Methadone Clinics Research Articles

Seroprevalence of hepatitis B virus infection, anti-HCV antibodies and HIV and knowledge among people who use drugs attending methadone therapy clinic in Tanzania; a cross-sectional study

BackgroundMethadone therapy clinics have been recently introduced in Tanzania, aiming at reducing risk behaviors and infection rates of viral hepatitis and HIV among people who use drugs. The objective of this study was to estimate the prevalence, associated factors and knowledge level of these conditions among people who use drugs attending a methadone clinic in Tanzania.MethodsWe enrolled 253 People who using drugs receiving Methadone therapy. Clinical data was retrospectively collected from the medical records and face-to face interviews were conducted to determine the behavioral risk factors and respondents’ knowledge on viral hepatitis and HIV.ResultsAn overall seroprevalence of viral hepatitis (either hepatitis B surface antigen or anti-hepatitis C virus) was 6.3%, while that of hepatitis B virus mono infection was 3.5% and anti-hepatitis C antibodies was 3.5%. Seroprevalence of HIV was 12.6%. Viral hepatitis was strongly predicted by advanced age (> 35 years) (p = 0.02) and staying at Kirumba area (p = 0.004), and HIV infection was predicted by increased age (> 37 years) (p = 0.04) and female sex (p < 0.001). Regarding the knowledge of viral hepatitis, majority of the respondents were unaware of the transmission methods and availability of hepatitis B virus vaccines and only 17% were classified as well informed (provided ≥4 correct answers out of 7 questions). Good knowledge was highly predicted by higher education level of the individual (p = 0.001).ConclusionsDespite the efforts to curb viral hepatitis and HIV infections through Methadone clinics, infection rates among people who use drugs are still high and the general knowledge on preventive measures is inadequate.

Treatment adherence and related factors among patients in the unique MMT private clinic in Vietnam in 2018

A cross-sectional study using the take-all sampling method was conducted among patients in the unique MMT private clinic in Vietnam in 2018. The study aimed to describe treatment adherence status and related factors of the patients. Data on socioeconomic characteristics, behaviours, treatment process, level of social/family support were collected and analyzed. The results showed that 88.2% of MMT patients completely adhere to the treatment program. Factors positively related to treatment adherence of MMT patients were living with spouse/partner (OR = 3.02 95% CI: 1.11 – 8.19), not using illicit drugs during MMT treatment (OR = 5.88; 95% CI: 1.77 – 19.56). The methadone clinic should pay attention to the factors positively related to treatment adherence in the counselling and support process for the patients.

OTP reform bill would make life better for patients

Still in its early stages of the legislative process, the BETTER MAT Act would reform opioid treatment programs (OTPs), sometimes referred to as methadone clinics, taking into account revised rules spurred by the COVID‐19 pandemic. These rules, which took effect more than a year ago and were instituted by the Substance Abuse and Mental Health Services Administration (SAMHSA), allowed for expanded methadone take‐homes and telehealth services, with the aim of reducing contact and possible virus transmission.

A novel model to improve access to care for patients with chronic hepatitis C attended in behavioral health facilities

Background: Chronic hepatitis C (C-HCV) is more prevalent in individuals with behavioral health (BH) diagnoses and those on opioid replacement therapy than in other groups. Accordingly, our aim was to evaluate the effect of C-HCV treatment on the quality of life (QOL) of individuals receiving opioid replacement therapy in a newly created C-HCV clinic attached to the methadone clinic in our 338 beds and 355,702 annual outpatient visits community hospital, serving the population of East Harlem, New York City, where it is located. Methods: Adult patients with behavioral health diagnoses were screened for C-HCV upon entry to the hospital and were referred for evaluation and treatment, as appropriate. The effect of treatment of C-HCV on the quality of life (QOL) was assessed by a questionnaire in which a maximum score of 174 is the worst QOL, and a score of zero is the best, at baseline, and at least 12 weeks post treatment. Results: Three hundred and eighty-seven patients with behavioral health diagnoses were screened. One hundred and fifteen of them had confirmed C-HCV. Twenty-one of those patients had attended the BH HCV clinic. Fourteen additional patients were evaluated at a later date. Nineteen patients agreed to participate in the QOL study. Of these, 15 (79%) completed therapy and were cured. A marked improvement in their QOL scores was documented at least 12 weeks after treatment. Conclusion: A model of care that includes C-HCV treatment in BH facilities leads to adherence to therapy and cure, which is associated with improved QOL and should be the standard practice.

