Introduction
The take-home policy adding to the methadone maintenance treatment (MMT) has been shown to improve the treatment outcomes. However, many countries with strict substance abuse policies still require patients to daily visit the clinics. Vietnam has started piloting the methadone take-home program since April 2021 in three provinces (two rural mountainous provinces and one urban city). This study aims to assess the initial feasibility and acceptability of the program after 6-month implementation.
Method
A mixed method study was conducted in three provinces piloting the methadone take-home program in Vietnam from September to December 2021. The quantitative data was extracted from medical records of 922/948 patients who received methadone take-home doses from April to September 2021. The qualitative data from 4 in-depth interviews with provincial leaders and program managers, 9 group discussions with healthcare providers and 6 group discussions with patients receiving methadone take-home doses.
Results
Although having few methadone diversions and mistaken, no serious overdose has been reported. Retention rate after 6 months in the methadone treatment was 96.7% and in the take-home program was 88.0%. The rate of missing at least one dose every month after being in the take-home program was less than 3%, lower to these rates before being in the program (7-10%). Both providers and patients acknowledged the benefits of the program including improved treatment adherence, increased employment opportunities, improved health status and family relationship. Providers were capable of handling their task. However, their work burden was not clearly reduced as the program’s expectation, mostly due to the extra monitoring and administration work.
Conclusions
It is feasible and acceptable to implement methadone take-home doses in both rural and urban areas in Vietnam to enhance treatment outcomes. More relaxing treatment guidelines should help reduce provider’s work burden and, therefore, facilitate expansion and sustainability of the program.