Abstract
This study evaluated the long-term effects of different psychosocial intervention models in methadone maintenance treatment (MMT) in Xi'an China. Patients from five MMT clinics were divided into three groups receiving MMT only, MMT with counseling psychology (CP) or MMT with contingency management (CM). A five-year follow-up was carried out with daily records of medication, monthly random urine morphine tests, and tests for anti-HIV and anti-HCV every six months. Drug use behavior was recorded six months after initial recruitment using a survey. Adjusted RRs and their 95% confidence intervals (CIs) were estimated using an unconditional logistic regression model or a Cox proportional hazard model. A total of 2662 patients were recruited with 797 in MMT, 985 in MMT with CP, and 880 in MMT with CM. Following six months of treatment, the injection rates of MMT with CP and MMT with CM groups were significantly lower than that of MMT (5.1% and 6.9% vs. 16.3%, x2 = 47.093 and 29.908, respectively; P<0.05). HIV incidences for MMT, MMT with CP and MMT with CM at the five year follow-up were 20.09, 0.00 and 10.02 per ten thousand person-years, respectively. HCV incidences were 18.35, 4.42 and 6.61 per hundred person-years, respectively, demonstrating that CP and CM were protective factors for HCV incidence (RR = 0.209 and 0.414, with range of 0.146 – 0.300 and 0.298 – 0.574, respectively). MMT supplemented with CP or CM can reduce heroin use and related risk behaviors, thereby reducing the incidence of HIV and HCV.
Highlights
Since the 1980s, drug abuse has become increasingly rampant in China with registered numbers of drug users increasing from 70,000 in 1990 to 1.794 million by the end of 2011 [1,2]
2662 participants were included in the study, with 797 participants in the maintenance treatment (MMT) group, 985 in the MMT with counseling psychology (CP) group, and 880 in the MMT with contingency management (CM) group
The drug use rate in the MMT with CP group was significantly lower than that of MMT with CM (x2 = 14.233; P,0.05), and the use rate in the MMT with CM group was significantly lower than MMT alone (x2 = 27.824; P, 0.05)
Summary
Since the 1980s, drug abuse has become increasingly rampant in China with registered numbers of drug users increasing from 70,000 in 1990 to 1.794 million by the end of 2011 [1,2]. The results showed that 92.3% of those surveyed thought methadone was a drug rehabilitation therapy, 64.2% thought addiction could be completely cured after two to three months of methadone use, 77.9% thought it was not necessary to continue lifelong methadone use, and 84.3% thought that methadone dosage needed to be gradually reduced to minimize harmful effects [24]. These general misconceptions may explain the high MMT drop-out rate. Their study showed that BDRC increased the MMT retention rate and reduced illicit drug use and behaviors that risk HIV infection. A five-year follow-up was carried out to evaluate the short-term and long-term effects of different psychosocial intervention on drug use behavior, MMT retention, and HIV/HCV incidence
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