Hepatitis C treatment outcomes among patients treated in co-located primary care and addiction treatment settings

BackgroundPersons with substance use disorders face major barriers to hepatitis C virus (HCV) treatment. Co-location of addiction and HCV treatment is appealing, yet there are limited data on outcomes using this model. This study evaluated HCV outcomes of patients treated with direct-acting antivirals (DAAs) by primary care providers in two sites of co-located addiction/HCV care. MethodsThe study conducted a retrospective chart review for all patients receiving DAA treatment from 2016 to 2018 at 1) a hospital-based primary care clinic with an office-based buprenorphine program, and 2) a primary care clinic within an opioid treatment program (i.e. methadone clinic). The study classified patients into 3 groups according to treatment status: buprenorphine maintenance, methadone maintenance, or neither. Descriptive analyses compared patient demographics, clinical characteristics, adherence to monitoring and treatment, and the primary outcome of sustained virologic response at 12 weeks (SVR12), defined as an undetectable HCV viral load at least 12 weeks after completing treatment. ResultsThis study included 50 patients who initiated DAA treatment. The majority of patients were unemployed (74.0%), did not smoke tobacco (54.0%), and had psychiatric comorbidities (80.0%). Many also experienced homelessness during treatment (22.0%) and experienced previous incarceration (36.0%). Only a few had recently injected drugs (4.0%). Seven of 7 (100%) patients were treated with buprenorphine, 21 of 24 (87.5%) patients were treated with methadone, and 17 of 19 (89.5%) patients receiving no opioid addiction treatment fully completed HCV DAA treatment. When including patients with missing SVR12 data with the cohort that did not achieve cure, we observe that 44 of 50 patients (88.0%) achieved SVR12. Excluding patients missing SVR12 data, we observed that 44 of 46 patients (95.7%) achieved SVR12. ConclusionPersons with substance use disorders treated with DAAs in co-located primary care and addiction treatment settings can achieve high rates of cure despite significant comorbidities and barriers. DAA treatment should be expanded to co-located HCV and addiction settings.

Facing the future of substance use disorders treatment in Vietnam – A case study for international development and cooperation

Vietnam made progress transitioning from a criminal justice to a health treatment response for substance use disorders (SUD) in recent years. This case study describes the evolution of Vietnam's SUD treatment system from 2005 to 2020 to understand and learn from the phases of its development. The case study is based on data from a predesigned interview guide for 47 respondents, literature and policy desk review and direct experience of the authors. Vietnam saw remarkable growth of opioid use disorder (OUD) treatment from 2005 when methadone was unavailable, to 2020 with 335 methadone clinics in all 63 provinces serving more than 52,200 patients. The growth in OUD treatment accounts for much of Vietnam's success managing its HIV epidemic for which injection drug use was a major vector. An unintended consequence, however, focused only on OUD as a strategy to address HIV and was unable to address multiple substances. Most elements of a modern evidence and community-based SUD treatment system exist in Vietnam; however, they are siloed and influenced by multiple government administrative jurisdictions. Faced with rising amphetamine and persistent alcohol use, the path ahead for Vietnam involves a choice between a reliance on compulsory rehabilitation centers or a plan to broaden the scope of substances and treatments, and further integrate with Vietnam's commune-based primary health system.

Purposeful Fentanyl Use and Associated Factors among Opioid-Dependent People Who Inject Drugs

