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

• Author / Creator

  TRAN, BACH XUAN

• 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.

• Subjects / Keywords

  • Quality of life
  • Adherence
  • Antiretroviral treatment
  • Vietnam
  • Methadone
  • Cost-effectiveness
  • Drug use
  • HIV/AIDS

• Graduation date

  Spring 2012

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R3MF0X

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.