利用 ADAPT-ITT 框架，为越南美沙酮患者解决甲基苯丙胺使用问题量身定制基于证据的干预措施。

Using ADAPT-ITT framework to tailor evidence-based interventions for addressing methamphetamine use among methadone patients in Vietnam.

机构信息

Centre for Training and Research on Substance use and HIV, Hanoi Medical University, Hanoi, Vietnam.

Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.

出版信息

Drug Alcohol Rev. 2023 Nov;42(7):1667-1679. doi: 10.1111/dar.13739. Epub 2023 Aug 23.

DOI:10.1111/dar.13739

PMID:37614129

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10848814/

Abstract

INTRODUCTION

Methamphetamine use threatens positive treatment outcomes in substance use and HIV, for people with opioid use disorders (POUD) in many countries. This paper describes the adaptation of four evidence-based interventions (EBI) (motivational interviewing, contingency management, Matrix group model and SMS text messaging) for treating methamphetamine use among POUD receiving methadone maintenance therapy in Vietnam.

METHODS

Following the ADAPT-ITT (Assessment-Decision-Administration-Production-Topical experts-Training-Testing) framework, we conducted 16 focus group discussions with POUD (n = 25) and providers (n = 22) at four methadone clinics in two largest cities (Hanoi in the North, Ho Chi Minh City in the South) to assess patterns of methamphetamine use and to get feedback on proposed EBIs. The proposed EBIs were properly adapted and used to train providers in two of the four methadone clinics. The revised EBIs were tested over 12 weeks among 42 POUD on methadone who use methamphetamine. Post-intervention feedback served to fine-tune the revised EBIs.

RESULTS

Insights about patterns of methamphetamine use suggested that EBIs should focus on different triggers to methamphetamine use among POUD receiving methadone treatment in the two cities. All EBIs should emphasise family-related topics to build a strong motivation for treatment. Participants suggested when, where and how each EBI should be delivered. Most participants were satisfied with the adapted EBIs. Limited human resources at methadone clinics might hinder implementation of the adapted EBIs.

DISCUSSION AND CONCLUSIONS

We successfully completed the adaptation of EBIs for POUD who use methamphetamine on methadone in Vietnam. The pilot testing of the adapted EBIs demonstrated feasibility and acceptability.

TRIAL REGISTRATION

NCT04706624. Registered 13 January 2021. https://clinicaltrials.gov/ct2/show/NCT04706624.

摘要

引言

在许多国家，冰毒的使用威胁到接受美沙酮维持治疗的阿片类药物使用障碍（POUD）人群的物质使用和艾滋病毒治疗的积极结果。本文描述了针对越南接受美沙酮维持治疗的 POUD 中冰毒使用的四种循证干预措施（MI、CCM、Matrix 小组模型和短信）的改编。

方法

根据 ADAPT-ITT（评估-决策-管理-生产-主题专家-培训-测试）框架，我们在两个最大的城市（北部的河内和南部的胡志明市）的四个美沙酮诊所进行了 16 次焦点小组讨论，参与者包括 25 名 POUD 和 22 名提供者，以评估冰毒使用模式，并就拟议的循证干预措施提供反馈。拟议的循证干预措施得到了适当的改编，并用于在四个美沙酮诊所中的两个培训提供者。在接受美沙酮治疗的 42 名冰毒使用者中，对经过修订的循证干预措施进行了为期 12 周的测试。干预后反馈用于微调修订后的循证干预措施。

结果

关于冰毒使用模式的见解表明，循证干预措施应针对两个城市接受美沙酮治疗的 POUD 中不同的冰毒使用触发因素。所有的循证干预措施都应该强调与家庭有关的话题，以建立对治疗的强烈动机。参与者提出了每种循证干预措施应在何时、何地以及如何实施。大多数参与者对改编后的循证干预措施表示满意。美沙酮诊所人力资源有限可能会阻碍改编后的循证干预措施的实施。