Introduction: In recent years, opioid-related mortality has increased steadily in the United States. Fentanyl, a synthetic opioid, has been a primary driver of the current wave of overdose-related deaths. Little is known, however, about fentanyl use among opioid-dependent people who inject drugs (PWID). We, therefore, sought to characterize purposeful fentanyl use among PWID. Methods: A cross-sectional survey was administrated to 104 opioid-dependent PWID on methadone who self-reported drug- or sex-related risk behaviors. Participants were recruited between July 2018 and October 2019 from a methadone clinic in New Haven, Connecticut. Multivariable logistic regressions were used to identify independent correlates of purposeful fentanyl use. Results: Overall, 43.2% and 22.1% of the participants reported any (lifetime) or recent (past 30 days) purposeful fentanyl use, respectively. Independent correlates of any purposeful fentanyl use were younger age (aOR= 0.94; p = 0.021), recent daily injection (aOR= 3.52; p = 0.047), recent cocaine use (aOR= 3.54; p = 0.041), and moderate/severe depression (aOR= 3.82; p = 0.028). Independent correlates of recent purposeful fentanyl use were moderate/severe depression (aOR= 10.94; p = 0.031), recently sharing injection equipment (aOR= 2.96; p = 0.044), and recently engaging in transactional sex (aOR= 3.60; p = 0.026). Conclusions: These findings indicate that opioid-dependent PWID on methadone remain at increased risk for overdose given the high prevalence of ongoing purposeful fentanyl exposure. Interventions to reduce the harms associated with fentanyl use should target young PWID and active fentanyl users, with an emphasis on achieving adequate methadone dosage and screening and treating depression in methadone-maintained patients who preferentially seek fentanyl.

Pre-exposure prophylaxis awareness, acceptability and potential stigma among medical and non-medical clinic staff in methadone treatment settings in northern New Jersey: The key role of non-medical staff in enhancing HIV prevention

BackgroundHIV prevention is needed among people who use drugs (PWUD) due to mixing sex and drugs, selling/trading sex, and/or injecting drugs. Pre-exposure prophylaxis (PrEP) is an extremely effective biomedical HIV prevention strategy, but uptake remains low among communities most in need of HIV prevention, including PWUD. Previous studies have found that providers are less willing to prescribe PrEP to PWUD, yet PWUD express high levels of PrEP acceptance. More research is needed to understand how people who provide substance use treatment services think about PrEP to maximize this biomedical prevention strategy. MethodsThe study conducted semistructured interviews with 29 staff members in two methadone clinic settings in urban northern New Jersey. Staff members included medical providers, methadone counselors, intake coordinators, front desk staff, lab technicians, security guards, and administrative/leadership personnel. ResultsAll staff recognized the need for HIV prevention among their patient populations, but most were either unaware of PrEP or unfamiliar with its purpose and how it works. Medical providers were more likely to have some PrEP knowledge in comparison to counselors and other staff, but the former largely did not have in-depth knowledge. Among those familiar with PrEP, many confused PrEP with HIV medication, as Truvada was the only FDA-approved PrEP at the time of the study. About half of participants expressed clear support for PrEP, while the other half expressed mixed or negative attitudes related to HIV, sexual behavior, and mistrust of the medication. Both the positive and negative perceptions entailed stigmatizing elements. RecommendationsDue to patients' frequent interactions with non–medical staff (e.g., front desk staff, lab technicians, etc.), all staff, not only medical personnel, should be aware of PrEP and comfortable discussing it to foster well-informed, nonjudgmental conversations about HIV prevention with patients. PrEP education should specifically address HIV and sexual-related stigma, as even positive perceptions of PrEP may entail stigmatizing elements.

Desire to avoid pregnancy and contraceptive use among female methadone patients in Los Angeles

ObjectiveOpioid use disorder (OUD) is increasing among U.S. women. Research indicates higher levels of unintended pregnancy among women with OUD as compared to the general population. Following formative in-depth research documenting the complexity of considerations around pregnancy in this population, we collected information on pregnancy preferences and contraceptive use among women attending methadone treatment. Study designWe surveyed women attending methadone clinics in Los Angeles in 2018. We used the Desire to Avoid Pregnancy (DAP) Scale, a 14-item instrument (0–4; 4 = highest desire to avoid pregnancy) to capture pregnancy preferences across 3 domains: cognitive desires, affective feelings, and anticipated consequences. We conducted factor analysis, descriptive analyses, and linear and logistic regressions to assess the DAP scale and to examine relationships between pregnancy preferences, sociodemographic characteristics, and contraceptive use. ResultsWomen (n = 46) expressed the full range of pregnancy preferences (DAP score range: 0.4–4.0; mean: 2.24, standard deviation: 1.02; Cronbach's α = 0.92). Overall, 40% used contraception at last sex. Women who reported a greater preference to avoid pregnancy were marginally more likely to use contraception at last sex as compared to women who were more open to pregnancy (odds ratio = 1.73; p = 0.09). ConclusionsSimilar to findings from other populations, responses to the Desire to Avoid Pregnancy scale among a sample of women with OUD revealed a broad range of pregnancy preferences. Pregnancy preferences were marginally associated with contraceptive use in this sample suggesting that the DAP may provide useful insights on pregnancy preferences that may facilitate contraceptive and preconception counseling in this population. ImplicationsGiven the complexity of considerations around pregnancy for women with opioid use disorder, the DAP scale may be a valuable tool to identify women's pregnancy and childbearing preferences and to facilitate alignment of women's sexual and reproductive health desires with appropriate services.

