JOURNAL OF 108 - CLINICAL MEDICINE AND PHARIVIACY Vol 9 - N°1/2014
Thuc trang ngiroi nghien ma tiiy triro'c khi tham gia dieu trj nghien cac chat dang thuoc phien bang thuoc Methadone tai thanh pho Hai Phong va thanh pho Ho Chi Minh
The Situation of Drug usage Before Being Treated witli Methadone for Opioids Addiction in Hai Phong and Ho Chi Minh City.
Hoang Dinh Canh*, Nguyen Thanh Long* Bd Yie Nguyan Van Hu-ng** //pc vien Qudny
Phuang phdp nghien cdu: Md ta cat ngang dugc tien hanh tU thang 5/2008-12/2009 tren 965 ngUdI nghien ma tuy (benh nhan) dUOc lua chon vao chuong trinh dieu tri bang Methadone tai thanh phd Hai phong (498 benh nhan) va thanh pho Hd Chi Minh (467 benh nhan). Ket qud nghien cdu: do tuoi trung binh la 31,5 tuoi; 63,9% sd benh nhan song ddc than; 46,4% cd thdi gian s U d u n g ma tuy t d 5 den 10 nam, 83,4% sU dung ma tuy bang dudng tiem chich; 97,9% da tUng tham gia cai nghien ma tuy it nhat mdt lan nhung bi that bai; 4 , 1 % sUdung chung b o m kim tiem; 13,8% ed quan he tinh due vdi gai ban dam khdng sU dung bao cao su; 40,8% cd hanh vi vi pham phap luat; dac biet cd 28,4% nhiem HIV;
16,4% nhi^m HBV; 56,9% nhiem HCV. Kien nghi: Nghien edu eung dda ra mdt sd khuyen nghj sdm trien khai thi diem dieu tri nghien cac chat dang thuoc phien bang thudc thay the Methadone va tang cUdng chat luong cac dich vu y te phdng lay nhiem HIV/AiDS tai Hai Phdng va TP. Hd Chi Minh.
Tif khoa: Nghien chich ma tuy, HiV/AIDS, dieu tri Methadone.
Summary
Methods: A cross-sectional descriptive study was carried out In 965 eligible patients of the Methadone Treatment Programme from May, 2008 to December, 2009 in Ho Chi Minh City and Hai Phong for the pilot period (467 patients in Hai Phong and 498 patients in Ho Chi Minh city). Results: it shows that the average age of the patients was 31.5 year olds and 63.9% of eligible patients were single.
Drug abuse behaviors; From 5 to 10 years of using drugs (46,4%), Injecting drugs (83,4%); 9 7 , 9 % of drug users had participated in detoxification activity but unsuccessfully. High risk behaviours for HIV infections: The rate of addictors having used the same syringe appropriated 4.1 percent. The rate of people who had not used condoms in having sex with sex workers was 13.8 percent. Other social behaviours. Violating the law was 40.8%; the high rate of HIV infection was 28,4%; the rate of HBV infection was 16.4%; and the rate of HBV infection was 56.9%. Requests: The study offers some recommendations for early developing the pilot Methadone treatment for opioid addiction and strengthening the quality of health services in order to prevent HIV/AIDS infection in Hai Phong and Ho Chi Minh City
Keywords: Drug addiction, HIV/AIDS, Methadone treatment
I'haii bien khoa hgc: TS. DO HOA BINH 122
TAP CHi Y DL/OC LAM SANG 108 Tip 9 - S6 1/2014
I.Datvande
d Viet Nam, van n^n ma tuy da va dang anh hudng n^ng ne den kinh te va trat tU xa hdi, tang ty le gia dinh ddi ngheo va tang tdi pham xa hdi. Cdng tac dieu tri nghien va dU phong tai nghien ma tuy da duoc trien khai nhUng cdn gap nhieu khd khan.
