Multilevel Integration Strategies to Enhance Service Provider Networks in Vietnam
| Status: | Not yet recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 9/28/2017 |
| Start Date: | January 2018 |
| End Date: | May 2020 |
| Contact: | Li Li, PhD |
| Email: | lililili@ucla.edu |
| Phone: | 310-794-2446 |
There is an urgent need for treatment service integration for People Living with HIV (PLH)
because many PLH have comorbid conditions, including substance use disorders and psychiatric
disorders, among others. Although providing integrated services to PLH who use drugs (PLHWUD)
has been proven to produce positive outcomes, multilevel challenges must be addressed,
including barriers at the policy, structural, and provider levels. Many countries, including
Vietnam, face challenges in the pursuit of multilevel integration of combination treatment
services and care. In Vietnam, injecting drug use accounts for nearly two-thirds of HIV
infection, and methadone maintenance therapy (MMT) services have rapidly expanded to 135
clinics with over 25,000 clients since 2008. There is a timely call as well as an opportunity
to identify, implement and evaluate new strategies to provide MMT and HIV treatment as an
integrated service system for PLHWUD. The study will take advantage of this window of
opportunity to explore and pilot integration strategies to address the multilevel challenges
associated with service integration in Vietnam.
because many PLH have comorbid conditions, including substance use disorders and psychiatric
disorders, among others. Although providing integrated services to PLH who use drugs (PLHWUD)
has been proven to produce positive outcomes, multilevel challenges must be addressed,
including barriers at the policy, structural, and provider levels. Many countries, including
Vietnam, face challenges in the pursuit of multilevel integration of combination treatment
services and care. In Vietnam, injecting drug use accounts for nearly two-thirds of HIV
infection, and methadone maintenance therapy (MMT) services have rapidly expanded to 135
clinics with over 25,000 clients since 2008. There is a timely call as well as an opportunity
to identify, implement and evaluate new strategies to provide MMT and HIV treatment as an
integrated service system for PLHWUD. The study will take advantage of this window of
opportunity to explore and pilot integration strategies to address the multilevel challenges
associated with service integration in Vietnam.
The purpose of this study is to develop and pilot test intervention strategies at the
provincial level (Aim 1), treatment agency level (Aim2), and community level (Aim 3). These
strategies aim to strengthen both horizontal and vertical collaboration and networking among
providers to better serve people living with HIV who use drugs (PLHWUD), including those who
are already in treatment and those who need to be linked to service. Commune health workers
(CHW) have great potentials to be mobilized to engage PLHWUD living in the community and to
work with providers at treatment clinics to support PLHWUD treatment retention and adherence.
E-technologies such as Facebook and e-chat will also be utilized to enhance provider-provider
coordination and provider-patient interaction.
The Specific Aims of the study are as follows:
Aim 1: Develop and implement structural-level strategies by establishing a provincial
coordination team to improve coordination and service integration.
Aim 2: Assess agency-level intervention outcomes on treatment-provider collaboration and
service integration of OPC services and MMT programs.
Aim 3: Assess community provider-level intervention outcomes by evaluating whether: 1) CHW in
the intervention group, compared to those in the control group, demonstrate improved levels
of collaboration with other clinical agencies, communication with patients, and service
referrals, and 2) PLHWUD in the intervention group, compared to those in the control group,
demonstrate improvements in treatment initiation, retention and adherence, and other mental
and biological outcomes.
Based on the findings from Aims 1 and 2 activities, this intervention will be conducted in
four provinces of Vietnam(Bac Giang, Hai Duong, Nam Dinh, and Nghe An). Randomization will
occur at the community level (20 communes assigned to the intervention group; 20 communes
assigned to the control group).
CONTROL COMMUNE ACTIVITIES:
A total of 40 CHW from 20 communes assigned to the control group will be invited to
participate in a one-time didactic lecture/meeting with other co-workers from their commune
health centers to learn about the importance of service integration.
CHW(n=40) and PLHWUD(n=120) from the control commune health centers will participate in a
baseline assessment and follow-up assessments at 3, 6, 9, 12-months.
