The Decade-Long Chinese Methadone Maintenance Therapy Yields Large Population and Economic Benefits for Drug Users in Reducing Harm, HIV and HCV Disease Burden.

Lei Zhang,Yin Liu,Yong Xu,Xia Zou,Nick Medland,Li Ling,Liwei Deng,Shu Su

doi:10.3389/fpubh.2019.00327

Abstract

Objectives: We aimed to conduct a comprehensive evaluation of the population impact of methadone maintenance treatment (MMT) for its future program planning.Methods: We conducted a literature review of the effects of MMT in China on HIV and HCV disease burden, injecting, and sexual behaviors and drug-related harm during 2004–2015. Data synthesis and analysis were conducted to obtain the pooled estimates of parameters for a mathematical model which was constructed to evaluate the effectiveness and cost-effectiveness of the program.Results: Based on a review of 134 articles, this study demonstrated that MMT is highly effective in reducing crime-related, high risk sexual, and injecting behaviors. The model estimated US$1,037 m which was invested in MMT from 2004 to 2015 has prevented 29,463 (15,325–43,600) new HIV infections, 130,563 (91,580–169,546) new HCV infections, 10,783 (10,380–11,187) deaths related to HIV, HCV and drug-related harm, and 338,920.0 (334,596.2–343,243.7) disability-adjusted life years (DALYs). The costs for each prevented HIV infection, HCV infection, death, and DALY were $35,206.8 (33,594.8–36,981.4), $7,944.7 ($7,714.4–8,189.2), $96,193.4 (92,726.0–99,930.2), and $3,060.6 ($3,022.0–3,100.1) respectively.Conclusion: The Chinese MMT program has been effective and cost-effective in reducing injecting, injecting-related risk behaviors and adversities due to HIV/HCV infection and drug-related harm among drug users.

Highlights

Sharing of injection equipment is the major risk factor for transmission of HIV and hepatitis C (HCV) among drug users (DUs) worldwide [1,2,3]
This study aims to provide a timely assessment of the effectiveness and cost-effectiveness of the decadelong Chinese maintenance treatment (MMT) program by assessing its role in harm reduction and prevention of HIV/HCV transmission with a mathematical model
The number of individuals receiving MMT increased from ∼3,000 in 2004, peaked at 208,000 in 2012, and decreased to 187,000 in 2015, covering 6% of total registered Chinese DUs (Figure 1)

Summary

Introduction

Sharing of injection equipment is the major risk factor for transmission of HIV and hepatitis C (HCV) among drug users (DUs) worldwide [1,2,3]. HIV infection requires lifelong treatment and treatment of HCV is expensive and of limited availability in all but the most resource-rich settings. Methadone maintenance treatment (MMT) is an evidence-based opioid substitution treatment for opiate addiction and injecting drug use. Evidence shows that MMT substantially reduces the frequency of drug use, sharing of injecting equipment and drugrelated crimes [4, 5]. In settings where drug use is closely related to commercial sex, MMT reduces commercial sex work and high-risk sexual exposure and provides opportunities for health education, safe sex education, and condom programs in MMT CENTERS [6, 7]. MMT is an effective intervention to reduce HIV and HCV transmission [8,9,10]

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Discussion

Conclusion