Methadone Maintenance Treatment Centers Research Articles

Retention rate in methadone maintenance treatment and factors associated among referred patients from the compulsory residential centers compared to voluntary patients.

Compulsory treatment has decades of history in Iran; both before and after the Islamic Revolution, but there are many debates regarding its efficacy and effectiveness. Retention Rate is one of the best indices to estimate the efficacy of treatment. This study will compare Retention Rate among people referred from compulsory treatment centers and volunteer participants. This was a retrospective (historical) cohort study that has been conducted among people who were taking methadone maintenance treatment (MMT). The study sample was selected from the MMT centers that admit both referral patients from compulsory centers and voluntary patients. All newly admitted patients from March 2017 to March 2018 were enrolled and followed up until March 2019. A total of 105 participants were recruited for the study. All were males with a mean age of 36.6 ± 7.9 years. Fifty-six percent of individuals were referred from compulsory residential centers. The total one-year retention rate of participants in this study was 15.84%. The one-year retention rate for the patients referred from compulsory residential centers and the non-referred patients was 12.28 and 20.45%, respectively (value of p = 0.128). Among the other studied factors, only marital status was significantly associated with MMT retention (p = 0.023). Although the average treatment adherence time for non-referred patients was about 60 days higher than those referred from compulsory residential centers, this study found no significant differences in retention days and a one-year retention rate. Further studies with larger sample sizes and longer follow-ups are needed to explore the efficacy of compulsory treatment methods in Iran.

Collaborative Referral Model to Achieve Hepatitis C Micro-Elimination in Methadone Maintenance Treatment Patients during the COVID-19 Pandemic.

Although hepatitis C virus (HCV) prevails in patients receiving methadone maintenance treatment (MMT), most do not receive anti-HCV therapy. This single-center observational study aimed to achieve HCV micro-elimination at an MMT center during the COVID-19 pandemic using a collaborative referral model, which comprised a referral-for-diagnosis stage (January 2020 to August 2020) and an on-site-diagnosis stage (September 2020 to January 2021). A multidisciplinary team was established and all MMT center patients were enrolled. HCV micro-elimination was defined as >90% of HCV-infected patients diagnosed and >80% of HCV-viremic patients treated. A total of 305 MMT patients, including 275 (90.2%) anti-HCV seropositive patients, were enrolled. Among 189 HCV-infected patients needing referral, the accumulative percentage receiving HCV RNA testing increased from 93 (49.2%) at referral-for-diagnosis stage to 168 (88.9%) at on-site-diagnosis stage. Among 138 HCV-viremic patients, the accumulative percentage receiving direct-acting antiviral (DAA) therapy increased from 77 (55.8%) at referral-for-diagnosis stage to 129 (93.5%) at on-site-diagnosis stage. We achieved an HCV RNA testing rate of 92.4% (254/275), an HCV treatment rate of 95.8% (203/212) and a sustained virological response rate of 94.1% (191/203). The collaborative referral model is highly effective in HCV RNA testing and HCV treatment uptake among MMT patients, achieving HCV micro-elimination.

Sexual Dysfunctions in Patients Receiving Opioid Agonist Treatment and Heroin-Assisted Treatment Compared to Patients in Private Practice-Identifying Group Differences and Predictors.

Background and AimsSexual dysfunctions (SDs) show a marked impact on a person’s general wellbeing. Several risk-factors like physical and mental illnesses as well as alcohol and tobacco use have to date been identified to contribute to the occurrence of SDs. The impact of opioid-agonist treatment (OAT) on SDs remains unclear, with some studies demonstrating an improvement after methadone maintenance treatment (MMT) initiation. However, no studies on the prevalence and predictors of SDs in heroin-assisted treatment (HAT) exist to date.MethodsA cross-sectional study was conducted with patients from a MMT center (n = 57) and a center specializing in HAT (n = 47). A control group of patients with mild transient illnesses (n = 67) was recruited from a general practitioner (GP). The International Index of Erectile Function, the Female Sexual Function Index, as well as measurements for psychological distress, depressive state, nicotine dependence, and high-risk alcohol use were employed. Patients also completed a self-designed questionnaire on help-seeking behavior regarding sexual health. Mann-Whitney-U tests and chi-square tests were performed for group comparisons and binary logistic regression models were calculated.ResultsTwenty-five percent of the GP sample (n = 17), 70.2% (n = 40) of the MMT sample, and 57.4% (n = 27) of the HAT sample suffered from SDs at the time of study conduction. OAT patients differed significantly from GP patients in depressive state, high-risk alcohol use, nicotine dependence, and psychological distress. Age, depressive state, and opioid dependence predicted the occurrence of SDs in the total sample. No differences between OAT and GP patients were found regarding help-seeking behavior.DiscussionAge, depressive state, and opioid dependence predicted the occurrence of SDs in the total sample. It remains unclear whether SDs are caused by opioid intake itself or result from other substance-use related lifestyle factors, that were not controlled for in this study. A lack of help-seeking behavior was observed in our sample, underlining the importance of clinicians proactively inquiring about the sexual health of their patients.ConclusionThe high prevalence of SDs observed in MMT does not differ from the prevalence in HAT. Clinicians should actively inquire about their patients’ sexual health in GP and OAT centers alike.

