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

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.

An adaptive design to screen, treat, and retain people with opioid use disorders who use methamphetamine in methadone clinics (STAR-OM): study protocol of a clinical trial.

BACKGROUND: Methamphetamine use could jeopardize the current efforts to address opioid use disorder and HIV infection. Evidence-based behavioral interventions (EBI) are effective in reducing methamphetamine use. However, evidence on optimal combinations of EBI is limited. This protocol presents a type-1 effectiveness-implementation hybrid design to evaluate the effectiveness, cost-effectiveness of adaptive methamphetamine use interventions, and their implementation barriers in Vietnam. METHOD: Design: Participants will be first randomized into two frontline interventions for 12 weeks. They will then be placed or randomized to three adaptive strategies for another 12 weeks. An economic evaluation and an ethnographic evaluation will be conducted alongside the interventions. PARTICIPANTS: We will recruit 600 participants in 20 methadone clinics. ELIGIBILITY CRITERIA: (1) age 16+; (2) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) scores ≥ 10 for methamphetamine use or confirmed methamphetamine use with urine drug screening; (3) willing to provide three pieces of contact information; and (4) having a cell phone. OUTCOMES: Outcomes are measured at 13, 26, and 49 weeks and throughout the interventions. Primary outcomes include the (1) increase in HIV viral suppression, (2) reduction in HIV risk behaviors, and (3) reduction in methamphetamine use. COVID-19 response: We developed a response plan for interruptions caused by COVID-19 lockdowns to ensure data quality and intervention fidelity. DISCUSSION: This study will provide important evidence for scale-up of EBIs for methamphetamine use among methadone patients in limited-resource settings. As the EBIs will be delivered by methadone providers, they can be readily implemented if the trial demonstrates effectiveness and cost-effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov NCT04706624. Registered on 13 January 2021. https://clinicaltrials.gov/ct2/show/NCT04706624.

Correlates of methamphetamine use severity among patients receiving methadone maintenance treatment for opioid use disorder in Vietnam.

OBJECTIVES: To assess the severity of methamphetamine use among methadone maintenance treatment (MMT) patients in Vietnam with opioid use disorder and concurrent methamphetamine use, and to identify risk factors associated with higher severity of methamphetamine use. METHODS: We used survey data and medical record abstractions from 428 people with opioid use disorder who also use methamphetamine while partaking in methadone treatment in five clinics in Hanoi, Vietnam. We used multinomial logistic regression to assess other risk factors and problems associated with high methamphetamine use severity. RESULTS: Those who reported injecting heroin in the past 3 months (AOR = 4.05, 95% CI [1.30, 12.55], p = 0.02), having a longer history of lifetime heroin use (AOR = 1.13, 95% CI [1.03, 1.24], p < 0.01), and having higher cravings (AOR = 1.97, 95% CI [1.31, 2.98], p < 0.01) and fatigue (AOR = 1.25, 95% CI [0.96, 1.61], p = 0.09) related to methamphetamine withdrawal had greater odds of high methamphetamine use severity. One of five clinics had a significantly higher percentage of methamphetamine use severity than others. CONCLUSION: Successful MMT in patients with opioid use disorder in Vietnam may additionally require methamphetamine-focused screening and intervention.

Biomonitoring of polycyclic aromatic hydrocarbons exposure in small groups of residents in Brisbane, Australia and Hanoi, Vietnam, and those travelling between the two cities.

Exposure to polycyclic aromatic hydrocarbons (PAHs) has been associated with adverse health outcomes. Concentrations of urinary PAH metabolites (OH-PAHs) provide an integrated measure of human exposure to PAHs but measurement of urinary OH-PAHs has not been done in Australia and rarely in Vietnam, where air pollution is of concern. In this study, we assessed exposure to PAHs in 16 participants living in Brisbane, Australia and Hanoi, Vietnam, with 4 participants travelling between the two cities during the monitoring period. A total of 312 first morning urine samples were collected over 10weeks and were analysed for nine OH-PAHs. Concentrations of the urinary OH-PAHs were 2-10 times higher in participants from Hanoi than those from Brisbane. For example, the median concentrations of 1-hydroxypyrene were 292pg/mL in Hanoi, compared to 64pg/mL in Brisbane. For participants travelling from Brisbane to Hanoi and back, differences in exposure to PAHs in these two cities resulted in corresponding changes of urinary OH-PAH concentrations, demonstrating that the more polluted environment in Hanoi was likely the source for higher PAH exposure there.

Work-related injury surveillance in Vietnam: a national reporting system model.

Developing nations bear a substantial portion of the global burden of injury. Public health surveillance models in developing countries should recognize injury risks for all levels of society and all causes and should incorporate various groups of workers and industries, including subsistence agriculture. However, many developing nations do not have an injury registration system; current data collection methods result in gross national undercounts of injuries, failing to distinguish injuries that occur during work. In 2006, we established an active surveillance system in Vietnam's Xuan Tien commune and investigated potential methods for surveillance of work-related injuries. On the basis of our findings, we recommend a national model for work-related injury surveillance in Vietnam that builds on the existing health surveillance system.

The utility of injury narratives for prioritising future prevention activities in small and medium enterprises in rural Vietnam.

