The Lancet Regional Health. Western Pacific (Jan 2022)

Assessment of a psychiatric intervention at community level for people who inject drugs in a low-middle income country: the DRIVE-Mind cohort study in Hai Phong, Viet Nam

  • Laurent Michel,
  • Sao Mai Le,
  • Giang Hoang Thi,
  • Philippe Trouiller,
  • Huong Duong Thi,
  • Oanh Khuat Thi Hai,
  • Khue Pham Minh,
  • Roselyne Vallo,
  • Delphine Rapoud,
  • Catherine Quillet,
  • Thuy Linh Nguyen,
  • Quang Duc Nguyen,
  • Tuyet Thanh NhamThi,
  • Jonathan Feelemyer,
  • Vinh Vu Hai,
  • Jean-Pierre Moles,
  • Hong Quang Doan,
  • Didier Laureillard,
  • Don C. Des Jarlais,
  • Nicolas Nagot

Journal volume & issue
Vol. 18
p. 100337

Abstract

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Summary: 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.