Provider Perspectives on Integration of Substance Use Disorder and HIV Care in Vietnam: A Qualitative Study
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al of Behavioral Health Services & Research, 2020. 1–12. c 2020 National Council for Behavioral Health. DOI 10.1007/s11414-020-09730-4
Provider Perspectives on Integration of Substance Use Disorder
EDSALL ET AL.
disorder is often neglected compared to other SUD treatment; (2) structural challenges must be addressed to increase integration feasibility; (3) workforce limitations; (4) societal and healthcare stigmatization of SUD; and (5) providers’ conflicting views regarding integration challenges. The experience of providers in Vietnam may be useful to other countries attempting to integrate HIV and SUD services.
Introduction People who inject drugs (PWID) bear a disproportionate burden of HIV, with an estimated HIV prevalence of 17.8% among PWID worldwide.1 Strategies to reduce injection drug use including medications for opioid use disorder (MOUD) such as methadone and buprenorphine have the potential to reduce the burden of HIV among PWID, 82.9% of whom inject mainly opioids.1 Provision of MOUD has been associated with improved HIV outcomes among PWID, including increased antiretroviral therapy (ART) initiation and adherence, enhanced viral suppression, and, among PWID in Asia specifically, reduced mortality.2 Methadone maintenance treatment (MMT) is associated with decreased HIV risk behaviors including sharing of injection equipment, sex with multiple partners, and unprotected sex.3 MOUD also has the potential to enhance the preventative benefits of ART at the population level, which could result in fewer new HIV infections among PWID.4 UNAIDS has called for expanded access to MOUD for improving HIV outcomes and decreasing HIV transmission.5 Countries in which any level of MOUD is available, however, account for just 64% of the estimated global population of PWID. Even in these countries, access to MOUD remains limited, reducing its potential population-level benefits.1 The close link between HIV and opioid injection presents an opportunity to expand treatment access through integration of MOUD with HIV care. Treatment integration can improve management of both HIV and opioid use disorder (OUD), facilitate greater adherence to treatment, and decrease acute care visits and costs.6, 7 The WHO consequently recommends incorporation of HIV care and social services into drug disorder treatment.8 However, significant barriers exist to widespread integration of MOUD and HIV care, including financing, recruitment and training of staff, and difficulties combining the distinct clinical practices of separate medical subspecialties.6 Integration of social services including behavioral health services may improve outcomes of OUD treatment; however, evidence of this has been inconclusive.9–11 It is possible that similar challenges to those facing integration of HIV care and MOUD have also limited the effectiveness of previous attempts to integrate behavioral health services with treatment for OUD. Several of these challenges are closely related to the attitudes of healthcare providers toward integration of MOUD and HIV care. For
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