MD/PhD Program, Oregon Health & Science University, Portland, OR, USA; Dept. of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA.
Addiction Medicine Program, Dept. of Medicine, Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA.
J Subst Abuse Treat. 2022 Mar;134:108451. doi: 10.1016/j.jsat.2021.108451. Epub 2021 May 1.
Non-prescribed opioid use is illegal in Vietnam. People who are apprehended for use of non-prescribed opioids may be arrested and incarcerated or sent to compulsory rehabilitation centers. For those on medication to treat opioid use disorder (MOUD), incarceration in either setting may disrupt treatment. This study estimates the effects of incarceration and compulsory rehabilitation on MOUD and HIV treatment outcomes in Vietnam.
Data are from a clinical trial testing the effects of MOUD on HIV viral suppression in six Vietnamese HIV clinics. Participants were assessed quarterly for 12 months. We assessed the associations between incarceration or compulsory rehabilitation during months 0-9 and study outcomes of receipt of MOUD, HIV clinic engagement, and antiretroviral therapy prescription during months 9-12, among those who were released by month 9 of the study, using logistic regression and zero-inflated negative binomial models.
At nine months, 25 of 258 participants (9.7%) were incarcerated or sent to compulsory rehabilitation at least once and completed the month 9 assessment. Of those, 19 (76.0%) did not receive MOUD in months 9 through 12. Both incarceration and compulsory rehabilitation were negatively associated with subsequent receipt of MOUD (aOR = 0.05, 95% CI = (0.01, 0.24); 0.14 (0.04, 0.50), respectively) and HIV clinic engagement (aOR = 0.13, 95% CI = (0.03, 0.71); 0.09 (0.02, 0.39), respectively). In the final three months of the study, participants who were incarcerated had 42.5 fewer days of MOUD (95% CI = 23.1, 61.9), and participants in compulsory rehabilitation had 46.1 fewer days of MOUD (95% CI = 33.8, 58.4) than those not incarcerated or in compulsory rehabilitation.
Our findings suggest that both incarceration and compulsory rehabilitation disrupt MOUD and HIV treatment among people with HIV and Opioid Use Disorder in Vietnam. Prioritization of evidence-based strategies to support engagement in care for people who use drugs could potentially expand HIV and Opioid Use Disorder treatment access and curb substance use more effectively than reliance on incarceration or compulsory rehabilitation.
在越南，非处方类阿片类药物的使用是非法的。因使用非处方类阿片类药物而被逮捕的人可能会被逮捕和监禁，或被送往强制康复中心。对于那些接受治疗阿片类药物使用障碍（MOUD）的人来说，在任何一种环境下监禁都可能会中断治疗。本研究旨在评估监禁和强制康复对越南 MOUD 和 HIV 治疗结果的影响。
数据来自一项临床试验，该试验测试了 MOUD 对六家越南 HIV 诊所中 HIV 病毒抑制的影响。参与者每季度评估一次，为期 12 个月。我们使用逻辑回归和零膨胀负二项式模型，评估了在研究的第 0-9 个月期间被监禁或强制康复与研究结果之间的关联，这些结果包括在第 9-12 个月期间接受 MOUD、HIV 诊所参与度和抗逆转录病毒治疗处方的情况，研究对象是在研究第 9 个月时已获释的人群。
在 9 个月时，258 名参与者中有 25 名（9.7%）至少被监禁或被送往强制康复中心一次，并完成了第 9 个月的评估。其中，19 人（76.0%）在第 9-12 个月期间未接受 MOUD。监禁和强制康复均与随后接受 MOUD 的情况呈负相关（调整后的比值比[aOR]分别为 0.05，95%置信区间[CI]为（0.01，0.24）；0.14，95%CI 为（0.04，0.50））和 HIV 诊所参与度（aOR 分别为 0.13，95%CI 为（0.03，0.71）；0.09，95%CI 为（0.02，0.39））。在研究的最后三个月，被监禁的参与者接受 MOUD 的天数减少了 42.5 天（95%CI 为 23.1，61.9），而被强制康复的参与者接受 MOUD 的天数减少了 46.1 天（95%CI 为 33.8，58.4）比未被监禁或强制康复的参与者少。
我们的研究结果表明，监禁和强制康复都干扰了越南 HIV 感染者和阿片类药物使用障碍者的 MOUD 和 HIV 治疗。优先考虑基于证据的策略，以支持吸毒者接受治疗，可能会比依赖监禁或强制康复更有效地扩大 HIV 和阿片类药物使用障碍治疗的可及性，并更有效地遏制物质使用。
