Abstract
ObjectiveTo assess the overall mortality of methadone maintenance treatment (MMT) clients in China and its associated factors.MethodsA total of 1,511 MMT clients, all of whom enrolled in China's first eight MMT clinics between March and December 2004, were included in this cohort study and followed for approximately six years, until June 2010. Mortality and its predictors were examined using Cox proportional hazards regression models.ResultsA total of 154 deaths were observed within 5,391 person-years (PY) of follow-up for an all-cause mortality rate of 28.6 per 1,000 PY. The leading causes of death were drug overdose (33.8%), HIV/AIDS-unrelated disease (21.4%), and HIV/AIDS (16.9%). The all-cause mortality rate of clients engaged in MMT for one year or less was roughly three times that of clients who stayed in MMT for four years or more (14.0 vs. 4.6, p<0.0001), HIV-positive subjects was nearly four times mortality rate than that of HIV-negative individuals (28.1 vs.6.8, p<0.0001). ART-naive HIV-positive subjects had approximately two times higher mortality rate than those receiving ART (31.2 vs. 17.3, <0.0001). After adjusting for confounding variables, we found that being male (HR = 1.63, CI: 1.03–2.57, p = 0.0355) and being HIV-positive (HR = 5.16, CI: 3.70–7.10, p<0.0001) were both associated with higher risk of death whereas increased durations of methadone treatment were associated with a lower risk of death (HR = 0.26, CI: 0.18–0.38, p<0.0001 for two to three years, HR = 0.08, CI: 0.05–0.14, p<0.0001 for four or more years).ConclusionOverall mortality was high among MMT clients in China. Specific interventions aimed at decreasing mortality among MMT clients are needed. Our study supports the need for keeping client at MMT longer and for expanding ART coverage and suggests the potential benefits of integrated MMT and ART services for drug users in China.
Highlights
Drug users (DUs) are well-known to have a much higher risk of death than non-DUs [1,2], with most likely causes of death being overdose, suicide, and HIV/AIDS-related disease [3,4,5]
Among DUs in Maintenance Treatment (MMT), mortality rates in other settings range from 2.4 per 1,000 PY to 14.9 per 1,000 PY [17,18], and factors found to be associated with improved survival include high methadone dose, long duration of MMT retention, and antiretroviral therapy (ART) for those who were HIV-positive [19,20]
As the requirement of China’s MMT protocol, clients were required to do the urine test monthly when they stayed in the MMT program
Summary
Drug users (DUs) are well-known to have a much higher risk of death than non-DUs [1,2], with most likely causes of death being overdose, suicide, and HIV/AIDS-related disease [3,4,5]. The high-risk behavior of injecting DUs was the initiator and the major driver of the early HIV epidemic in China. In an attempt to combat the growing drug abuse and HIV/ AIDS epidemics, China’s National Methadone Maintenance Treatment (MMT) Program was piloted in 2004, scaled up starting in 2006, and as of April 2012, encompassed 747 clinics nationwide, covering more than 350,000 DUs, cumulatively. Among DUs in MMT, mortality rates in other settings range from 2.4 per 1,000 PY to 14.9 per 1,000 PY [17,18], and factors found to be associated with improved survival include high methadone dose, long duration of MMT retention, and antiretroviral therapy (ART) for those who were HIV-positive [19,20]. Mortality among DUs in China’s MMT program has far not been assessed
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