Trong nhCfng nam gan day, dieu trj nghien cac chat dang thudc phien bang thudc thay the Methadone dugc nhi^u qudc gia ap dung va cho ket qua kha quan. Td kinh nghiem cua cac nude, Chinh phu da giao Bd Y t§ ti^n hanh thi diem 0§ an "Oieu tn nghien cac chat dang thude phien bIng thudc Methadone" tai thanh phd Hd Chi Minh va Hai Phdng tii dku nam 2008. Muc tieu nghien edu: Md td hdnh vi nguy ca lay nhiem HIV, hdnh vi vi pham phdp ludt vd xdc dinh ty le hien nhiem HIV, viem gan B, viem gan C d binh nhdn trUdc khi tham gia dieu tri nghien cdc chdt dgng thuoc phiin bdng thuoc Methadone tai thdnh phd Ho Chf Minh vd Hdi Phdng, Tam eosdeung cap thdng tin cho viec trien khai Be an thi diem theo Quyet djnh cda Thd tUdng Chinh phu .
2. Doi tucrng va phUcfng phap nghien cuTu 2.1. Doi tuang nghiin edu
Benh nhan dugc lUa chgn vao chuong trinh dieu trj b^ng Methadone tai thanh phd Ho Chi Minh va Hcii Phdng trong giai doan thi diem se dugc mdi tham gia vao nghien edu.
2.2. Dja diem vi thdi gian nghiin edu
• TP. Hell Phdng: nghien cdu dugc thdc hien tai 3 CO s6 dieu tri Methadone thudc: quan Le Chan, quan 3. Ket qud nghien citu
3.1. Mptsddacdiem nhan khau hpe,xi hpicua
,Ng6 Quyen, huyen Thuy Nguyen (moi quan/huy^n cd 1 eg sd).
-TP. Hd Chi Minh: nghien cdu dugc thUc hien tai 3 ca sd dieu tn Methadone thude: quan 4, quan 6 va quan Binh Thanh (moi quan cd 1 co sd).
Thdi gian nghien edu: td thang 5/2008 den thang 12/2009.
2.3. PhUcfng phap nghien ahi
-Thiet ke nghien edU: Nghien cdu md ti cat ngang.
- Cd mau va phuong phap chgn mau: Chgn toan bd benh nhan dugc lua chgn vao chuang trinh dieu trj bang Methadone tai thanh phd Hd Chi Minh va Hai Phdng trong giai doan thi diem. Tdng sd benh nhan duge mdi tham gia nghien eUu la 965 (Thanh phd Hai Phdng 467 benh nhan va TP. Hd Chi Minh 498 benh nhan). Cac ddi tugng tham gia nghien cdu hoan toan tU nguyen va dap Ung day dCi tieu ehi lUa chgn ddi tugng tham gia chuang trinh dieu trj thi diem do BdYte quy djnh [1].
- Phuang phap thu thap thdng tin: Phdng van trUe tiep doi tugng nghien cdu being bd eau hdi thiet ke sin, Thu thap cac thdng tin trong hd so benh ^n trudc khi tham gia ehUdng trinh dieu trj. Xet nghiem nudc tieu phat hien ma tuy; xet nghiem HIV, viem gan B va viem gan C.
- Xd ly sd lieu bSng phan mem SPSS phien bSn 18.0; ap dung thuat thdng ke so sanh, phan tich ket quci: Sddung testx^ deso sanh cac tyle.
doi tupng (benh nhan) nghien cdu
Bang 3.1. Dac diem ve gidi tinh va tuoi
Bac diem Gidi tfnh:
- N a m -NCf Nh6m tuoi:
-DM\ 20 - T O 2 0 - 2 4 -TCr25-29 - T t r 3 0 t r 4 I S n Tudi trung binh
Tp Hai Phong (n=467) SL
458 9 12 35 94 326
%
98,1 1,9 2,6 7,5 20,1 69,8 33,8 ± 0 . 4
TpH6Chflv;inh(n=498) SL
453 40
3 60 215 220
%
92,0 8,0 0,6 12,0 43,2 44,2 29,4 + 0,2
Chung (n=965) SL 916 49 15 95 309 546 31,5
%
94,9 5,1 1,6 9,8 32,0 56,6
±0,2
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol 9 - N°1/2014
Phan Idn sd ddi t u g n g nghien cdu (DTNC) la 56,6%, n h d m t u d i t d 25 - 29 c h i e m 32,0%, nhdm Uj6i nam gidi (94,9%); t u d i t r u n g binh cua cac DTNC la t d 2 0 - 2 4 chiem 9,8% va n h d m t u d i dUdi 20 ehiem t / 31,5 ± 0,2. Trong d o , n h d m t u d i t d 30 t r d len chiem le 1,6%.
