Abstract
BackgroundHuman immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections among methadone maintenance treatment (MMT) participants remain high. Optimized HIV and HCV prevention strategies for MMT clinics in resource-limited regions are urgently needed. This study aims to develop an MMT system dynamic model (SDM) to compare and optimize HIV and HCV control strategies in the MMT system.MethodsWe developed an MMT-SDM structure based on literature reviews. Model parameters were estimated from a cohort study, cross-sectional surveys and literature reviews. We further calibrated model outputs to historical data of HIV and HCV prevalence among MMT participants in 13 MMT clinics of Guangdong Province. Lastly, we simulated the impact of integrated interventions on HIV and HCV incidence among MMT participants using the MMT-SDM.ResultsThe MMT-SDM comprises MMT clinics, MMT participants, detoxification centers, and HIV and HCV transmission, testing and treatment systems. We determined that condom promotion was the most effective way to reduce HIV infection (2013-2020: 2.86% to 1.76%) in MMT setting, followed by needle exchange program (2013-2020: 2.86% to 2.56%), psychological counseling (2013-2020: 2.86% to 2.71%) and contingency management (2013-2020: 2.86% to 2.72%). Health education had marginal impact on reducing HIV incidence among MMT participants (2013-2020:2.86% to 2.84%) from 2013 to 2020. By contrast, psychological counseling (2013-2020: 7.54% to 2.42%) and contingency management (2013-2020: 7.54% to 2.96%) had been shown to be the most effective interventions to reduce HCV incidence among MMT participants, followed by needle exchange program (2013-2020: 7.54% to 5.76%), health education (2013-2020: 7.54% to 6.35%), and condom promotion program (2013-2020: 7.54% to 6.40%). Notably, HCV treatment reduced HCV incidence by 0.32% (2013-2020: 7.54% to 7.22%).ConclusionsIn conclusion, we generated a valuable system dynamic model to analyze the Chinese MMT system and to guide the decision-making process to further improve this system. This study underscores the importance of promoting condom use in MMT clinics and integrating psychosocial interventions to reduce HIV and HCV infections in MMT clinics in China.
Highlights
Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections among methadone maintenance treatment (MMT) participants remain high
This study underscores the importance of promoting condom use in MMT clinics and integrating psychosocial interventions to reduce HIV and HCV infections in MMT clinics in China
We developed an MMT system dynamic model (MMT-SDM), which revealed the complexity of the MMT system in China, and used this model to explore the effectiveness of integrated HIV/HCV prevention programs in the MMT setting in reducing HIV and HCV infections
Summary
Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections among methadone maintenance treatment (MMT) participants remain high. The simple services without effective interventions may limit the effectiveness of the MMT program [11] Interventions such as health education, condom promotion and needle exchange programs have been implemented to curb the HIV/HCV epidemics among drug users in different settings [12,13,14,15]. These measures have been shown to have various efficacies among different groups of at-risk populations. These interventions were not routinely implemented in MMT program in China, and the HIV/ HCV-lowering effects of integrating these services in MMT clinics are unknown
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