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A systems approach toward climate resilient livelihoods: A case study in Thai Nguyen province, Vietnam.

ABSTRACT: This study aims to identify strategic actions towards climate resilient livelihoods and secure income for smallholder farmers in Thai Nguyen province of Vietnam using a systems approach and system dynamic modelling tools. Information and data for this research was collected through surveys, interviews, focus group discussions and workshops with relevant stakeholders and 187 farmers in two vulnerable districts during October 2019-April 2020. Findings of this study uncovered a number of shortcomings of the government policies and approaches in climate change adaptation. Local initiatives, community learning and ownership seem to be neglected. This research has substantiated the effectiveness and validity of systems approaches and tools in structuring and solving complex issues in agricultural research and development under the interwoven relationships between environmental and human factors. Climate resilient production models and practices are just part of the systemic interventions that need to be implemented in a coordinated manner towards a more resilient future of the farming communities. This study has addressed the current knowledge gap and the need for using integrated approaches and decision support systems for unravelling ill-structured and/or complex issues of climate change adaptation (CCA). It also provided practical recommendations for informed CCA policies and implementation.

SUBMITTER: Ha TM

PROVIDER: S-EPMC7689166 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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A systems approach toward climate resilient livelihoods: A case study in Thai Nguyen province, Vietnam.

Ha Tuan M TM Kühling Insa I Trautz Dieter D

Heliyon 20201118 11

This study aims to identify strategic actions towards climate resilient livelihoods and secure income for smallholder farmers in Thai Nguyen province of Vietnam using a systems approach and system dynamic modelling tools. Information and data for this research was collected through surveys, interviews, focus group discussions and workshops with relevant stakeholders and 187 farmers in two vulnerable districts during October 2019-April 2020. Findings of this study uncovered a number of shortcomin ...[more]

PMID: 33294686

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Project description:BackgroundHazardous alcohol use is prevalent among people living with HIV (PWH), leading to sub-optimal HIV treatment outcomes. In Vietnam, alcohol use is highly normative making it socially challenging for PWH to reduce or abstain. We used mixed methods to develop a quantitative scale to assess alcohol abstinence stigma and examined the association between alcohol abstinence stigma with alcohol use among PWH in Vietnam.MethodsWe conducted qualitative interviews with 30 PWH with hazardous alcohol use from an antiretroviral therapy (ART) clinic in the Thai Nguyen to inform item development. Alcohol use was assessed using the Alcohol Use Disorders Identification Test. We tested items in a survey of 1,559 ART clinic patients to assess internal consistency and structural validity. We used log binomial modeling to estimate associations between any reported alcohol abstinence stigma and alcohol use.ResultsUsing the results from the qualitative interview data, we developed the alcohol abstinence stigma scale with seven final items with scores ranging from 0 (no stigma) to 28 (high stigma). The scale had good internal consistency (α = 0.75). Exploratory factor analysis suggested the presence of three factors: internalized, experienced, and anticipated stigma that explained 56.9% of the total variance. The mean score was 2.74, (SD = 4.28) and 46% reported any alcohol abstinence stigma. We observed a dose-response relationship between alcohol abstinence stigma and alcohol use. PWH who reported any alcohol abstinence stigma had greater hazardous alcohol use (aPR = 1.32, 95% CI: 1.12, 1.56), harmful alcohol use (aPR = 2.26, 95% CI: 1.37, 3.72), and dependence symptoms (aPR = 3.81, 95% CI: 2.19, 6.64).ConclusionAlcohol abstinence stigma is associated with increased alcohol levels of alcohol use among PWH in Vietnam, signaling challenges for alcohol reduction. Consideration of alcohol abstinence stigma will be essential for the design of effective alcohol reduction interventions and policy efforts to prevent adverse health consequences of alcohol use among PWH.

Project description:BackgroundHazardous alcohol use is detrimental to persons with HIV (PWH), impacting medication adherence and liver function, yet globally resources to target alcohol use behavior in this population are limited. Few studies have identified the costs of integrating alcohol reduction interventions into HIV care.ObjectiveTo estimate the costs of implementing and delivering two evidence-based behavioral counseling interventions targeting hazardous alcohol use among persons with HIV and to estimate the costs of scale-up in ART clinics in Thai Nguyen, Vietnam.MethodsWe undertook a micro-costing approach to determine the costs of delivering two adapted evidence-based interventions to reduce alcohol use: an intensive combined cognitive behavioral therapy and motivational enhancement therapy-informed intervention (CoI) and an abbreviated brief alcohol intervention (BI). A total of 294 participants with hazardous alcohol use were identified through a brief screening tool and received the CoI (n = 147) and the BI (n = 147) over 3 months. We estimated costs using time and motion studies, budget analysis, staff interviews, and participant questionnaires. Data were collected from 2016 to 2018 in VND and converted to USD.ResultsThe total cost of implementation and administration of the intervention to 147 participants receiving the CoI was $13,900 ($95 per participant) and to 147 participants receiving the BI was $5700 ($39 per participant). Implementation and startup costs including training accounted for 27% of costs for the CoI and 28% for the BI. Counselor costs accounted for a large proportion of both the CoI (41%) and the BI (30%).ConclusionsImplementing and delivering alcohol reduction interventions to people with HIV in Vietnam with appropriate fidelity is costly. These costs may be reduced, particularly counselor labor costs, by using an evidence-based brief intervention format. Future research should explore the budgetary impact of brief and combined interventions to reduce hazardous alcohol use, particularly among vulnerable populations.

Project description:BackgroundIn Vietnam, an estimated 256,000 people are living with HIV, and 58% of HIV-infections reported are among people who inject drugs (PWID). While antiretroviral therapy (ART) is widely available in Vietnam, marginalized hard-to-reach male PWID, demonstrate significantly reduced and delayed access to ART.MethodsWe investigated the effect of a randomized four-arm multi-level intervention trial on ART initiation among male PWID. Our analysis was conducted among a subset of trial participants (n = 136), who were newly diagnosed as HIV-infected, treatment naïve, and eligible for ART (baseline late diagnosis). The trial arms included: 1, standard of care (HIV testing and counseling); 2, structural-level intervention (door-to-door communications and community video screenings); 3, individual-level intervention (counseling plus group support); and 4, individual-level plus structural-level intervention. In a time-to-event analysis, we used a non-parametric approach for competing risks to estimate cumulative incidence function (CIF) for ART initiation (event of interest) by arm and the difference in CIF for each trial arm as compared to Arm 1. Follow-up was conducted at 6, 12, 18 and 24 months. Data collection occurred from 2009 to 2013.FindingsBy 24-months, 61.0% initiated ART, and 30.9% had died prior to ART initiation. In the first 6 months, participants in arm 4 (individual plus community intervention) had a 28% (95% confidence interval (CI): 6-50%) increased probability of initiating ART. Despite increasing coverage of ART in all arms throughout follow-up, participants in arm 4 retained a 31% (95% CI: 5-56%) increased probability of initiating ART. The individual and community components of the intervention were only effective when delivered together.ConclusionsMarginalized, hard-to-reach men, who do not routinely engage in HIV services, and therefore come into care late, may benefit significantly from both individual counseling and group support, in combination with community-focused stigma reduction, when being referred and attempting to initiate urgently needed ART.

Dataset Information

A systems approach toward climate resilient livelihoods: A case study in Thai Nguyen province, Vietnam.

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A systems approach toward climate resilient livelihoods: A case study in Thai Nguyen province, Vietnam.

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