Bang 3.2. Dac diem ve hon nhan va hgc van
Dac diem
Tmh trang hon nhan:
- O o c t h a n - Bang co vo/chong Trinh dp hoc van.
-Tieu hoc t r d xuong -THCS - PTTH t r d len
Tp Hai Phong fn=467) SL
270 197
44 206 217
%
57,8 42,2
9,4 44,1 46,5
Tp Hd Chi IVIinh (n=498) SL
347 151
57 233 208
%
69,7 30,3
11.4 46,8 41.8
Chung (n=965) SL
617 348
101 439 425
%
63,9 36.1
10.5 45,5 4 4 0 Ty [e DTNC ddc than ehiem ty le cao (63,9%), sd DTNC cd t r i n h dp hoc van THCS va PTTH t r d len chiem ty le chu yeu (45,5% va 44,0%).
3.2. Hanh vi nguy ca liy nhiem HIV vi hanh vi vi pham phap luat cua DTNC 3.2.1. Hdnh vi sddung ma tuy
Bang 3.3. Hanh vi suT dung ma t u y
Hanh VI SLfdung ma tuy Tham men sir dung ma tuy
tCf 5-10 nam SCfdung Heroin SCfdung ma tuy bang
dudng tiem chich Da tCfng cai nghien nhung
tai nghien
Tp Hai Phdng (n=467) SL 229 375 375
451
%
49,2 80,3 80,3
96,6
TpHoChilWinh fn=498) SL 217 434 423
494
%
43,8 87,1 84,9
99,2
Chung (n=965) SL 446 809 798
945
%
46,4 83,8 82,7
97,9
T y i e O T N C CO thoi gian s d d u n g ma tuy t d 5 - 1 0 c6 4 , 1 % s d d u n g chung b o m l<inn t i e m (Biff) vdi ban nam chiem 46,4%, da so cac doi t u o n g sCr d u n g chich c h u n g . Co 97,9% so doi t u o n g da tdng cai heroin (83,8%), sd doi t d g n g tiem chich ma tuy nghien it nhat 1 lan nhdng deu bi tai nghien.
(82,7%) Trong so cac doi t u o n g tiem chich ma tuy,
3.2.2. Hanh viquan hi tinh due
Bdng 3.4. Quan he tinh due (QHTD) trong vong 1 thang qua
HSnh vi QHTD
Co QHTD
Trong d d cd QHTD vdi GBD Co sCfdung BCS l<hi QHTD vdi GBD
Tp HSi Phong (n=467) SL 229 17 14
%
49,0 7,4 82,4
Tp Ho Chf IWinh (n=498) SL 222 13 11
%
44,6 5,8 91,7
Chung (n=965) SL 451 30 25
%
46,7 6,6 86,2 Sd DTNC ed QHTD vdi gai ban dam (GBD) t r o n g vdng 1 thang qua ehiem 6,6%, t r o n g d d cd sd d u n g bao cao su (BCS) khi QHTD vdi GBD chiem 86,2%.
3.2.3. Ti^p cdn dich vu vd sU dung dich vu y te, cdc dich vu hd trgxd hdi cua DTNC trUdc khi tham gia dieu tri bdng Methadone
Bang 3.5. Thifc trang tiep can djch v u y t e v a h o t r g x a hoi Tiep can va s d d u n g
dich vy y te, xa hdi Tdv^n XNtU nguyen Dieu tri ARV
Dieu tri nhiem triing cd hoi Dieu trj Lao
Dieu trj chuyen khoa tam than Ho trg sau cai nghien Tiep can BKT sach Ti^p can Bao cao su
Tp Hal Phong (n=467) TS 316 15 5 4 0 0 40 24
%
67,7 3,2 J 1,1 0,9 0 0,0 8,6 5,1
Tp Ho Chi fvlinh (n=498) TS 306 108 25 35 1 32 39 48
%
61,6 21,7 1
5,0 7,0 0,2 6,4 7,8 9,7
Chung (n=965) TS 622 123 30 39 1 32 79 72
%
64,5 12,8 3,1 4,0 0,1 3,3 8,2 7,5 Djeh vu t u van xet nghiem tU nguyen dugc DTNC sU d u n g chiem ty le cao nhat (64,5%), dich vy dieu tri ARV (12,8%), thap nhat la dieu trj chuyen khoa tam than (0,1%). Sd-OTNC sUdung cac dich vu hd t r g sau cai nghien thap (3,3%), tiep can chuang t r i n h BKT sach va BCS thap (7,5 - 8,2%).