Lapse and Relapse Rates in Narcotics Anonymous versus Methadone Maintenance Treatment: A 12-Month Prospective Study.

Objective: The present study aimed to compare lapse and relapse-free survival between patients treated in Narcotics Anonymous (NA) groups and Methadone Maintenance Treatment (MMT) centers and to determine the relationship between social support scale and treatment outcome. Method: This study was a prospective, 12-month cohort study using the random sampling method to select 100 newcomer patients treated by the NA Association as well as 100 patients in MMT centers. The data were collected using a demographic questionnaire and Social Support Appraisals (SSA) scale at the onset of the study along with follow-up phone calls every other week. Results: All participants were male, aged between 18 and 65 with a mean (SD) age of 38.98 (± 10.85) years. Prevalence of relapse in 12 months was 60.5%. The lapses in the MMT group and relapses in the NA group were significantly higher (P < 0.001). The younger patients with lower levels of education are at greater risk of lapse/relapse. The mean score of SSA was significantly higher in the MMT group than the NA group in all subscales, including friends, family, and the others' support (P < 0.001). The mean scores of SSA subscales for the participants without relapse in the NA group was significantly higher in comparison to the MMT group. Conclusion: Detection of factors related to drug abuse relapse/lapse may help addiction therapists to identify drug abuse patients with lapse/relapse and to develop treatment and policy guidelines to prevent relapse in addiction recovery.

Social determinants of addiction in population Middle age in the city of Yazd

Background: There are several factors involved in drug abuse and since some of these effective factors, especially social factors, can be changed and corrected; By recognizing them, more effective prevention programs can be implemented.This case study was performed with the aim of determining the social factors of addiction in people middle age living in the city of Yazd.&#x0D; Methods: In this case-control study during 2019- 2020, 150 Substance user who referred to methadone maintenance treatment centers (MMTC) were involved in a case group and 150 subjects, matched in terms of sex and age, were selected as a control group during 2019. The cases were selected by cluster sampling method from Yazd methadone maintenance treatment centers. The selection of witnesses was done from the neighbors of the cases.&#x0D; Data collection tool was a researcher-made questionnaire that includes three parts: demographic questions, economic and social factors and Substance use-related questions. The content validity of the questionnaire was affirmed by experts and its reliability, obtained by Cronbach's alpha coefficient, was 0.75. The cases were selected by cluster sampling from MMTC.&#x0D; The data were analyzed using SPSS software and logistic regression model was used to find the related characteristics.&#x0D; Results: The results of logistic regression model show that individuals working in non-organizational jobs had the highest share in relation to Substance user , with an odds ratio of 4.65. The use of drugs, Substance user first-degree relatives, and Substance user friends were with the odds ratio of 3.4, 2.97, and 2.6, respectively are significantly related to Substance user and have the highest risk for Substance user (P = 0.0001).&#x0D; Conclusion: The results of this study indicate that Substance user individuals had more social risk factors compared to the general population. Therefore, planned measures to reduce these risk factors among the community, especially young people and their friends, by family and community officials are necessary. And the family plays a decisive role in choosing a friend for their children.

The effects of anxiety on relapse of patients with opioid use disorders under methadone maintenance treatment: control of the confounding variables

ABSTRACTThe current study has been carried out in order to investigate the effects of anxiety on the relapse of patients with opioid use disorders (OUDs) under methadone maintenance treatment (MMT). In this cross-sectional study, 2676 patients with OUDs, referred to MMT centers of Kermanshah from 2005 to 2017 were entered into the study. In order to evaluate the level of anxiety, Beck Anxiety Inventory (BAI) was used. The results showed that after controlling the role of other influential variables, the age of onset of substance use has significant effect on relapse, but there were no significance relationship between gender, age of quit, income, marital status, and education level with relapse. With the increase in anxiety score, the odds of relapse increased, so that people who had severe anxiety 3.43 (2.58 – 4.55) times greater relapse than those with a low level of anxiety. Nonlinear diagram showed that the highest increase in the odds of relapse was among those who had an anxiety score of 7 to 25 and then, with a moderate slope, the odds likelihood of relapse increased. Considering the effects of anxiety on relapse, it is recommended that health-care programs in all MMT centers need to have more focus in order to address anxiety among patients, in a more effective way.

