Psycho-social services are an essential component in Methadone out-patient clinics in Vietnam Presenter: Nguyen To Nhu M.D.; Ph.D. Program Manager Family Health International/Vietnam Email: tonhu@fhi.org.vn Co-authors: Nguyen Thi Huynh (VAAC), Rachel Burdon (FHI), Pham Huy Minh (FHI), Hoang Nam Thai (FHI), Nguyen Thi Minh Ngoc (USAID), Ha Viet Dong (FHI)
Outline Overview Client flow Psychosocial services Contribution of psychosocial services Discussion Next steps
Why do we need psychosocial services? Evidence from many studies shows adding psychosocial support to MMT significantly improves treatment efficacy: Reductions in heroin use Retention in treatment
Hai Phong city Thành phố Hải Phòng Thuy Nguyen dist Thủy Nguyên Ngo Quyen dist Ngô Quyền Pilot MMT sites Lê Chân Le Chan dist Quận 6 Dist 6 Ho Thành Chi phố Hồ Minh Chí Minh city Binh Thanh dist Quận BìnhThạnh Dist 4 Quận 4 Decision No 5073/QD-BYT dated Dec 12, 2007 13 staff in each clinic including 2 counselors Started in April 08
MMT Vietnam Model an Integrated Community Based Approach Comprehensive Psychosocial support services: drug counseling peer support link to vocational training and job placement Address three paradigms of addiction: Biological Methadone replacement Psychological Addiction counseling Sociological social support group for patients Linkage with HIV care and treatment
Client flow Client registration Doctor s assessment Counselor s assessment Joint decision Selection committee Methadone commence and clinical management Risk reduction counseling for non eligible applicants rejected participants Patient and family preparation On going voluntary psychosocial supports
Preparation before enter MMT program
Available psychosocial services 11 counselors in Assessing the treatment 6 clinics motivation and psycho-social suitability 9 peer Prepare patients before entering supporters or MMT program group leaders Providing ongoing individual and group counseling (adapted Matrix manual) Involve family support and Monthly family meetings collaboration Social support groups Case management, linkage and referral
From 3 USAID/FHI supported clinics Individual counseling: 557/8004 Group counseling: 7/167 Group education: 52/1446 Family meeting: Monthly Adherence to treatment Relapse prevention Positive thinking and living i Referral and linkage services
Assessment Method Data sources and method Baseline: Intake assessment tform 6-8 months: Cross sectional survey using structured questionnaire (n=678) Retrospective review client s record both clinical and counseling profile (n=521) Data analysis Combine 3 data sets by patient IDs. STATA version 10 Stratified by day in treatment (30 days, 60 days ). Heroin use: both reported (survey) and urine test t in the past month (clinical record)
1057 patients on MMT (778 on maintenance phase 87% stopped Heroin use after 60 days in Tx Source: MOH report, 2009 Very good adherence to treatment. e t <5% drop out rate (death, jail, rehab center) Less risky behaviors of HIV transmission 74.8% gained weight and improved appearance
Quotes from the field "the counselors here are more deserving...working hard for us...we see you here every day with no holiday "thank you for saving my children "you have informed me of my son s progress thank you for my son s progress" "thank you to the clinic for helping my son make a lot of progress with your support" "thank you for helping my son stay away from heroin Source: Mentoring and supervision report week 7 in Hai Phong. Alan Degilio, Associate Services Clinical Coordinator, Drug and Alcohol treatment center, Adelaide, Australia
Comparison with international outcomes Rate of drug-pos sitive urin ne samp les 1 0.9 0.8 07 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 Sherbaum Y, Kluwig J, Specka M, Drause D, Merget, B, Finkbeiner, T, & Gastpar, M. Eur. Addic. Res. 2005; 11: 163-171. Before MMT Start of CBT End of CBT 3 month Follow-up MM T only MMT+CBT 6 month Follow-up
Discussion: possible contributions to good outcomes Right dose is given Completely voluntary and good motivation Positive effects of counseling and psychosocial support Given short follow-up time, 6-8 monthis honey honey moon period Hand pick patients with strict selection criteria Good attitude from the clinic staff Good support from family members Others?
H.E. Deputy Prime Minister Truong Vinh Trong visited clinic Source: Ministry of Health, Binh Thanh MMT clinic in HCMC
ROLLING OUT DRUG COUNSELING TOT Trainers i Training Mentors Practice Practice Advanced Advanced skill based counseling courses Practice Basic Basic Skill Counseling based Courses
Implementation Challenges Voluntary and using adapted international drug counseling approach is a totally new concept to Vietnam High workload, working even in the weekend and holidays High number of drug users with complex psychosocial needs Lack of referral services Coordination with other agencies and donors in the scaling up plan
Acknowledgments Ministry of Health, Vietnam Administration of HIV/AIDS Control Dedicated field project staff PEPFAR prevention team USAID for funding Robert Ali, Adelaide University Kevin Mulvey, former STO/FHI Dr. Stephen J. Mills and FHI colleagues