Geographical and socioeconomic disparities in opioid access in Mexico, 2015–19: a retrospective analysis of surveillance data

SummaryBackgroundIn 2015, Mexico implemented regulatory changes and an electronic system to improve access to prescription opioids. We aimed to investigate trends in opioid dispensing after the implementation of these changes and assess how opioid dispensing varied geographically and by socioeconomic status.MethodsIn this retrospective analysis of prescription medication surveillance data, we analysed dispensing data for group 1 medications (all opioids, including morphine, methadone, hydromorphone, oxycodone, tapentadol, fentanyl, sufentanil, and remifentanil) obtained from the Federal Commission for the Protection against Sanitary Risk database for 32 states and six large metropolitan areas in Mexico. We calculated crude annual opioid prescriptions per 10 000 people at the national, state, and municipal levels. Adapting methods from the report of the Lancet Commission on Palliative Care and Pain Relief, we calculated the need for palliative opioids by state, and then assessed the observed opioid dispensing rates as a percentage of expected need by geographical socioeconomic status. Within the six major metropolitan areas, we mapped the geocoded location of opioid prescriptions and assessed the association between opioid dispensing and socioeconomic status as well as the association between opioid dispensing and time to US border crossing for areas on the US–Mexico border.FindingsBetween June 25, 2015, and Oct 7, 2019, opioid dispensing rates increased by an average of 13% (95% CI 6·8–19·6) per quarter (3 months). The overall national opioid dispensing rate during the study period was 26·3 prescriptions per 10 000 inhabitants. States with a higher socioeconomic status had higher opioid dispensing rates than states with lower socioeconomic status (rate ratio [RR] 1·88, 95% CI 1·33–2·58, p=0·00016) after controlling for the estimated opioid requirement per state, the presence of methadone clinics, and the presence of tertiary hospitals and cancer centres. The same association between opioid dispensing and socioeconomic status was observed in the metropolitan areas, and in those metropolitan areas on the US–Mexico border a 20% decrease (RR 0·80, 95% CI 0·75–0·86) in opioid dispensation was observed per each SD increase (SD 17·1 min) in travel time to the border.InterpretationMeasures introduced by the Mexican federal Government to increase opioid access for patients with palliative care needs were only marginally successful in raising opioid prescription rates. Opioid access should be improved for patients with palliative care needs who live in geographical areas of lower socioeconomic status.FundingUS National Institutes of Health.

Prevalence of Amphetamine-Type Stimulant Use and Related Factors among Methadone Maintenance Patients in Ho Chi Minh City Vietnam: A Cross-Sectional Study

ABSTRACT The objective of this study was to determine the prevalence of amphetamine-type stimulant use and associated factors among methadone maintenance treatment (MMT) patients. In 2018, a cross-sectional study was conducted on 967 MMT patients at two methadone clinics in Ho Chi Minh City that serve Vietnamese patients. Amphetamine-type stimulant use was assessed by rapid urine test and face-to-face interview using the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) tool. The prevalence of amphetamine-type stimulant use assessed by urine test was 25.4%. According to ASSIST, the prevalence of moderate and high risk amphetamine-type stimulant use was 15.5% and 1.1%, respectively. Amphetamine-type stimulant use and hazardous use were more prevalent in younger patients, having a part-time job, drug injection, having a lower score of self-health assessment, treated with a higher dose of methadone and missing methadone dose in the past 3 months. By contrast, patients who were HIV positive were less likely to use amphetamine-type stimulants. Cannabis and heroin use were significantly associated with amphetamine-type stimulant use (OR = 1.46; 95% CI: 1.38–8.67; and OR = 1.50; CI: 1.04–2.18, respectively) and hazardous use (OR = 4.07; CI: 1.67–9.92; and OR = 2.38; CI: 1.56–3.63, respectively). Screening and interventions are needed to cope with this issue on time, particularly in young patients, having drug injection and concurrent drugs user groups.