The Use of Psychoactive Substances and Illegal Drugs in the Albanian Society.

To create a representative picture of the prevalence and the total number of drug users in Albania from 2012 to 2016, and compare those numbers to previous years with other available data. The required data for the conductance of this study was collected from three different fronts, namely The Institute of Forensic Medicine (IFM), Clinical Toxicology and Addictions Service, University Hospital "Mother Theresa" Tirana (CTS) and Methadone Maintenance Treatment Centers. The study targets all individuals who have consumed at least once abusive drugs and psychotropic substances during the period 2012-2016 in the Republic of Albania. A total of 7050 reported cases over the given period were reviewed. Overall, Cannabis Sativa was the highest consumed drug, present in 62.58% of the cases. Other substances with a noticeable prevalence of use were heroin (15.02%) and cocaine (5.1%). It was found out that there were 36 drug-related deaths from 2012 to 2016. During this period of time, only 9 individuals resulted positive for Sexually Transmitted Infections (STI), of which, one positive for Hepatitis C and the remaining 8 positives for HIV. About 25% of drug users in Albania belong to the young subgroup of the population (13-32 years old). Overall, taking into consideration all three databases, the number of drug users has significantly increased. There are more officially reported drug users today compared to 2012, however, different trends are observed during different periods. Youngsters are more eager and tempted to use and experiment more with safer and less harmful drugs like cannabis, meanwhile, as age increases, there is a tendency to shift towards more potent and dangerous drugs. Prevention and reducing the prevalence of use of psychoactive drugs is one of the main goals of public health.

Treatment needs of drug users: The perspective of Iranian women

ABSTRACTBackground: Treatment needs and health-care issues in women are completely different from those of men. In order to develop and apply successful treatment programs for substance-dependent women, gender-based differences should be considered to provide them with effective health care and treatment services.The present study was conducted to investigate the views of substance dependent women about their health care and treatment needs.Methods: In-depth and semi-structured interviews were conducted among 20 opiate using women who were chosen through purposeful sampling from camps, methadone maintenance treatment (MMT) centers and women’s prison in Sanandaj, Iran in 2015. Data were analyzed using content analysis (a conventional approach).Findings: Three main factors were recognized through data analysis: individual factors, structural factors, and social factors.Conclusions: The results of the study suggests the need for structural changes such as improving comprehensive services and enhancing referral system regarding gender-based differences to provide the substance-dependent women with more effective treatment and medical care.

Pattern of Substance Abuse and Prevalence of Risk Factors of HIV and Hepatitis among Addicted Women in Western Iran.

Background:Women are the first victims in most of social damages and corruptions. However, due to some social and cultural reasons, the most of the drug addiction studies in Iran target male population. Hence, this study aimed to investigate the pattern of substance abuse and prevalence of HIV and hepatitis risk factors among addicted women.Methods:This is a cross-sectional study conducted on women referred to methadone maintenance treatment centers of Western Iran (Kermanshah province). Data were collected through interview by a psychologist who is working full time in the centers.Results:A total of 138 addicted women were studied. Among whom, 50 individuals were aged >45 years old (36.2%), 135 individuals (97.8%) had a history of substance abuse in their family, and 66 individuals (40.5%) initiated drug use before age 20. The most common substances were opium and crack with a proportion of 76.8% and 9.4%, respectively. Prevalence of positive HIV and hepatitis B among addicted women were 18.8% (26 persons) and 5.0% (7persons), respectively. Three (2.1%) of addicted women with HIV also had HBV. The most commonly HIV transmission were drug injections (30.7%) and unprotected sex (11.5%).Conclusions:Although women do not constitute a significant part of substance abuse, increasing trend of women addiction, on one hand, and high prevalence of risk factors related to HIV or hepatitis in women, on the other hand; show that officials and experts are required to seriously consider prevention and harm reduction programs for women.

Age of Substance Use Onset in Kermanshah Province: Results from a Large Cross-Sectional Study

Objectives: The aim of this study is to determine the epidemiology of substance use in terms of age of initiation, duration of use and age of patients when they seek the treatment. Methods: This cross-sectional study was performed on drug-dependent individuals (4176 subjects), who had referred to methadone maintenance treatment (MMT) centers of Kermanshah province, western Iran, during year 2015. The information was gathered by psychologists working in substance use wards, who interviewed clients seeking treatment. Results: Mean age of substance use initiation was 24.1 ± 8.2 year. On average, males and females became dependent on illegal drugs only after 3.6 and 2.5 year since substance use initiation, respectively. The chance of treatment failure for persons over 55 years was 2.5 (95%CI: 1.6 - 3.8) times higher than that for patients aged less than 24 years old. Generally, chance of treatment failure increased by 1.2 (1.1 to 1.3) for every one-year increase since substance use initiation. Conclusions: Given that the age of substance use initiation is very low in Kermanshah and it has a declining trend in Iran, and has a declining trend, increase/decrease in prevalence/age of using illegal drugs is expected unless efforts are made to change status and implement preventive programs.

