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


Other title
Drug use
Antiretroviral treatment
Quality of life
Type of item
Degree grantor
University of Alberta
Author or creator
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 of Public Health Sciences

Date accepted
Graduation date
Doctor of Philosophy
Degree level
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.
License granted by BACH TRAN ( 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.
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