ERA

Download the full-sized PDF of Cost - effectiveness of integrating methadone maintenance with antiretroviral treatment in injection-driven HIV epidemicsDownload the full-sized PDF

Analytics

Share

Permanent link (DOI): https://doi.org/10.7939/R3MF0X

Download

Export to: EndNote  |  Zotero  |  Mendeley

Communities

This file is in the following communities:

Graduate Studies and Research, Faculty of

Collections

This file is in the following collections:

Theses and Dissertations

Cost - effectiveness of integrating methadone maintenance with antiretroviral treatment in injection-driven HIV epidemics Open Access

Descriptions

Other title
Subject/Keyword
Methadone
Adherence
HIV/AIDS
Drug use
Vietnam
Antiretroviral treatment
Cost-effectiveness
Quality of life
Type of item
Thesis
Degree grantor
University of Alberta
Author or creator
TRAN, BACH XUAN
Supervisor and department
Ohinmaa, Arto (Public Health Sciences)
Examining committee member and department
Russell, Margaret (Community Health Sciences, University of Calgary)
Jacobs, Philip (Medicine and Dentistry)
Veugelers, Paul (Public Health Sciences)
Ohinmaa, Arto (Public Health Sciences)
Houston, Stan (Medicine and Dentistry)
Department
Department of Public Health Sciences
Specialization

Date accepted
2011-11-04T19:31:52Z
Graduation date
2012-06
Degree
Doctor of Philosophy
Degree level
Doctoral
Abstract
In the household survey, Health-Related Quality of Life (HRQL) of patients on antiretroviral treatment (ART) was profoundly reduced and significantly lower among drug users (DUs) than that of non-DUs, especially in the psychological and social dimensions. Drug use is known to negatively affect HIV/AIDS treatment outcomes; that made it essential to integrate drug dependence treatment into HIV/AIDS treatment policies in Vietnam’s injection-driven HIV epidemics. The effectiveness and cost-effectiveness of Methadone Maintenance Treatment (MMT) were assessed using secondary data of the first MMT cohort in Vietnam. The findings showed that the rates of concurrent drug use during MMT among HIV-positive DUs rapidly decreased at the first trimester (18.1%), and then stabilized during the next 2 trimesters (11.8% and 14.4%). Improvements in HRQL were large over 9 month follow-up and highest in the psychological dimension. However, MMT patients with ongoing drug use (30.5%) and injection (20.5%) reported large decrements in all HRQL dimensions compared to those abstinent to drug. A social ecological model was applied to explore multilevel predictors of ongoing drug use, and it revealed higher likelihood in those patients who had higher levels of prior opioid dependence, peer pressure, took ART or tuberculosis treatment, and had more health concerns. The subsequent economic evaluation determined that MMT was cost-effective for HIV-positive DUs in term of gains in Quality-Adjusted Life Years; however, it might not be cost-effective for those patients who continued to inject drug. The modeling study sought to assess the potential integration of ART and MMT for HIV-positive DUs. A decision analytical model was developed to compare the costs and consequences of 3 ART strategies: 1) only ART model 2) the separated ART-MMT model as currently delivered in Vietnam, and 3) direct administered ART-MMT where patients took methadone and ART regimens under supervisions of health workers. The findings indicated that integrating ART and MMT services for HIV-positive DUs facilitated the use of directly observed therapy that can bring about clinically important improvements in health outcomes. This approach was also incrementally cost-effective in this large injection-driven HIV epidemic.
Language
English
DOI
doi:10.7939/R3MF0X
Rights
License granted by BACH TRAN (bxtran@ualberta.ca) on 2011-11-03T23:49:57Z (GMT): Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of the above terms. The author reserves all other publication and other rights in association with the copyright in the thesis, and except as herein provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
Citation for previous publication

File Details

Date Uploaded
Date Modified
2014-04-24T22:44:05.027+00:00
Audit Status
Audits have not yet been run on this file.
Characterization
File format: pdf (Portable Document Format)
Mime type: application/pdf
File size: 563777
Last modified: 2015:10:12 14:19:19-06:00
Filename: Bach Fall 2011 (4).pdf
Original checksum: 03aa5c37422c591b4e3514bf247b0483
Well formed: false
Valid: false
Status message: Unexpected error in findFonts java.lang.ClassCastException: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject cannot be cast to edu.harvard.hul.ois.jhove.module.pdf.PdfDictionary offset=558042
Page count: 132
Activity of users you follow
User Activity Date