Background
Methods
Survey design and sampling
Level | Settings | Site Name | Type of services | Sample size |
---|---|---|---|---|
Province | Nam Dinh City | Provincial AIDS Center (PAC) | MMT+ VCT | 270 |
District (rural) | Xuan Truong District | District Health Center (DHC) | MMT+ VCT + ART + GH | 151 |
District (urban) | Tu Liem District | District Health Center | MMT+ VCT + ART + GH | 201 |
District (urban) | Long Bien District | District Health Center | MMT+ VCT + ART + GH | 184 |
District (urban) | Ha Dong District | Regional Polyclinic (RPC) | MMT+ GH | 210 |
Measures and instruments
Measurement of willingness to pay
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The problem: Patients were reminded the negative impacts of opioid use on HIV prevention, care, and treatment. This included an increased risks of transmitting HIV to others if they shared needles and syringes, a sub-optimal adherence and poorer outcomes of HIV/AIDS treatment, and a deteriorated health status and quality of life [30‐33]. Also, other socioeconomic impacts of opioid dependence were discussed, for instance, stigma and discrimination, economic burden, and poverty risk of households. Traditional drug rehabilitation services available for opioid users showed limited long-term efficacy, and a large proportion of patients relapsed to drug abuse after several rehabilitation periods.
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The attributes of MMT services: The patients were then introduced into the effectiveness of MMT as a substitution therapy for opioid dependants. MMT is cost-effective in reducing the frequency of opioid use, improving health status and quality of life of patients, supporting adherence to ART [9, 34, 35]. In addition, drug users taking MMT can have earlier access to health care services, receive adequate health information, counselling, and referrals, which in turn, may reduce other risky health behaviours, for example, alcohol use disorders [31]. Furthermore, patients can continue to be productive, released from stigma, discrimination, and financial burden of opioid as well as health care expenses associated with opioid abuse [34].
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The market: The patients were presented the scale-up plan of MMT services that would be offered to them or their family members. Patients would be required to visit the MMT clinics once a day to take MMT under direct supervisions of health care workers. Currently, MMT services are delivered by the public health care system, and offered free-of-charge, however, its coverage is very low as of 20% by 2013 [36]. Since the international financial support is decreasing, it would be difficult for the Government to expand the coverage of this service. The patients were then asked the maximum they were willing to pay out-of-pocket for the MMT services.
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The CV method: has been widely used as a valid method for eliciting patients’ preference and WTP and has been applied in the previous study in Vietnam [20]. Double-bounded dichotomous choice questions backed by an open-ended question were used for eliciting patients’ WTP for MMT services. Initially, patients were asked if they were willing to pay for a monthly fee of 1,000,000 Vietnam Dong (~US$ 50) to take MMT. This starting value was the most-update estimation of unit cost for one-month MMT. If the respondent indicated a WTP the first amount offered, then interviewers asked a follow-up question with the new threshold at double the first one. If the respondent was unwilling to pay, interviewers then halved the price. The question was repeated until the amount to be offered was four times or one-fourth of the starting value. Finally, patients were asked an open-ended question follows the double-bounded binary questions: “What is the maximum price you would be willing to pay per month for the MMT?” Fig. 1. presents the details of CV questions.
