比 30.1%，p 值 0.010），但患有 CMD 的人的不依从率高于没有 CMD 的人（40.5%比 25.6%，p 值 0.045）。在没有 HIV 的人中，没有 CMD 的人美沙酮不依从率高于有 CMD 的人，但在有 HIV 的人中，情况正好相反。
在 HIV 感染者、CMD 患者或同时患有这两种疾病的 MMT 患者中，物质使用和美沙酮不依从之间存在复杂的重叠。在该人群中，我们发现 PLH 中 CMD 和物质使用的患病率很高，而患有 CMD 的人物质使用和美沙酮不依从的患病率也很高。优先为 HIV 感染者提供心理健康护理服务，可以帮助提高他们对物质使用障碍治疗的参与度，并降低 HIV 传播的风险。
