Research Institute For Health Science

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Research Institute For Health Science

Recruiting experience in an

Recruiting experience in an opioid

g

p

opioid

p

substitution treatment trial against HIV

incidence among injection drug users

in rural areas in northern Thailand

Wittaya

Wittaya PromjukPromjuk A i

A i AA tttt Apinun

Apinun AramrattanaAramrattana Tasanai

Tasanai VongchakVongchak

R h I tit t f H lth S i Chi M i U i it R h I tit t f H lth S i Chi M i U i it Research Institute for Health Science, Chiang Mai University Research Institute for Health Science, Chiang Mai University

IHRA’s

IHRA’s 2020thth _{International Conference, Bangkok Thailand}_{International Conference, Bangkok Thailand}

Presented on

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1.Background.Background

HPTN 058 A Phase III randomized controlled

To develop the work efficacy, the community team has

trial to evaluate the efficacy of drug

treatment in prevention f HIV i f ti

the community team has

gathered working experiences

with IDUs in HPTN 058 Study.

of HIV infection among opiate dependent

injectors _{Aim = 305 IDU/104 week}

Objectives

1. To examine the effective approach to reach IDUs

2. To collect dataand situationlearned in the field which will be useful for working with IDUsg 3. To examine the data related to risk reduction among IDUs

Method

Documentary research Documentary research

- Field note - Interview

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2.. PreviousPrevious Recruitment Recruitment Procedure (

Procedure (20062006--20072007)) 2

2.. PreviousPrevious Recruitment Recruitment Procedure (

Procedure (20062006--20072007))

Snow Ball Snow Ball Public Relations Meeting with IDU-CWG Cooperation with target Organization Research Research Project Projectjj GO

GO & NGO& NGO GOs

GOs & NGOs& NGOs

2007 : Enroll 3 participants/months, 1 participant per month for 4 months p p , p p p (27 participants in 8 months)

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3.. CurrentCurrent Recruitment Recruitment Procedure (

Procedure (20082008--20092009)) 3

3.. CurrentCurrent Recruitment Recruitment Procedure (

Procedure (20082008--20092009)) _{to identify communities}1.Data collection

with opiate IDUs from various sources especially IDUs,

Field Survey from Field Survey from

IDU’s Guidance

IDU’s Guidance get Information from local IDU

2.Area selection and Survey target communities

with potential opiate use

Field Survey Field Survey

5. Expanding into IDU networks

in the target areas

from local IDU

IDU

with potential opiate use Field survey by Recruiter

:

y y from IDU’s from IDU’s Guidance Guidance

s

Snow Ball

:

3.Approaching and motivating

4.Gaining entrée to at least 1 IDU In the area

pp g g

community leaders and key informants to introduce the study as well as asking them to introduce drug users g

to the team

2008 : Average enrollment of 7/month (79 in 1 year) Strong &

2009 : Average enrollment for 1st _{quarter of 10/month ( 35 in 3.5 months)}

St o g & Weak Points

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Fang &

North

Heroin area Study Area

Study Area Study Area

Study Area Recruiters work in

152Villages Chiang Mai 91 Villages

Chiang Rai Chiang Rai Fang & Fang & Mae Aye Mae Aye

Chiang Mai 91 Villages Chiang Rai 15 Villages Lampang 23 Villages

Payao 23 Villages

Payao Payao y g Chiang Mai Chiang Mai Base site Base site y y

East

Ngaw Ngaw Lampang Lampang Jom Thong 68 km. Ngaw Ngaw Om koi Om koi 190 km.

South

Opium area

275 km.

Mae Tuen

South

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Description of community with IDUs (Rural area)

1) Previous or current opium plantation

2) Locate near the border 2) Locate near the border

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The differences of measurement and price of opium-heroin by area

Opim Sub unit of opium in each area Ngaw Lampang “Med”

Joint” Tap

Ngaw, Lampang Med

Chiang Kam, Payao “Tam Leung” Om Goi, Chiang Mai “Ther Si”

Heroin

Measurement in each area is not Measurement in each area is not different, i.e. “On”, “Big”, “Tua”

Retail price 400-500 baths per “Tua” and

Province 2006 (฿) 2007 (฿) 2008 (฿) 2009 (฿) Chiang Rai 1 000 1 000-1 200 1 200-1 500 1 500-1 600

50-100 bahts for Chiang Rai

Chiang Rai 1,000 1,000 1,200 1,200 1,500 1,500 1,600 Chiang Mai 3,500-4,000 4,000-5,000 5,000-6,000 5,000-6,000 Lampang N/A 4,000-5,000 5,000-6,000 N/A

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Daily life of rural IDUs (Drug use time)

The study staff have to comply

with the participant’s time table

1 U d

with the participant s time table.

1.Use drug in the morning

3 Night time 2.Use drug and 3.Night time

other activities during the day

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Changes in drug use behavior Changes in drug

use behavior

1) Ch f i j t h i t th b t

1) Change from inject heroin to other substances

2) IDUs in rural areas turn to alcohol addiction

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Research Institute For Health Science_{Problems on risk}

reduction in rural area

1) Risk from the use and how to obtain needles and syringe

1) Risk from the use and how to obtain needles and syringe

2) Lack of opportunity to join drug treatment program

3) Lack of self prevention from sexual risk

3) Lack of self prevention from sexual risk

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Challenges in working with rural IDUs Challenges in working with rural IDUs

Participant’s behavior Traveling & Transportation Language and Nationality

1)Difficult route 1) Languagebarrier among hill 1) Enhancing punctual 1) Difficult route

(Rainy season)

2)N bli t t ti

1) Languagebarrier among hill tribe participants

) g p

appointment

2) No public transportation or insufficient public

transportation

2) Participants with no Thai ID

card (only high land ID card)

2) Enhancing punctual

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Rural Village in recruitment area Rural Village in recruitment area Rural Village in recruitment area Rural Village in recruitment area

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Opium injection Opium injection Opium injection Opium injection

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conclusion

Recruitment procedure must comply with study criteria and conditions and is flexible information

Recruitment procedure must comply with study criteria and conditions, and is flexible IDUs themselves are the most important source in working with the

Adjustment with the participant’s time table

Aware of the changes of drug used in each area

IDUs in rural area, especially hill tribe people, still lack life’s quality improvement. , p y p p , q y p

So, they continues their risk behavior.

G t l t h ld f i i lif ’ lit f l i l

Recommendations Recommendations

Quality of Governmental sectors should focus on improving life’s quality of people in rural area

along with risk reduction concept.

Th h ld b b h i l t d IDU i Th il d h t f IDU i

Quality of life

There should be a behavioral study on IDUs in Thailand on each type of IDUs in

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Acknowledgement

- US National Institute of Health (NIH)

J h H ki U i it

- John Hopkins University

- Research Institute of Health

Sciences, Chiang Mai University

- Chiang Mai Provincial Health Officeg

-Om Goi Hospital, Mae Suay Hospital,

Ngaw Hospital Lampang Hospital Ngaw Hospital, Lampang Hospital

- TDN Chiang Mai

- PSI Chiang Rai

- All IDUs, Villagers and IDU CWGs