Implementation of an innovative community-based access to psychiatric care for people who use drugs in the City of Haiphong, Vietnam: the DRIVE-Mind project
Abstract
Background
Psychiatric comorbidities are frequent among people who inject drugs and are associated with poorer outcomes in terms of HIV prevention and care. Preliminary data showed that in Haiphong, Vietnam, access to psychiatric care is particularly low for this population despite frequent methamphetamine use and the burden of dual disorders. The objective of this project is to implement an innovative and alternative community-based access to psychiatric care in the city of Haiphong, targeting people who inject drugs from the ANRS-NIDA DRIVE cohort.
Method.
Starting in 2016, a large cohort of PWID was recruited in the city of Haiphong to assess the impact of a community-based intervention on HIV prevention and care, in order to extinct HIV incidence in this population. PWID from the cohort suffering from a psychiatric disorder (mainly depression, suicidal risk and psychotic syndrome confirmed by MINI structured psychiatric interview and clinical evaluation) were recruited in the nested DRIVE-Mind cohort for a 12 months follow-up during a visit of the DRIVE cohort. Interventions included community-based support by trained peers (information on mental health, mental disorders and treatment, linkage to care for HIV and drug use/methadone/harm reduction, social support, recall of appointments, family intervention, support for treatment adherence) with a peer-referent identified for each PWID, and free psychiatric consultations in the peer offices including delivery of medical treatment from psychiatrists of the mental health department of Haiphong.
Results
Among the 1212 PWID coming back for follow-up visit of the DRIVE cohort (March-April 2019), 430 were screened positive for a mental health disorder and referred to a psychiatrist, 233 met the selection criteria for inclusion, signed the consent form et were recruited in the DRIVE-Mind cohort. 210 (90,1%) were male, 22 (9,4%) female and 1 (0,4%) transgender; their median age was 45 (39-52), 96 (41.2%) were HIV positive and 82 treated with ARV (85.4%), 178 (76.4%) were HCV positive, 55 (23.6%) had a history of suicide attempt. 136 (58.4%) were treated with methadone, 166 (71.2%) were injecting heroin and 106 (45.5%) smoking ice during the last 6 months. 80 (34.3%) had urine test positive for ice, 144 (61.8%) for opiates, 140 for methadone (60.1%) and 6 for cannabis (2.6%). Among them, 192 (82.4%) were diagnosed with a depression, 114 (48.9%) with a psychotic syndrome including 54 (23.2%) a ice-related psychotic syndrome, 15 (6.4%) presented a severe suicidal risk and 26 (11.2%) were considered as severely ill or the most extremely ill patients according to the Clinical Global Impression scale. Follow-up visits were scheduled up to weekly, according to the clinical situation, with a mi-term (6 months) evaluation of the cohort before endpoint. This mid-term evaluation will be presented at the Lisbon conference.
Conclusion
The strong peer involvement in the city of Haiphong together with the shared will among all stakeholders to face a critical situation related to the increase of ice use, allowed to develop an accessible and innovative model of care. The DRIVE-Mind cohort should help to document its impact and formulate recommendations.
