Presenting author: Laurent Michel
Presenting author biography:
L Michel is MD, PhD, psychiatrist and specialist in addiction medicine. He is the head of the Pierre Nicole Centre in Paris, France and researcher in the CESP/Inserm 1018 unit (Villejuif, France).
Implementation of a community-based psychiatric intervention among people who inject drugs in the City of Haiphong, Vietnam: the DRIVE-Mind project.
Laurent Michel, Sao Mai Le, Oanh Khuat Thi Hai, Khue Pham Minh, Philippe Trouiller, Roselyne Vallo, delphine Rapoud, Catherine Quillet, Thuy Linh Nguyen, Quang Duc Nguyen, Tuyet Thanh NhamThi, Giang Hoang Thi, Jonathan Feelemyer, Vinh Vu Hai, Jean-Pierre Moles, Didier Laureillard, Don Des Jarlais, Nicolas Nagot
Background: Access to psychiatric care for people who inject drugs (PWID) is limited and stigmatized in most low-middle-income countries (LMICs). Innovative interventions involving peer support, and based on skill transfer and task shifting, are needed. We aim to describe and assess the impact of a community-based psychiatric intervention among PWID in Hai Phong, Vietnam.
Methods: In a cohort study with one year psychiatric follow-up, PWID diagnosed with a psychotic disorder, a major depressive episode, or suicide risk, were recruited from the wider Drug-Related Infections in ViEtnam (DRIVE) project in the city of Hai Phong. The community-based psychiatric intervention included specialized follow-up (free consultations with psychiatrists, free medication, referral to mental health department for hospitalization when necessary) and support from community-based organisations (case management, harm reduction, administrative support, linkage to HIV care, methadone maintenance treatment and mental health support). The main outcome was reduction/remission of symptoms assessed with the MINI International Neuropsychiatric interview and the Clinical Global Impression scale. Access to and retention in psychiatric care, quality-of-life and stigmatization were also measured pre and post-intervention.
Results: Among the 1212 participants screened from March to May 2019, 271 met the inclusion criteria, 233 (86.3%) accepted the intervention and 170 completed the follow-up (72.9%). At inclusion, 80.6% were diagnosed with current depression, 44.7% with psychotic disorder and 42.4% with suicide risk. After a one-year follow-up, these proportions dropped to 15.9%, 21.8%, and 22.9% respectively. Quality-of-life and perceived stigma related to mental health were also significantly improved, while drug use decreased only marginally.
Conclusion: Community-based psychiatric interventions are both feasible and efficient in the Vietnamese context. Peers can play a crucial role to facilitate access and psychiatric care for the most marginalized populations. Similar interventions should be implemented and evaluated in different LMICs and contexts.