3.2.4. Hdnh vi vi pham phdp lugt
Bang 3.6. Tinh trang vi pham phap luat
Tinh trang vi pham
C6 hdnh vi vi pham phap luat Cd ti^n su
C6 t i l n i n
C6 hdnh vi bao luc gia dinh
Tp Hai Phong (n=467) SL 161 44 112 398
%
34,5 9,5 24,0 85,2
T p H d Chi Minh (n=498) SL 233 82 87 474
%
46,8 16,5 17,5 95,2
Chung (n=965) SL 394 126 199 872
%
40,8 13,0 20,6 90,4
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol 9 - N°1/2014
3. Ty le nhiem HIV, viem gan B va viem gan C Sd DTNC cd hanh vi vi pham phap luat chiem t y
le cao (40,8%). so doi t d g n g cd tien sd (13,0%), co tien an (20,6%), phan Idn doi t d g n g da t d n g gay ra bao ldc gia d i n h (90,4%).
Bang 3.7. Ty le hien nhiem HIV, v i e m gan B va v i e m g a n C
Xet nghiem mau
HIV dddng tinh HBV duong tinh HCV dddng tinh
Tp Hal Phdng (n=467) SL 124 55 200
%
26,6 11,8 42,8
TpHoChilVlinh (n=498) SL 150 103 349
%
30,1 2 0 7 70,1
Chung (n=965) SL 274 158 549
%
28,4 16,4 56,9 Ty le nhiem HIV d benh nhan trddc dieu tri
IVlethadone tai TP. Hd Chi IVlinh (30,1%) cao han benh nhan d TP.Hai Phdng (26,6%). Ty le n h i ^ m viem gan C eua benh nhan d TP.Hd Chi Minh rat cao (chiem 70,1%).
4. Ban luan
4.1. Die diem nhan khau hoe - xa hpi Ddi t u g n g nghien cdu la ngUdi nghien chich ma tuy tap t r u n g d n h d m tuoi > 30 (ehiem 56,6%). Ty le nay cao han ket qua nghien cdu IBBS 2005-2006 tai Ha Ndi (46,8%), Quang Ninh (36,1%) Da Nang (40,9%), TP. Hd Chi IVlinh (36,8%) [2]. Ben canh do, sd ddi t u o n g doe than chiem ty le cao (63,9%), do do viec tnen khai cac bien phap can thiep giam tac hai hoac cai nghien tai cpng d d n g gap nhieu khd khan.
4.2. Hanh vi nguy ea lay nhiem HIV vi hanh vi vi pham phip luat
Trong sd cac ddi t d g n g tiem chich ma tuy, chi cd 4 , 1 % sd d u n g ehung bom kim t i e m (BKT) vdi ban chich ehung. Ket qua nay thap han bao cao IBBS 2009 ty le sd d u n g ehung BKT t r o n g 1 thang qua tai Ha Ndi (12,0%), Quang Ninh (8,0%), Yen Bai (13,0%), Can Tho (14,0%) [3] Ket qua nghien cUu eho thay, sd DTNC cd QHTD vdi GBD t r o n g v d n g 30 ngay qua chiem ty le thap (6,6%). Tuy nhien, van cdn 13,8%sd ddi t u a n g khdng sd d u n g BCS khi QHTD vdi GBD.
Dieu d d cang lam t a n g n g u y ca lay nhiem HIV trong n h d m doi t d g n g nay va gay khd khan trong viec kiem soat lay nhiem HIV cho vd, ban tinh qua QHTD.