Statistical analysis
Results
Nam Dinh | Xuan Truong | Tu Liem | Long Bien | Ha Dong | Total |
p-value | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | N | % | N | % | N | % | ||
Age | |||||||||||||
18- <30 | 35 | 13.0 | 27 | 17.9 | 40 | 19.9 | 18 | 9.8 | 40 | 19.1 | 160 | 15.8 | 0.05 |
30- <35 | 80 | 29.6 | 36 | 23.8 | 51 | 25.4 | 46 | 25.0 | 53 | 25.2 | 266 | 26.2 | |
35- <40 | 81 | 30.0 | 33 | 21.9 | 58 | 28.9 | 51 | 27.7 | 43 | 20.5 | 266 | 26.2 | |
40- <45 | 38 | 14.1 | 27 | 17.9 | 27 | 13.4 | 33 | 17.9 | 42 | 20.0 | 167 | 16.4 | |
> =45 | 36 | 13.3 | 28 | 18.5 | 25 | 12.4 | 36 | 19.6 | 32 | 15.2 | 157 | 15.5 | |
Sex | |||||||||||||
Male | 266 | 98.5 | 151 | 100.0 | 199 | 99.0 | 181 | 98.4 | 206 | 98.1 | 1003 | 98.7 | 0.56 |
Female | 4 | 1.5 | 0 | 0.0 | 2 | 1.0 | 3 | 1.6 | 4 | 1.9 | 13 | 1.3 | |
Marital status | |||||||||||||
Single | 101 | 37.4 | 29 | 19.2 | 44 | 21.9 | 30 | 16.3 | 47 | 22.4 | 251 | 24.7 | <0.01 |
Live with spouse | 148 | 54.8 | 116 | 76.8 | 135 | 67.2 | 139 | 75.5 | 147 | 70.0 | 685 | 67.4 | |
Live with partner | 0 | 0.0 | 0 | 0.0 | 1 | 0.5 | 1 | 0.5 | 1 | 0.5 | 3 | 0.3 | |
Divorced | 19 | 7.0 | 6 | 4.0 | 20 | 10.0 | 12 | 6.5 | 15 | 7.1 | 72 | 7.1 | |
Widow | 2 | 0.7 | 0 | 0.0 | 1 | 0.5 | 2 | 1.1 | 0 | 0.0 | 5 | 0.5 | |
Educational attainment | |||||||||||||
Illiterate | 4 | 1.5 | 1 | 0.7 | 5 | 2.5 | 3 | 1.6 | 4 | 1.9 | 17 | 1.7 | <0.01 |
Elementary | 21 | 7.8 | 29 | 19.2 | 23 | 11.4 | 19 | 10.3 | 27 | 12.9 | 119 | 11.7 | |
Secondary | 103 | 38.2 | 87 | 57.6 | 82 | 40.8 | 68 | 37.0 | 86 | 41.0 | 426 | 41.9 | |
High | 121 | 44.8 | 28 | 18.5 | 74 | 36.8 | 83 | 45.1 | 81 | 38.6 | 387 | 38.1 | |
Vocational | 12 | 4.4 | 5 | 3.3 | 6 | 3.0 | 2 | 1.1 | 7 | 3.3 | 32 | 3.2 | |
University | 9 | 3.3 | 1 | 0.7 | 11 | 5.5 | 9 | 4.9 | 5 | 2.4 | 35 | 3.4 | |
Employment | |||||||||||||
Unemployed | 76 | 28.2 | 25 | 16.6 | 64 | 31.8 | 41 | 22.3 | 53 | 25.2 | 259 | 25.5 | <0.01 |
Self-employed | 159 | 58.9 | 67 | 44.4 | 94 | 46.8 | 110 | 59.8 | 112 | 53.3 | 542 | 53.4 | |
White collars | 5 | 1.9 | 1 | 0.7 | 6 | 3.0 | 5 | 2.7 | 5 | 2.4 | 22 | 2.2 | |
Workers, Farmers | 10 | 3.7 | 54 | 35.8 | 11 | 5.5 | 7 | 3.8 | 18 | 8.6 | 100 | 9.8 | |
Students | 0 | 0.0 | 0 | 0.0 | 2 | 1.0 | 0 | 0.0 | 0 | 0.0 | 2 | 0.2 | |
Other jobs | 20 | 7.4 | 4 | 2.7 | 24 | 11.9 | 21 | 11.4 | 22 | 10.5 | 91 | 9.0 | |
Religion | |||||||||||||
Cult of ancestors | 247 | 91.5 | 96 | 63.6 | 184 | 91.5 | 171 | 92.9 | 198 | 94.3 | 896 | 88.2 | <0.01 |
Buddhism | 13 | 4.8 | 16 | 10.6 | 11 | 5.5 | 9 | 4.9 | 10 | 4.8 | 59 | 5.8 | |
Catholic | 10 | 3.7 | 39 | 25.8 | 4 | 2.0 | 1 | 0.5 | 2 | 1.0 | 56 | 5.5 | |
Protestant | 0 | 0.0 | 0 | 0.0 | 2 | 1.0 | 3 | 1.6 | 0 | 0.0 | 5 | 0.5 |
Nam Dinh | Xuan Truong | Tu Liem | Long Bien | Ha Dong | Total |
p-value | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | N | % | N | % | N | % | ||||||||
HIV positive | 22 | 8.4 | 7 | 5.3 | 25 | 13.2 | 19 | 11.2 | 9 | 4.4 | 82 | 8.6 | 0.01 | ||||||
ART | 16 | 5.9 | 6 | 4.0 | 23 | 11.4 | 15 | 8.2 | 6 | 2.9 | 66 | 6.5 | 0.02 | ||||||