OBJECTIVES: Injuries are a leading cause of work-related disability and death in rapidly developing countries such as Vietnam. The authors' objective was to demonstrate the utility of detailed injury narratives, derived from a household survey, in providing information on the determinants of work-related injuries to inform potential intervention targets. METHODS: In a cross-sectional survey administered to 2615 households of a rapidly developing community of Vietnam where many workers engage in both agriculture and industrial work, the authors collected information about self-reported work-related injuries, annual hours worked in each industry and narrative text describing the circumstances of each injury. The authors used a customised coding taxonomy to describe injury scenarios. RESULTS: Several intervention themes emerged, including the implementation of machine guarding, the use of cut resistant gloves and safety glasses which would benefit the small- and medium-sized enterprises. Calculation of incidence rates using full-time equivalents, stratified by work group, provided some unexpected observations of the risks of working in agriculture; workers who work in agriculture in addition to another industry are at an increased risk of fatigue or overexertion and other consequences of working too hard in their agricultural activities. CONCLUSIONS: A lack of aggregate injury statistics makes it difficult for the owners of small- and medium-sized enterprises to recognise a priori the most effective safety interventions. This analysis of detailed injury narratives with an appropriate taxonomic basis offers the ability to focus on the level of cause, activity and source and may inform the choice of various potential interventions at the workplace or enterprise level.

The burden of occupational injury: a 1-year prospective study in Xuan Tien Commune, Viet Nam.

BACKGROUND: Developing nations carry a substantial portion of the global burden of injury, but without reliable injury surveillance, there is no way to characterize or prioritize the causes of work-related injury for prevention. METHODS: Injury data from 52 treatment sites in the Xuan Tien Commune, Vietnam with over 10,000 inhabitants were collected between January 1 and December 31, 2006. Injured residents were interviewed to determine work-relatedness, relevant causes, disability, and burden. RESULTS: Five hundred four work-related injuries were reported from formal treatment sites (incidence rate of 87 per 1,000 FTE) with a mean lost work day of 11 days. Four thousand five hundred seventy-four lost work day equivalents were estimated based on actual days lost to recover plus work days lost earning income to pay for medical costs, accumulating a total direct burden to the community of 8,641 lost work day equivalents. Almost half of that burden was caused by work in manufacturing. First aid boxes placed in 40 manufacturing enterprises yielded the 2nd highest reporting source. CONCLUSION: This study demonstrated the feasibility and value at the local level to build an active injury surveillance system which could have a large impact on preventing the burden of injuries in workplaces in Vietnam.

Occupational injuries in a commune in rural Vietnam transitioning from agriculture to new industries.

OBJECTIVES: We explored the impact on work-related injuries of workers splitting time between industry and agriculture, a common situation in developing countries. METHODS: In 2005, we administered a cross-sectional survey to 2615 households of Xuan Tien, a developing rural community of Vietnam, regarding self-reported injuries and hours worked for 1 year. We defined groups as working in industry, agriculture, or a mix of both. RESULTS: Overlapping employment (part time in agriculture and up to full time in industry) increased the risk of injury in both agricultural and industrial work. This pattern held across all work groups defined by the relative amount of time worked in agriculture. Those working fewer than 500 hours annually in agriculture had an agricultural injury rate (872 per 1000 full-time equivalents) that was more than 4 times higher than the average rate overall (203 per 1000) and the rate for workers employed only in industry (178 per 1000). CONCLUSIONS: Working in agriculture for short durations while working in industry increased the risk of injury substantially in both types of work.

The work-related burden of injury in a rapidly industrialising commune in Viet Nam.

BACKGROUND: Health and injury surveillance data of the highest achievable quality are needed in order to appropriately allocate scarce resources at the local and national levels. METHODS: This is the first reported surveillance study of injury using a complete community sample in Viet Nam. Workplaces in Xuan Tien Commune most likely to benefit from intervention were identified and ranked by the magnitude of the problem (or highest injury count), the risk (highest incidence rates) and the burden (the effect of injuries on the livelihoods of workers). RESULTS: 591 injuries occurring in the month prior to survey administration were recalled, which satisfied the injury case criteria of this study (the annualised incidence rate (IR) was 681 per 1000 residents). 482 were attributed to work activities (82%), yielding an annualised IR of 1001/1000 full time employee equivalents (FTE). The highest number of injuries occurred in the manufacturing sector (n=299), followed by agriculture with far fewer injuries (n=70). The highest rate of injury was in the transport, storage and communications sector (annualised IR 1583/1000 FTE), followed by manufacturing (1235/1000 FTE) and agriculture (844/1000 FTE). CONCLUSION: This study identified patterns of risk which, because data collection reflected work culture, are believed to be more reliable than those from previous studies. Interventions in the manufacture of machinery and equipment sector (the largest industry in the commune) would have the most impact in reducing occupational injuries. Despite the trend towards manufacturing, agriculture is still a high priority with a continuing substantial impact.

A survey of work-related injury in a rapidly industrializing commune in Vietnam.

Estimating the burden of occupational injury in developing countries might provide support for strengthening injury prevention during industrialization. A cross-sectional survey was administered to all households in the Xuân Tiên Commune in Vietnam to collect information on the characteristics of work and injuries in the month before the survey. Of all households, 2615 (99%) completed the survey, comprising 10,416 residents and 5485 workers with 8478 jobs. Respondents reported 591 injuries (an annualized incidence rate [IR] of 681 per 1000 residents), 482 (82%) of which occurred during work activities (annualized IR of 1011 per 1000 full-time equivalents). Nonagricultural work was considerably more hazardous than agricultural work (1033 vs. 844 injuries per 1000 full-time equivalents, respectively). Working at home was prevalent, with 28% of households having a family-owned business. The injury IRs in this study were approximately 10 times higher than those reported in prior studies from Vietnam. High injury rates represent a substantial economic and social burden on a rapidly industrializing country and underscore the importance of injury prevention guided by surveillance data.