Continuity of illicit drug use among Malay patients attending methadone clinics in Kelantan, Malaysia

The study aimed to determine the prevalence of continuity of illicit drug use and its associated factors among Malay opioid users receiving methadone treatment in Kelantan, Malaysia. This cross-sectional study involved a total of 150 respondents. Sociodemographic characteristic of participants, level of religiosity, and quality of life were collected using the self-administered questionnaires. The prevalence of continuity illicit drug use was 38.7% (n = 58) by self-report and 40.7% (n = 61) by positive urine test result for drugs. Positive hepatitis C status and high quality of life in the psychological health domain were associated with low continuity of illicit drug use by self-reported data and urine drug test results. In conclusion, the continuity of illicit drug use among methadone program users is still high, especially among those on methadone therapy for less than 2 years.

Willingness to initiate pre-exposure prophylaxis (PrEP) and its use among opioid-dependent individuals in drug treatment

BackgroundPeople who use drugs (PWUD) continue to experience a disproportionate HIV burden due to drug- and sex-related risk behaviors. Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV infection, but very little is known about PrEP use among PWUD and their willingness to initiate PrEP. MethodsWe conducted a cross-sectional survey among 234 HIV-negative, opioid-dependent individuals recruited from an urban methadone clinic. Participants were assessed using an audio-computer assisted self-interview technique. Bivariate and multiple logistic regressions were used to explore independent correlates of actual PrEP use and willingness to initiate PrEP. ResultsOne-fourth (25.6 %) of participants had previously used PrEP. Over two-thirds (67.1 %) of participants had previously heard of PrEP, and 65.0 % were willing to take it. In multivariable logistic regression analyses, the number of times participants engaged in HIV testing (aOR = 1.66, p < 0.01) and whether they visited a healthcare provider (aOR=20.81, p = 0.02) were associated with a higher likelihood of PrEP use, while perceived HIV risk (aOR=2.71, p < 0.01) and previous use of PrEP (aOR=3.57, p < 0.01) were significantly associated with willingness to initiate PrEP. ConclusionPrEP use was low among PWUD, but their willingness to initiate PrEP was moderate, which indicated a significant discrepancy between actual PrEP use and willingness to use it. Our findings highlight the importance of healthcare providers engaging opioid-dependent individuals in discussions about PrEP and the need for innovative strategies to increase their awareness of PrEP and modify their perceptions of HIV risk.

Estimate cost of providing methadone maintenance treatment at a methadone clinic in Nairobi Kenya: direct costs.

Methadone maintenance treatment is reported as cost-effective in treatment of opioid use disorder. Estimated cost of providing methadone varies widely in different regions but there is no data regarding cost of methadone treatment in Kenya. The aim of this study was to estimate the cost of methadone maintenance treatment at a methadone maintenance treatment clinic in Nairobi, Kenya from the perspective of the government, implementing partner and the clients. Data was collected for the period of February 2017 to September 2018 for 700 enrolled clients. The cost of providing methadone treatment was estimated as the sum of salaries, laboratory test, methadone and other commodities costs. The outcome was daily cost of methadone per client. The costs are given in Kenya Shillings (Ksh). The cost of treating one client is approximately Ksh. 149 (US$1.49) per day which amounts to Ksh 4500 (US$ 45) per month. This is from the estimated direct costs such as salaries which accounted for 86.4%, methadone 9.6%, tests and other consumables at 4%. The estimated average dose per patient per day is 60mg.This excludes indirect costs such as capital and set up cost, maintenance cost, training, drug import and distribution and other bills. The findings of this study show that the estimate cost of providing methadone at Nairobi, Kenya is comparable to that in other centers. This can help to inform policy makers on continued provision of methadone treatment in the country.

Do Mock-Ups, Presentations of Evidence, and Q&amp;As Help Participants Voice their Opinions During Focus Groups and Interviews About Supervised Injection Services?