Ever inject drug | 222 | 82.2 | 91 | 60.3 | 153 | 76.1 | 119 | 64.7 | 161 | 76.7 | 746 | 73.4 | <0.01 | ||||||
Current drug use | 15 | 5.6 | 17 | 11.3 | 0 | 0.0 | 6 | 3.3 | 11 | 5.2 | 49 | 4.8 | <0.01 | ||||||
Location of previous drug rehabilitation | |||||||||||||||||||
Home | 213 | 85.9 | 103 | 75.7 | 122 | 63.5 | 104 | 59.8 | 132 | 68.8 | 674 | 71.6 | <0.01 | ||||||
Private voluntary centre | 108 | 43.6 | 50 | 36.8 | 97 | 50.5 | 98 | 56.3 | 97 | 50.5 | 450 | 47.8 | 0.01 | ||||||
Compulsory center | 74 | 29.8 | 13 | 9.6 | 68 | 35.4 | 69 | 39.7 | 32 | 16.7 | 256 | 27.2 | <0.01 | ||||||
# drug rehabilitation | |||||||||||||||||||
None | 22 | 8.2 | 15 | 9.9 | 9 | 4.5 | 10 | 5.4 | 18 | 8.6 | 74 | 7.3 | <0.01 | ||||||
1--5 episodes | 155 | 57.4 | 110 | 72.9 | 138 | 68.7 | 121 | 65.8 | 151 | 71.9 | 675 | 66.4 | |||||||
6--10 | 72 | 26.7 | 24 | 15.9 | 45 | 22.4 | 37 | 20.1 | 33 | 15.7 | 211 | 20.8 | |||||||
> 10 | 21 | 7.8 | 2 | 1.3 | 9 | 4.5 | 16 | 8.7 | 8 | 3.8 | 56 | 5.5 | |||||||
Mean | 95% CI | Mean | 95% CI | Mean | 95% CI | Mean | 95% CI | Mean | 95% CI | Mean | 95% CI | ||||||||
Daily cost of drug use (1000 vnd) | 405 | 318 | 492 | 251 | 200 | 303 | 444 | 175 | 714 | 299 | 172 | 427 | 356 | 245 | 468 | 336 | 295 | 376 | 0.02 |
Duration on MMT (month) | 11.5 | 10.6 | 12.4 | 9.3 | 8.4 | 10.1 | 27.7 | 26.0 | 29.4 | 18.7 | 17.2 | 20.2 | 15.2 | 14.1 | 16.3 | 16.3 | 15.6 | 17.0 | 0.02 |
Variable | Willing to pay | Monthly price (1000 Vietnam Dong) | ||||
---|---|---|---|---|---|---|
N | No. | % | Mean | (95% CI) | ||
Overall | 1016 | 970 | 95.5% | 639 | 575 | 704 |
MMT models | ||||||
Nam Dinh | 270 | 259 | 95.9% | 595 | 478 | 712 |
Xuan Truong | 151 | 148 | 98.0% | 594 | 433 | 755 |
Tu Liem | 201 | 193 | 96.0% | 694 | 539 | 849 |
Long Bien | 184 | 174 | 94.6% | 689 | 532 | 845 |
Ha Dong | 210 | 196 | 93.3% | 631 | 489 | 774 |
History of drug rehabilitation | ||||||
None | 74 | 69 | 93.2% | 495 | 298 | 691 |
1–5 times | 675 | 648 | 96.0% | 639 | 559 | 718 |
6–10 times | 211 | 202 | 95.7% | 689 | 542 | 836 |
> 10 times | 56 | 51 | 91.1% | 636 | 369 | 904 |
HIV status | ||||||
Positive | 82 | 45 | 54.9% | 435 | 237 | 632 |
Negative | 876 | 870 | 99.3% | 660 | 591 | 730 |
N/A | 58 | 55 | 94.8% | 622 | 325 | 919 |
Duration on MMT | ||||||
Not yet | 28 | 24 | 85.7% | 545 | 135 | 954 |
1–3 months | 115 | 110 | 95.7% | 815 | 581 | 1049 |
4–6 months | 74 | 72 | 97.3% | 609 | 370 | 848 |
7–12 months | 257 | 246 | 95.7% | 607 | 483 | 730 |
13–24 months | 341 | 327 | 95.9% | 582 | 482 | 682 |
25–36 months | 166 | 157 | 94.6% | 598 | 450 | 747 |
37–60 months | 35 | 34 | 97.1% | 1102 | 600 | 1604 |
Coef. | 95% CI | |
---|---|---|
MMT model (MMT + VCT - ref) | ||
Rural MMT-ART-VCT-GH (dropped) | ||
Urban MMT-ART-VCT-GH | −188*** | (−262; −113) |
MMT + Regional poly clinic | −174*** | (−257; −92) |
Educational attainment (Illiterate - ref) | ||
Elementary | 128** | (30; 226) |
Secondary | 75** | (11; 139) |
Vocational | 200** | (32; 368) |
Age groups (18- < 25 - ref) | ||
40- <45 | 77* | (−7; 162) |
Self-reported health problems (vs. No) | ||
Usual activities | −92 | (−225; 42) |
Pain/ Discomfort | −140*** | (−222; −57) |
HIV negative vs. positive | 75 | (−22; 171) |
Had outpatient care last year (vs. No) | 79** | (13; 146) |
Historical expenses on opiates (5 levels) | ||
Highest vs. Lowest | 117*** | (43; 190) |
Sex: female vs. male | −238* | (−515; 40) |
Income per capita (Lowest - ref) | ||
Medium | 65 | (−18; 148) |
High | 112*** | (32; 192) |
Highest | 124*** | (45; 204) |
Constant | 253*** | (172; 334) |