Provider-patient communication about substance abuse in HIV settings in Hanoi, Vietnam Open Access

An, Ly (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/qz20st37f?locale=en
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Abstract

Background: Since 2005, the national ART program in Vietnam has been scale up through a nationwide network of outpatient clinics (OPCs), which providing antiretroviral therapy (ART) to 57,6000 patients. It is estimated that the national ART program prevented 18,110 AIDS-related deaths between 2000 and 2009, cumulatively. However, these achievements are challenged by the substance abuse among ART patients, which is proven to negatively impact on adherence to ART treatment. Although many studies have shown that early detection, screening and treatment for substance abuse could improve HIV care quality and effectiveness, there is a gap of studies on provider-patient communication about substance abuse in HIV settings.

Objectives: This study aims to describe the communication between HIV providers and patients in HIV settings, explore factors that impact on the communication, and compare these communication among three models of treatment integration between ART and MMT treatment.

Methods: The qualitative data from this thesis is drawn from the original parent study on the need of integration substance abuse treatment into HIV antiviral treatment in 17 OPCs in Hanoi. 29 ART patients and 19 HIV providers volunteered to be interviewed.

Results: Five topics of provider-patient communication are patients' health issues, ART treatment adherence, patients' daily life challenges or difficulties, HIV transmission prevention, and substance abuse. Both patients and HIV providers are hesitant to talk about substance abuse. Providers working in the none-integration model seem to be more hesitant to talk about drug use than those working in the integrated model. Four factors influence on the communication are stigma, perceptions of substance abuse's impact on ART treatment, the "poor adherence" label, and limited expertise of HIV physicians.

Discussion: ART patients conceal their substance abuse to maintain their personal image as a good adherence patient to avoid confronting HIV providers. Training on substance abuse screening and treatment for HIV providers, integrating HIV treatment with substance abuse related services, and adding substance abuse screening content into ART treatment standard guideline will improve the communication between HIV providers and ART patients on substance abuse. Moreover, a good provider-patient relationship will make patients feel more comfortable to disclose their substance use behaviors.

Table of Contents

List of tables and figures................................................................................................. iii
Definition of key terms.................................................................................................... iv
I. Introduction............................................................................................................... 1
1. Objectives............................................................................................................... 3
2. Background and Rationale........................................................................................... 4
II. Literature Review........................................................................................................ 8
1. Substance abuse and ART treatment............................................................................ 8
2. Provider-patient relationship in ART treatment................................................................ 11
3. Communication about substance abuse in HIV settings..................................................... 12
III. Method.................................................................................................................... 13
1. Population and study setting....................................................................................... 13
2. Participants.............................................................................................................. 14
3. Data Collection.......................................................................................................... 15
4. Thematic Analysis...................................................................................................... 16
IV. Results .....................................................................................................................16
1. Participant characteristics ..........................................................................................16
2. Content of communication between providers and ART patients .........................................19
Patients' Health Issues .......................................................................................... 20
ART Treat ment Adherence ..................................................................................... 20
Daily life challenges or difficulties ............................................................................. 21
HIV transmission prevention .................................................................................... 22
Substance A buse................................................................................................... 22
3. Communication about substance abuse.......................................................................... 23
Communication about illicit drug use........................................................................... 25
Communication about alcohol abuse........................................................................... 31
4. Factors influencing communication on substance abuse..................................................... 32
Stigma.................................................................................................................. 33
Perceptions of substance abuse's impact on ART treatment............................................ 35
The "poor adherence" label....................................................................................... 36
HIV physician's expertise.......................................................................................... 37
V. Discussion.................................................................................................................. 39
Reference....................................................................................................................... 44

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