Controversial facilities (e.g., supervised injection services (SIS), methadone clinics, and social housing) may require feasibility studies that asses their acceptability among community stakeholders before their implementation. However, controversies about these facilities may make stakeholders ambivalent or hesitant to express opinions about them because various sources of information disagree about their harms and benefits. We responded to this challenge by creating and piloting the use of “grounding aids” or tools, objects, and methods used before qualitative data collection to provide research participants with an experience in which they can learn about how the controversial facility operates in practice. Before interviews and focus groups in a recent SIS feasibility study we conducted, participants were introduced to three of these grounding aids: a physical mock-up of an SIS, a presentation regarding evidence on SIS, and a Q&amp;A with SIS staff. We then asked additional questions in the interviews and focus groups about participants’ experience with these grounding aids. With few exceptions, participants generally perceived the grounding aids to help them express their opinions without feeling that we were directing their opinions about SIS. Participants’ reasons for this included that the grounding aids helped them experience unfamiliar aspects of SIS visually and concretely, served as a cue for questions and as a reference for discussions, and personalized SIS and its operations. We also observed that they voiced less hesitancy overall regarding SIS than participants in our previous feasibility studies where we did not employ these grounding aids before data collection. Researchers planning to study perceptions of controversial facilities or other phenomena about which sources of information tend to disagree on may want to consider creating, evaluating, and using grounding aids to improve participant responsiveness.

HHS OIG audit of OTPs finds operations impacted by COVID‐19

Opioid treatment programs (OTPs, sometimes known as methadone clinics) had many challenges during COVID‐19, an audit by the Office of Inspector General (OIG) of the federal Department of Health and Human Services (HHS) released last month has found.

PMH43 Difference in Precision of Retention Estimates for Mandated Versus Patient-Chosen Medication-Assisted Treatment (MAT) Alternatives for Opioid Use Disorder (OUD)

We demonstrate how estimates of retention on OUD treatment in methadone clinics (MC) vs office-based buprenorphine (OB) in environments where treatments are mandated by protocol (MC=82.6%; OB=85.3%) are generally optimistic relative to results to be expected when patients are offered choices of treatments. Manski called this estimation problem a “mixing problem.” Various solutions are possible; most yield only bounds on estimates, the simplest being that for which no assumptions are employed. The method employs a counterfactual argument, using “potential” outcomes of treatment assignments, only one of which is observed. It suggests that there are 4 fractions of patients, two for which treatment is inconsequential (patients succeed or fail regardless of treatment) and two for which only one or the other of the treatments is successful. Speculation on the sizes of these fractions consistent with the observed trial outcomes with mandated treatments yields bounds on retention for a scenario where patients choose which of the two treatments they receive. If outcomes are ordered (e.g. for all patients, OB > MC) then the success percentage bounds correspond to those observed when mandated [82.6%, 85.3%]. This is also the case if treatment is independent of outcomes. However, when employing no assumptions (no prior information), bounds on retention percentages when patients have choices are shown to be wider [67.9%, 100%] than the observed range in the trial. Outside trials, patients generally have treatment choices and outcomes will generally differ from environments with mandated treatments. The wider bounds result from patients choosing treatments at the extremes (optimizing or minimizing their success), choosing treatments that work (or don’t work) for them. Perfect foresight being rare, predicting outcomes must, absent assumptions, allow for both extremes – and anywhere in between. Other ranges are possible with various assumptions on prior outcomes or treatment policies.

HIV and HCV infection status and related risk factors in drug users at the Sino-Vietnamese border in Guangxi, 2012 — 2019

