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Finding what works: identification of implementation strategies for the integration of methadone maintenance therapy and HIV services in Vietnam

BACKGROUND: Integration of methadone maintenance therapy (MMT) and HIV services is an evidence-based intervention (EBI) that benefits HIV care and reduces costs. While MMT/HIV integration is recommended by the World Health Organization and the Centers for Disease Control and Prevention, it is not wi...

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Autores principales: Go, Vivian F., Morales, Giuliana J., Mai, Nguyen Tuyet, Brownson, Ross C., Ha, Tran Viet, Miller, William C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837557/
https://www.ncbi.nlm.nih.gov/pubmed/27097726
http://dx.doi.org/10.1186/s13012-016-0420-8
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author Go, Vivian F.
Morales, Giuliana J.
Mai, Nguyen Tuyet
Brownson, Ross C.
Ha, Tran Viet
Miller, William C.
author_facet Go, Vivian F.
Morales, Giuliana J.
Mai, Nguyen Tuyet
Brownson, Ross C.
Ha, Tran Viet
Miller, William C.
author_sort Go, Vivian F.
collection PubMed
description BACKGROUND: Integration of methadone maintenance therapy (MMT) and HIV services is an evidence-based intervention (EBI) that benefits HIV care and reduces costs. While MMT/HIV integration is recommended by the World Health Organization and the Centers for Disease Control and Prevention, it is not widely implemented, due to organizational and operational barriers. Our study applied an innovative process to identify implementation strategies to address these barriers. METHODS: Our process was adapted from the Expert Recommendations for Implementing Change (ERIC) protocol and consisted of two main phases. In Phase 1, we conducted 16 in-depth interviews with stakeholders and developed matrices to display barriers to integration. In Phase 2, we selected implementation strategies that addressed the barriers identified in Phase 1 and conducted a poll to vote on the most important and feasible strategies among a panel with expertise in cultural context and implementation science. RESULTS: Barriers fell into two broad categories: policy and programmatic. At the policy level, barriers included lack of a national mandate, different structures (MMT vs. HIV clinic) for cost reimbursement and staff salaries, and resistance on the part of staff to take on additional tasks without compensation. Programmatic barriers included the need for cross-training in MMT and HIV tasks, staff accountability, and commitment from local leaders. In Phase 2, we focused on programmatic challenges. Based on voting results and iterative dialogue with our expert panel, we selected several implementation strategies in the domains of technical assistance, staff accountability, and local commitment that targeted these barriers. CONCLUSIONS: Key programmatic barriers to MMT/HIV integration in Vietnam may be addressed through implementation strategies that focus on technical assistance, staff accountability, and local commitment. Our process of identifying implementation strategies was simple, low cost, and potentially replicable to other settings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13012-016-0420-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-48375572016-04-21 Finding what works: identification of implementation strategies for the integration of methadone maintenance therapy and HIV services in Vietnam Go, Vivian F. Morales, Giuliana J. Mai, Nguyen Tuyet Brownson, Ross C. Ha, Tran Viet Miller, William C. Implement Sci Research BACKGROUND: Integration of methadone maintenance therapy (MMT) and HIV services is an evidence-based intervention (EBI) that benefits HIV care and reduces costs. While MMT/HIV integration is recommended by the World Health Organization and the Centers for Disease Control and Prevention, it is not widely implemented, due to organizational and operational barriers. Our study applied an innovative process to identify implementation strategies to address these barriers. METHODS: Our process was adapted from the Expert Recommendations for Implementing Change (ERIC) protocol and consisted of two main phases. In Phase 1, we conducted 16 in-depth interviews with stakeholders and developed matrices to display barriers to integration. In Phase 2, we selected implementation strategies that addressed the barriers identified in Phase 1 and conducted a poll to vote on the most important and feasible strategies among a panel with expertise in cultural context and implementation science. RESULTS: Barriers fell into two broad categories: policy and programmatic. At the policy level, barriers included lack of a national mandate, different structures (MMT vs. HIV clinic) for cost reimbursement and staff salaries, and resistance on the part of staff to take on additional tasks without compensation. Programmatic barriers included the need for cross-training in MMT and HIV tasks, staff accountability, and commitment from local leaders. In Phase 2, we focused on programmatic challenges. Based on voting results and iterative dialogue with our expert panel, we selected several implementation strategies in the domains of technical assistance, staff accountability, and local commitment that targeted these barriers. CONCLUSIONS: Key programmatic barriers to MMT/HIV integration in Vietnam may be addressed through implementation strategies that focus on technical assistance, staff accountability, and local commitment. Our process of identifying implementation strategies was simple, low cost, and potentially replicable to other settings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13012-016-0420-8) contains supplementary material, which is available to authorized users. BioMed Central 2016-04-20 /pmc/articles/PMC4837557/ /pubmed/27097726 http://dx.doi.org/10.1186/s13012-016-0420-8 Text en © Go et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Go, Vivian F.
Morales, Giuliana J.
Mai, Nguyen Tuyet
Brownson, Ross C.
Ha, Tran Viet
Miller, William C.
Finding what works: identification of implementation strategies for the integration of methadone maintenance therapy and HIV services in Vietnam
title Finding what works: identification of implementation strategies for the integration of methadone maintenance therapy and HIV services in Vietnam
title_full Finding what works: identification of implementation strategies for the integration of methadone maintenance therapy and HIV services in Vietnam
title_fullStr Finding what works: identification of implementation strategies for the integration of methadone maintenance therapy and HIV services in Vietnam
title_full_unstemmed Finding what works: identification of implementation strategies for the integration of methadone maintenance therapy and HIV services in Vietnam
title_short Finding what works: identification of implementation strategies for the integration of methadone maintenance therapy and HIV services in Vietnam
title_sort finding what works: identification of implementation strategies for the integration of methadone maintenance therapy and hiv services in vietnam
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837557/
https://www.ncbi.nlm.nih.gov/pubmed/27097726
http://dx.doi.org/10.1186/s13012-016-0420-8
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