Acceptability and feasibility of long-acting injectable antiretroviral therapy for HIV-infected persons who inject drugs in Vietnam: A qualitative study


Area one: Characteristics of the intervention Relative Advantage
  • (1)

    [Patients] hide [ART] of all, but they are still worried because they are afraid that they will not be able to comply with the medicine because, for example, they hide it when they return to their hometown so that they do not dare to bring the medicine bottle with them. –HIV Counselor

  • (2)

    Because I still do drugs and often forget to take the oral pills. This drug is very good, I just need to tell my family to remind me to have injections once a month. I think I can do this, taking medication on a daily basis is quite difficult for me now. – 44-year-old male PWID, not on ART, lost follow-up

  • (3)

    I think if this injectable type is available now i will be the first to ask for the injections and then i can tell if this type is ok or not i will be the first to support this program. It saves me time taking medication every day and it doesn’t cause any problems at all. – 36 year old male PWID, on ART

  • (4)

    I’ve seen people take oral medication for ten years, but I haven’t seen anyone use injections, so I don’t want to change anything. I still think oral medicine is effective, I will choose to take oral pills. – 43 year old male PWID, on ART

  • (5)

    There are many situations that make me think about drugs, if I’m too sad or too happy I think about it too. There are many things that can make me think. The needles will remind me of that too. – 36 year old male PWID, on ART

  • (6)

    The injectable type has the advantage that it doesn’t take time and I don’t forget to take the drug, but it has the problem that many people will feel pain. Some people are afraid of injections, in general, like normal injections, we also feel pain, some people are afraid of needles, this is their disadvantage.” – 36 year old male PWID, on ART

complexity
  • (7)

    … in my opinion the implementation of injectable ART will be much more difficult than TLD … in terms of the facilities, I think it is not too difficult to adapt guiding documents, but it is difficult to adapt their services. Why? The Services of TLD and TLE [tenofovir, lamivudine, efavirenz] are equal. The way patients get TLD is now the same as how they got TLE in the past, nothing has changed. But when the injectable drug is brought into treatment, the problems are where to set up injection rooms, how the attendant services will work if a shock event occurs, where the pharmacy is located, how the drug will be transported, who will dispense the medicine, and how to given the injections… in the current procedure, the patients come here every 3 months to get medicines, now it is adjusted to once a month, it is clear that there is a need to set up a mechanism to remind the patients. The doctors themselves have to remember the days that patients have to bring back to the clinics for injections. All of this needs to be adjusted. So it’s obviously a lot harder than the transition from TLE to TLD. – Decision Maker (MOH)

Costs
  • (8th)

    The cost acceptance depends on the patients, depends on each patient group, and if the cost is high, no group will accept it. When the price is high but good, other groups can accept it, but it is difficult for the addict group to accept the high price.- Decision Maker (MOH)

Domain two: exterior attitude patient needs and resources
  • (9)

    It [TLD] has only one weakness, that is, patients often get questions from other people like “Why do you have to take medication every day?”. If the oral pills can also solve the problem of such questions, I think they will choose the oral option rather than the injection. – Politician (MOH)

External Politics
  • (10)

    I suggested that we should prioritize HIV infected people who inject drugs so they could get ID cards even if they lost their ID cards, ID papers… I also suggested that because [PWID] didn’t have enough money to pay the 20% of the treatment fee…if they don’t take medication it means the viral load in their blood goes up and they are very contagious to others. But many people in other ministries said that in terms of priority, it is not called a priority because people with meritorious service to the revolution, families of martyrs, etc. are given priority. These groups are just high-risk groups we need to watch out for. – Decision Makers (VAAC)

Domain three: attitude Structural Features
  • (11)

    I think that [my colleagues] will support it. We expect something more comfortable for patients. I know that the initial phase will be so difficult, but gradually it will get better. For injections, we only need to advise patients who have an appointment for the injection. We will not have to advise as much and every day as we do now. – Service provider (clinic director)

implementation climate
  • (12)

    I think that for patients who are currently in treatment, especially patients who use opiates or drugs, we find that the oral treatment model is now very effective … currently in Hanoi, the percentage of patients who reach viral load is below the viral load threshold is 98%..- Decision Maker (MOH)

readiness for change
  • (13)

    Our clinic has changed the treatment methods many times. So far it has been changed 103 times, then mother-child transmission treatment. There are many projects with many technologies, but as long as we are well trained, we will work well, our people here are used to it, we are doing this job, so we always have to update new knowledge with new technology, there is nothing to confuse. service provider (doctor)

  • (14)

    For this [injectable medication], I see that when we have a new drug and present it to the patients, they will be very excited, and I am very excited myself. First, I know its implications. I need to know about its effects first, whether it’s been approved by an agency or announced by the World Health Organization. Second, if we have a new drug like this, I will discuss it with patients to see how they respond. For medical staff like us, we think it’s very good.” – Service provider (clinic director)

  • (fifteen)

    I’m happy when it’s good for the patient. If injectable ART is good and has fewer side effects than oral forms, patients will prefer it. When we switched from TLE to TLD it was better because the TLD pill is smaller and only needs to be taken once a day and has no side effects. So without a doubt, patients choose it. For the injection, the injection causes pain and it is not as easy as taking pills. But if patients get an injection monthly, have no side effects, no drug reactions, and the timing of the injection is flexible, I think patients will choose injections. And I will be happy for them. – Service provider (clinic director)

Domain four: characteristics of individuals belief in knowledge and self-efficacy
  • (16)

    [O]Our clinic has changed the treatment methods [for HIV] many times. So far it has been changed 103 times, then mother-child transmission treatment. There are many projects with many technologies, but as long as we are well trained [on administering LAI]we will work well, our people here are used to it, we do this job, so we always have to update new knowledge with new technology, there is nothing to confuse –provider (doctor)

  • (17)

    It is not at all difficult to advise a new client about injectable medicines. Because for people who inject drugs, taking pills every day is the biggest difficulty. It’s easier for me to convince her to get monthly shots. If they know of cases that get injections and don’t have side effects, that’s fine. But if their friends get injections and have side effects, they’ll consider it.” Service provider (clinic director)

Individual identification with the organization
  • (18)

    In general I really believe in the treatments offered here, whatever they advise me, it’s because they only want the best for me, that’s what I see. That is, if the medical staff here advise me about this treatment, this treatment must be good, so I have complete trust in the medical staff here. – 41-year-old male PWID, on ART

Domain Five: Implementation Process engage
  • (19)

    Let me give you an example: when we treat methadone, patients have to come every day to take it. But when we moved to giving it once every 3 days, while it was a good idea that patients didn’t have to travel much, in reality there weren’t many patients who chose this option. Although it was very good in testing, but when it’s widely used, patients haven’t decided, so we have to evaluate whether patients accept it or not. – Decision Maker, Hanoi Center for Disease Control

Carry out
  • (20)

    We never categorize the HIV infected people into any group, whether they are drug users or whatever, they are all HIV patients and for every HIV infected patient, whatever group they belong to, they have equal access to treatment. This means that advice, testing and the benefits of treatment are the same for everyone, regardless of the target group. – Politician (MOH)



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