Objective To understand the prevalence rates and the related risk factors of HIV, HCV and HIV/HCV coinfection in drug users in the Sino-Vietnamese border areas of Guangxi, and we provide reference for high-risk intervention in this population. Methods From April to June every year from 2012 to 2019, a questionnaire developed by the state was used to carry out continuous cross-sectional surveys on the post surveillance sites in Guangxi border areas, community drug addicts and morphine urine test positive persons in methadone clinics in the past month, and blood samples were taken from them for the detections of HIV and hepatitis C virus (HCV) antibodies. Results A total of 12 842 drug users were monitored from 2012 to 2019. The overall positive rates of HIV, HCV and HIV/HCV co-infection were 3.84%, 43.34% and 3.14%, respectively. HIV, HCV and HIV/HCV co-infection rates showed an decrease trend year by year. The prevalence differed in drug users with different demographic characteristics. Logistic regression analysis showed that HIV infection related risk factors included being female, primary education and injecting drug use. HCV infection related risk factors included 20 years old or more, divorced or widowed, minorities other than Han and Zhuang, being traditional drug user or mixed drug user, and injecting drug use. HIV/HCV co-infection related risk factors included being female, primary education and injecting drug use. Conclusion The HIV infection rate and HCV antibody positive rate in drug users in border areas of Guangxi were relatively high, and the infection rate of HIV/HCV combined infection were low. The use of novel type drugs was in increase. Targeted effective interventions should be conducted in female and older drug users as well as drug users having a history of injection drug use. 摘要:目的 了解广西中越边境地区吸毒人群中HIV、丙肝病毒(HCV)及HIV/HCV合并感染情况及其影响因素, 为在该人群中开展髙危行为干预提供参考依据。 方法 2012—2019年间每年4一6月, 采用国家统一制定的问卷对广 西中越边境哨点监管场所、社区和美沙酮门诊最近1个月吗啡尿检阳性者开展连续横断面调査, 并采集调査对象血液 标本进行HIV和HCV抗体检测。 结果 2012—2019年共监测12 842名毒品使用者。HIV感染率为3.84%, HCV抗体 阳性率为43.34%, HIV/HCV合并感染率为3.14%。HIV、HCV及HIV/HCV合并感染率整体上呈逐年下降的趋势。不同 行为特征的吸毒人群感染情况不同。Logistic回归分析显示, 女性、小学学历、有注射吸毒史是感染HIV的危险因素。年龄>20岁、离异或丧偶、除汉族和壮族外的其他少数民族、传统毒品和混合毒品使用者、有注射毒品史是感染HCV的 危险因素。而女性、小学文化、有注射毒品史是HIV/HCV合并感染的危险因素。 结论 广西边境吸毒人群整体HIV感 染率和HCV抗体阳性率较髙, HIV/HCV合并感染率较低, 新型毒品使用者比例呈上升趋势。提示需针对女性、髙年龄 组及有注射吸毒史的吸毒人群开展有效干预措施。

Increased flexibility in methadone take-home scheduling during the COVID-19 pandemic: Should this practice be incorporated into routine clinical care?

In the context of the COVID-19 pandemic and the state of emergency that the government of Spain declared, the rapid adaptation of health services is of paramount importance to preserve access to and continuity of service delivery. This research note underscores the importance of ensuring a sufficient quantity of methadone take-home doses for patients on methadone maintenance treatment (MMT) to maximize their adherence to government-imposed lockdown restrictions and social distancing measures designed to curtail the spread of SARS-CoV-2. We evaluate the impact of COVID-19 on take-home medication (number of days provided) in a methadone clinic in Barcelona (Catalonia, Spain). This work conveys that we should consider maintaining the take-home practices that we adopted in response to the pandemic, even after the pandemic has abated.

Retention and outcomes for clients attending a methadone clinic in a resource-constrained setting: a mixed methods prospective cohort study in Imphal, Northeast India

BackgroundOpioid substitution therapy (OST) with buprenorphine has been widely available in India since 2007, but the introduction of methadone occurred much later in 2012, and availability remains limited. Illicit injecting drug use is a long-standing public health problem in Manipur, a state in Northeast India characterised by major resource constraints and political unrest. We investigated retention and outcomes for clients attending a methadone-based OST program in Manipur with the aim of strengthening the evidence base for development of relevant policies and programs.MethodsAll clients enrolling in the methadone clinic over a 1 year period were invited to be part of a prospective cohort study, which followed up and surveyed both retained and defaulting clients for 12 months post-enrollment to assess retention as well as social, behavioural and mental health outcomes. Additionally, we conducted semi-structured qualitative interviews to supplement quantitative information and identify factors contributing to retention and drop-out.ResultsOf the 74 clients enrolled, 21 had dropped out and three had died (all defaulters) by 12 months post-enrollment, leaving 67.6% still in the program. Using an intention-to-treat analysis, meaningful and statistically significant gains were observed for all social, behavioural and mental health variables. Between baseline and 12 months there were reductions in needle sharing, drug use, property crime, anxiety, depression and suicidal thoughts; and improvements in physical health, mental health, quality of family relationships, employment and hopefulness. Factors contributing to retention and drop-out were identified, including the centrality of family, and general lack of awareness of and misunderstanding about methadone.ConclusionEven in parts of India where resources are constrained, methadone is an effective treatment for opioid dependence. Scaling up the availability of methadone elsewhere in Manipur and in other areas of India experiencing problematic opioid dependence is indicated.