Academic journal article Bulletin of the World Health Organization

Willingness to Pay for Methadone Maintenance Treatment in Vietnamese Epicentres of Injection-Drug-Driven HIV infection/Volonte De Payer Pour le Traitement D'entretien a la Methadone Dans Les Epicentres Vietnamiens D'infection Par le VIH Resultant De L'injection De Drogue

Academic journal article Bulletin of the World Health Organization

Willingness to Pay for Methadone Maintenance Treatment in Vietnamese Epicentres of Injection-Drug-Driven HIV infection/Volonte De Payer Pour le Traitement D'entretien a la Methadone Dans Les Epicentres Vietnamiens D'infection Par le VIH Resultant De L'injection De Drogue

Article excerpt

Introduction

Over the past decade, there has been a dramatic expansion of services in developing countries to prevent and treat human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), with substantial support from global health initiatives. During 2000-2008, overall spending on HIV infection and AIDS in low- and middle-income countries increased approximately 10-fold, to US$ 13.7 billion. (1) Rapid and comprehensive responses to the HIV pandemic have substantially improved the health and social well-being of populations in various settings. For example, in the region denoted by the United Nations as Asia and the Pacific, where the burden of HIV infection is second only to that in Africa, there was an average 20% decline in new infections annually during 2001-2009. (2) In addition, widespread scale-up of antiretroviral therapy (ART) has encouraged HIV testing and early access to health-care services and has improved health status and quality of life among people living with HIV infection. (3,4) HIV transmission in this region is driven primarily by three high-risk behaviours: unprotected sex between males and female commercial sex workers, injection opioid use (hereafter, "injection drugs") and unprotected sex between males. Governments can halt and reverse the HIV epidemic and save money if they achieve universal coverage of comprehensive interventions among these high-risk populations. (4)

Ensuring sufficient resources is central to the success and sustainability of HIV programmes. However, budget constraints due to the global economic slowdown make it more difficult for governments to effectively fund multiple competing social and health issues. (1) Viet Nam has one of the fastest growing epidemics of HIV infection in Asia and is experiencing economic and epidemiologic transitions. Although the HIV epidemic in Viet Nam is still in a concentrated stage, the potential for a generalized epidemic is increasing, as indicated by a very high prevalence of HIV infection among high-risk groups and by a hidden epidemic among females. (5-8) Moreover, resources for HIV services mainly involve funding from international donors, which is rapidly decreasing as Viet Nam emerges as a middle-income country. According to projections of the Vietnamese National HIV Strategic Plan for 2011-2015, over this period the total cost of HIV services will increase by 60%, to approximately US$ 150 million. (9) The costs of ART will increase from 6 to 8% per year and the costs of HIV prevention will double. Meanwhile, the government budget can fund only 6 to 12% of the total cost of all HIV-related services. (9,10) This has created a sense of urgency in efforts to strengthen the health-care system and ensure the sustainability of interventions for the control of HIV infection.

After accounting for contributions from international donors and the national government, Viet Nam remains nearly 50% short of the resources needed to fund HIV services during 2013-2020. The Vietnamese Ministry of Health identified several potential strategies to reduce this deficit, including decreasing costs, improving efficiency and mobilizing resources from a wide variety of sources, such as co-payments from users of health services. (9,10) Of the HIV-related services currently offered free of charge, there are several reasons why methadone maintenance treatment (MMT) is of great interest for piloting the co-payment strategy. First, Viet Nam has a large population of people who inject drugs and more than two thirds of the estimated 210 000 individuals with HIV infection use injection drugs. (10-12) Second, the pilot MMT programme in Viet Nam was proven to be a cost-effective component of HIV prevention and treatment services. (11,13,14) Third, it will cost approximately US$ 97 million to reach the national target of 65% MMT coverage among injection drug users by 2015. (11) Assessing the willingness of users to pay for MMT services will help the government determine effective financing mechanisms and contribute to the sustainability of HIV-related interventions in Viet Nam. …

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