Ty leDTNC tiep can va sd d u n g cac dieh vy yte va can thiep khdng eao: Dieh vu t d van xet nghiem t u nguyen (64,5%), dieh vu dieu trj ARV (12,8%). Ben canh do, viec tiep can c h u a n g t r i n h BKT sach va BCS thap (7,5 - 8,2%), dieu do cho thay viec then khai e h u a n g t r i n h BKT va BCS tai Hai Phdng va TP. Ho Chi IVlinh chua thue sU hieu qua vdi n h d m ddi tdpng NCMT. Ben canh do, sd ddi t u g n g vi pham phap luat chiem ty le cao (40,8%), cdng tac q u i n ly, giao due ddi t u a n g nay ngay cang gap nhieu khd khan.
4.3. Ty le nhiem HIV, viim gan B vi viim gan C Ty le hien nhiem HIV d benh nhan trUdc dieu tri M e t h a d o n e t i n h cea hai dja p h d d n g la 28,4%. Ty le nay t h a p hdn d San La (31,1%), Dien Bien (43,0%), Yen Bai (36,7%) [3]. Tuy nhien, ty le nhiem viem gan C n h d m n h d m ddi t u g n g nghien cdu la rat cao (56,9%).
5. Ket luan
Trong sd 965 ngUdi nghien t h a m gia dieu ti tai 2 t h a n h p h d , sd ddi t u g n g cd t h d i gian nghien td 5 den 10 nam chiem 46,4%; sd d u n g ma tuy b^ng d d d n g t i e m chich chu yeu (83,4%); Trong so ngddi t i e m chich ma tuy, ty le sU d u n g chung bom kim t i e m : 4 , 1 % . Cd 97,9% sd ddi t u g n g da tdng cai
nghien nhUng deu bj tai n g h i e n . Cd 13,8% cd quan he tinh due vdi gai ban d a m k h d n g s d d u n g bao cao su. Co hanh vi vi p h a m p h a p luat (40,8%). Ty le nhiem HIV cao (28,4%), n h i e m HBV (16,4%) va nhiem HCV (56,9%).
6. Kien nghi
T d cac ket qui nghien cdu tren, chung t d i khuyen nghi can t a n g c u d n g ehuang t r i n h truyen thdng de nang cao kien thufc ve HIV/AIDS cho n h d m NCMT. D d n g t h d i sdm trien khai thi d i e m dieu tri nghien cac chat dang t h u d e phien bang t h u d c thay the Methadone va tang cUdng chat lugng cac dich vy y te phdng lay nhiem HIV/AIDS tai Hai Phdng va TP.Hd Chi Minh.
Tai lieu tham khiio
1. Bp Y te (2007), HUdng dan d i l u tri nghien cac chat dang thudc phien b^ng thudc Methadone va Hudng dan thuc fii&n, Quyet dinh sd 5076/QB-BYT ngSy 12/12/2007,
Bd Y te (2006), Bao cao ket qu3 ChUong trinh giim sat ket hgp hanh vi va cac chi sd sinh hgc (IBBS) tai V i f t Nam (2005 - 2006).
Bd Y te (2009), Bao eao ket quS ChUdng trinh giam sat ket hgp hanh vi va cac chi sd sinh hoc (IBBS) tai Viet Nam.
Nguyen Thanh Long (2008), "Nghien cUu t)f le nhiem HIV va eae yeu t d hanh vi nguy cO lay nhiem HIV trong nhdm nghien chich ma tuy tai mdt sd huyen tinh Lai Chau nam 2007', Tap chf Y hgc du phong, XVIII (4 (96)): 80-87.
Nguyen Chf Lung, Nguyen Thanh Long, Hd Ba Do (2007), 'Thuc trang va nguy ca lay nhiem HIV/AIDS d nhdm Nghien ehich ma tuy va Gai mai dam tai An Giang (2004-2005)" Tap chi Y hgc Quan sU, 32 (3): 104-108.
UNAIDS (2009), AIDS epidemic update December 2009
available at http://data.unaids.org/pub/Report/2009/JC1700_Epi
_Update_2009_en.pdf. 2009.
Nguyen, T A , et al (2001), Risk factors for HIV-I seropositivity in drug users under 30 years old in Haiphong. Vietnam. Addiaion, 2001.96 (3); p. 405-13.