INTERVENTION COMMUNE ACTIVITIES:
A total of 40 CHW from 20 communes assigned to the intervention group will be invited to
participate in the intervention that will consist of two in-person sessions lasting
approximately 90 minutes over two weeks with 8-10 CHW in each session.
Booster sessions of the intervention training will be offered to CHW once every month during
the first three months and once every three months thereafter. The booster session will focus
on CHW' reports of their experiences, reinforcement of efforts, and continued skill building
for problem solving. CHW(n=40) and PLHWUD(n=120) from the intervention commune health centers
will participate in a baseline assessment and follow-up assessments at 3, 6, 9, 12-months.
The efficacy of the intervention will be assessed at baseline, 3, 6, 9, and 12-month
follow-ups.
provincial level (Aim 1), treatment agency level (Aim2), and community level (Aim 3). These
strategies aim to strengthen both horizontal and vertical collaboration and networking among
providers to better serve people living with HIV who use drugs (PLHWUD), including those who
are already in treatment and those who need to be linked to service. Commune health workers
(CHW) have great potentials to be mobilized to engage PLHWUD living in the community and to
work with providers at treatment clinics to support PLHWUD treatment retention and adherence.
E-technologies such as Facebook and e-chat will also be utilized to enhance provider-provider
coordination and provider-patient interaction.
The Specific Aims of the study are as follows:
Aim 1: Develop and implement structural-level strategies by establishing a provincial
coordination team to improve coordination and service integration.
Aim 2: Assess agency-level intervention outcomes on treatment-provider collaboration and
service integration of OPC services and MMT programs.
Aim 3: Assess community provider-level intervention outcomes by evaluating whether: 1) CHW in
the intervention group, compared to those in the control group, demonstrate improved levels
of collaboration with other clinical agencies, communication with patients, and service
referrals, and 2) PLHWUD in the intervention group, compared to those in the control group,
demonstrate improvements in treatment initiation, retention and adherence, and other mental
and biological outcomes.
Based on the findings from Aims 1 and 2 activities, this intervention will be conducted in
four provinces of Vietnam(Bac Giang, Hai Duong, Nam Dinh, and Nghe An). Randomization will
occur at the community level (20 communes assigned to the intervention group; 20 communes
assigned to the control group).
CONTROL COMMUNE ACTIVITIES:
A total of 40 CHW from 20 communes assigned to the control group will be invited to
participate in a one-time didactic lecture/meeting with other co-workers from their commune
health centers to learn about the importance of service integration.
CHW(n=40) and PLHWUD(n=120) from the control commune health centers will participate in a
baseline assessment and follow-up assessments at 3, 6, 9, 12-months.
INTERVENTION COMMUNE ACTIVITIES:
A total of 40 CHW from 20 communes assigned to the intervention group will be invited to
participate in the intervention that will consist of two in-person sessions lasting
approximately 90 minutes over two weeks with 8-10 CHW in each session.
Booster sessions of the intervention training will be offered to CHW once every month during
the first three months and once every three months thereafter. The booster session will focus
on CHW' reports of their experiences, reinforcement of efforts, and continued skill building
for problem solving. CHW(n=40) and PLHWUD(n=120) from the intervention commune health centers
will participate in a baseline assessment and follow-up assessments at 3, 6, 9, 12-months.
The efficacy of the intervention will be assessed at baseline, 3, 6, 9, and 12-month
follow-ups.
Inclusion Criteria:
CHW:
- Age 18 or over
- Be a service provider to PLHWUD attending commune health centers in one of the 40
communes selected selected for the study
- Voluntary written informed consent
PLHWUD:
- Age 18 or over
- HIV positive (self-report)
- Currently using opiates or has a history of opiate use (self-report) and seeking
services at the commune health centers in one of 40 communes selected from the study
- Has not received treatment services from OPC or MMT clinics (i.e., is treatment
naive).
- Voluntary written informed consent
Exclusion Criteria:
CHW:
- Inability to give informed consent
PLHWUD:
- Inability to give informed consent
- Currently receiving treatment from OPC or MMT clinics
We found this trial at
2
sites
10920 Wilshire Boulevard
Los Angeles, California 90024
Los Angeles, California 90024
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