Facilitating the Decentralization of Methadone Maintenance Therapy Services into Communities in Vietnam

摘要 越南目前正在下放其美沙酮维持疗法(MMT)分配网络，以 其地方社区卫生中心(CHC)，这为研究权力下放提供了机会之窗 将减少危害和艾滋病毒相关的医疗服务纳入基于社区的医疗保健环境。公社 越南卫生工作者(CHW)对减少伤害和感知存在广泛的误解 与治疗吸毒者相关的重大挑战。需要干预努力来解决 这些问题保证了去中心化服务模式的顺利实施。建议的两年期 研究计划设计和试行干预措施，以促进提供分散的MMT/艾滋病毒服务 通过越南富梭省的三个阶段。在第一阶段，我们将与MMT客户端进行任务分析 以及与服务提供商的跨职能分析，以确定与大多数 程序延误、错误、冗余和/或不必要的返工。我们还将评估每个CHC的 提供MMT服务的能力和准备情况。在第二阶段，在干预地图的框架下， 一个多学科工作组将经历六个步骤来设计干预措施并制定其 实施和评估计划。干预的主要重点是流程优化，将是 通过面对面培训和移动电话应用程序使用相结合的方式执行。在第三阶段，我们 将在六个以CHC为基础的MMT分发地点进行干预试点。六个社区卫生委员会将被随机分配到一个 干预条件或控制条件。对CHW和MMT客户的干预结果将是 在基线、3个月和6个月时进行评估。干预措施将根据以下情况进行修订和最终确定 可接受性/可行性评估数据、过程评估数据和干预促进者的反馈 和参与者。

Abstract Vietnam is currently decentralizing its methadone maintenance therapy (MMT) dispensing network to its local commune health centers (CHC), which provides a window of opportunity to study decentralization of harm reduction and HIV-related healthcare services into community-based healthcare settings. Commune health workers (CHW) in Vietnam have widespread misconceptions about harm reduction and perceived significant challenges associated with treating people who use drugs. Intervention effort is needed to address these issues to ensure a smooth implementation of the decentralized service model. The proposed two-year study plans to design and pilot test an intervention to facilitate the delivery of decentralized MMT/HIV services via three phases in Phu Tho Province, Vietnam. In Phase 1, we will conduct task analysis with MMT clients and cross-functional analysis with service providers to identify the steps/tasks that are associated with most procedural delays, errors, redundancies, and/or unnecessary reworks. We will also evaluate each CHC’s capacity and readiness to deliver the MMT services. In Phase 2, under the framework of intervention mapping, a multidisciplinary working group will go through the six steps to design the intervention and develop its implementation and evaluation plan. The intervention, with a primary focus on process optimization, will be executed through a combination of in-person training and mobile phone application utilization. In Phase 3, we will pilot the intervention in six CHC-based MMT distribution sites. The six CHC will be randomized to either an intervention condition or a control condition. The intervention outcomes on CHW and MMT clients will be evaluated at baseline, 3-, and 6-months. The intervention will be revised and finalized based on acceptability/feasibility evaluation data, process evaluation data, and feedbacks from intervention facilitators and participants.