Citation

Michel L, Le SM, Thi GH, Trouiller P, Thi HD, Thi Hai OK, Minh KP, Vallo R, Rapoud D, Quillet C, Nguyen TL, Nguyen QD, NhamThi TT, Feelemyer J, Hai VV, Moles JP, Doan HQ, Laureillard D, Des Jarlais DC, Nagot N. Lancet Reg. Health West. Pac. 2022; 18.

Copyright

(Copyright © 2022, Elsevier Publishing)

DOI

10.1016/j.lanwpc.2021.100337

PMID

unavailable

Abstract

BACKGROUND: Access to psychiatric care for people who inject drugs (PWID) is limited/absent and stigmatized in most low-middle-income countries (LMICs). Innovative interventions are needed. We aimed 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. Access to and retention in psychiatric care, quality-of-life and stigmatization were also measured pre and post-intervention.

FINDINGS: 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.

INTERPRETATION: Community-based psychiatric interventions are both feasible and efficient in the Vietnamese context. Similar interventions should be implemented and evaluated in other, different LMICs. Funding:: This work was supported by grants from NIDA (US) (#DA041978) and ANRS (France) (#13353). The funding agencies had no role in designing the research, data analyses, or preparation of the report. © 2021 The Author(s)

Language: en

Keywords

adult; human; mental health; suicide; female; male; quality of life; social support; major depression; hospitalization; risk factor; major clinical study; controlled study; psychiatrist; community care; clinical feature; Human immunodeficiency virus infection; psychiatric diagnosis; follow up; methadone treatment; psychiatric treatment; cohort analysis; risk reduction; remission; case management; Viet Nam; Article; administrative personnel; outcome assessment; total quality management; social stigma; low income country; middle income country; injection drug user; mental health care access