UNC Vietnam Publishes Landmark Findings: A Tailored Implementation Approach Improves HIV Intervention for People Who Inject Drugs in Vietnam

Newswise — Chapel Hill, NC – A UNC Vietnam team led by Vivian Go, PhD, and Bill Miller, MD, PhD, researchers with the UNC Institute for Global Health and Infectious Diseases–in collaboration with Hanoi Medical University and the Vietnam Ministry of Health–found that tailoring implementation strategies to local clinic needs significantly improved the delivery of a proven HIV intervention for people who inject drugs. Published in The Lancet, the new trial addressed a challenge in global health: how to effectively implement the evidence‑based intervention “Systems Navigation and Psychosocial Counseling” (SNaP) in diverse clinical environments. Although SnaP has been shown to improve initiation of anti-retroviral therapy and viral suppression, the optimal strategy for scaling it up in real‑world settings remained unclear.

“Our findings show that even in highly centralized health systems, a flexible, locally informed approach can improve how evidence‑based interventions are delivered,” said Dr. Go, Professor of Health Behavior at the Gillings School of Global Public and Vietnam Country Director.

The study marks a major milestone in Vietnam’s efforts to strengthen HIV treatment access and outcomes for people who inject drugs, a population disproportionately affected by HIV and often underserved by traditional health systems.

Study Purpose and Design

The trial enrolled 277 clinic staff and 723 people with HIV who inject drugs across 42 HIV testing sites, in 10 provinces and cities, evaluating two approaches to scaling up the SNaP intervention. Sites were chosen based on the number of HIV tests performed, HIV positivity rate, and the size of the population covered by the site. Eligible participants were 18 or older, not on anti-retroviral therapy at enrollment, and had injected drugs within the previous six months.

The 42 HIV testing sites were randomized to one of two approaches. For the standard approach, sites implemented a fixed package of 15 core strategies. In the tailored approach, the sites used the same 15 strategies plus 10 additional strategies selected by each site based on local barriers.

“Pre‑implementation and ongoing assessments were critical to alloweach site in the tailored arm to identify its own operational barriers, such as staffing gaps, workflow challenges, or client engagement issues. The clinics could then select strategies to directly addressed those barriers,” said Dr. Miller, Professor of Epidemiology at the Gillings School.

Primary outcomes were fidelity, how closely each clinic delivered the SNaP intervention the way it was designed to be delivered, and initiation of anti-retroviral therapy. Secondary effectiveness outcomes were the current use of anti-retroviral therapy and medications for opioid use disorder and viral suppression.

Key Findings

• Higher fidelity to SNaP delivery:Clinics using the tailored approach achieved substantially higher fidelity scores compared with those using the standard approach.
• Near‑universal initiation of anti-retroviral therapy:Almost everyone receiving SNaP initiated antiretroviral therapy in both approaches.
• Improved viral suppression:In the tailored approach, participants achieved significantly higher viral suppression, demonstrating that better implementation quality translated into better clinical outcomes.

The combination of standard and tailored strategies proved more effective than the standard package alone, showing that a one‑size‑fits‑all model is less effective for complex service delivery settings. The study also demonstrated that large‑scale tailoring is feasible, providing a replicable model for other countries and programs.

UNC Institute for Global Health and Infectious Diseases

Established in 2007, the UNC Institute for Global Health & Infectious Diseases at the UNC School of Medicine started over 30 years ago with infectious disease physician researchers studying HIV in China and Malawi. Through the years, our work has expanded to include emerging pathogens, cancer, women’s health and vector-borne disease like malaria–shaping policy through evidence-based research around the world. At UNC-Chapel Hill, the Institute facilitates research excellence while nurturing emerging scientists to advance patient care and practice, addressing the most important global health issues of our time–through research, training and service.