Multilevel Integration Strategies to Enhance Service Provider Networks in Vietnam
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 320
- 试验地点
- 4
- 主要终点
- PLHWUD's service utilization
研究概览
简要总结
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.
详细描述
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.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •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
- •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
排除标准
- •Inability to give informed consent
- •Inability to give informed consent
结局指标
主要结局
PLHWUD's service utilization
时间窗: Changes from baseline to 3-, 6-, 9- and 12- month follow-ups
This will be measured by PLHWUD's utilization of health services including OPC and MMT. Both their access and adherence to treatments will be assessed.
CHW interaction with providers of other treatment agencies
时间窗: Changes from baseline to 3-, 6-, 9- and 12- month follow-ups
This will be measured by a multi-item scale on interaction with other treatment providers
次要结局
- CHW's service provision(Changes from baseline to 3-, 6-, 9- and 12- month follow-ups)
- PLHWUD's service satisfaction(Changes from baseline to 3-, 6-, 9- and 12- month follow-ups)
- CHW's patient-provider interaction with PLHWUD(Changes from baseline to 3-, 6-, 9- and 12- month follow-ups)
研究者
Li Li
Professor in Residence
University of California, Los Angeles