Influence of social network on drug use among clients of methadone maintenance treatment centers in Kunming, China.

AimsTo examine drug use behavior of clients attending Methadone Maintenance Treatment (MMT) programs and its relationship with the clients’ social network characteristics.DesignCross-sectional study.SettingFour MMT clinics in Kunming, Yunnan province, China.Participants324 consecutive MMT clients.MeasurementsA structured, self-completed questionnaire on background characteristics and existing social network. Current drug use was assessed by urine test for opiate metabolites.AnalysisThe association between client's social network characteristics and their own current drug use behavior is analysed using multiple logistic regression adjusting for socio-demographic characteristics. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) are obtained to give the strength of the associations.FindingsMMT clients were more likely to concurrently use heroin while attending MMT if their social network had any of the following characteristics: more than half of the members were older than them (AOR = 1.03, 95% CI = 1.00,1.06), any member had a high level of influence on them (AOR = 6.47, 95% CI = 2.86,14.65) and any member joined them in using drugs (AOR = 1.94, 95% CI = 1.04,3.63). Having a social network member who could provide emotional support (AOR = 0.11, 95% CI = 0.03,0.35), having a spouse and/or child in their social network (AOR = 0.44, 95% CI = 0.24,0.81) and having a social network member with a high level of closeness (AOR = 0.28, 95% CI = 0.09,0.90) were associated with a decreased odds of heroin use.ConclusionSocial networks who could provide MMT clients with emotional support and a close relationship were significant factors for reducing the risk of concurrent drug use among clients attending MMT clinics in Kunming, China. Behavioral interventions should address the role of family and social network members in providing support to these clients.

An investigation of an open-access model for scaling up methadone maintenance treatment.

To examine retrospectively patient and programmatic outcomes following the development and implementation of an 'open-access' model in which prospective patients were enrolled rapidly in methadone maintenance treatment, irrespective of ability to pay, and provided real-time access to multiple voluntary treatment options. Medical and administrative records were abstracted to compare data for 1year before and 9years after initiating the implementation of an open-access treatment model in May 2007. Methadone maintenance treatment center in Connecticut, USA. Individuals with opioid use disorder entering treatment between July 2006 and June 2015. In June 2015, 64% (n=2594) of the sample were men and 80% (n=3133) reported that they were white. The Network for the Improvement of Addiction Treatment-informed open-access treatment model uses process improvement strategies to improve treatment access and capacity. Census, waiting time, retention, non-medical opioid use, patient mortality and financial sustainability (net income and state-block grants as proportions of revenue). In the 9years following the initial implementation of the open-access model, patient census increased by 183% from 1431 to 4051, and average waiting-time days decreased from 21 to 0.3 (same day) without apparent deleterious effects on rates of retention, non-medical opioid use or mortality. Between fiscal years (FY) 06 and FY 15, net operating margin rose from 2 to 10%, while state-block grant revenues declined 14% and the proportion of total revenue from state-block grant revenue decreased from 49 to 24%. An open-access model for rapid enrolment of people with opioid use disorder in methadone treatment appears to improve treatment access, capacity, and financial sustainability without evidence of deleterious effects on treatment outcomes.

Association between DRD2 gene polymorphisms and the dosage used on methadone maintenance treatment program

Objective: To investigate the association between three single nucleotide polymorphism (SNP) genes DRD2 (rs1800497, rs6275, and rs1799978) and the dosage used on methadone maintenance treatment (MMT). Methods: From the methadone maintenance treatment centers, 257 MMT patients were recruited to participate in a case-control study and divided into two groups-control groups under low dosage (n=89) and case (n=168) group with high dosage. Quanto software was used to estimate the sample size as 180. Information related to social-demographic status, history on drug use and medication were collected. And DRD2 SNPs were genotyped to explore the relationship between polymorphism of DRD2 gene and the dosage of methadone maintenance treatment. Results: Distributions of DRD2 rs6275 between different groups were significantly different. Patients carrying TC genotype needed lower dose of methadone when compared to the patients that carrying CC genotype counterparts (OR=0.338, 95% CI: 0.115-0.986). Patients that carrying C allele at rs6275 needed lower methadone dose than those that carrying genotype TT (OR=0.352, 95% CI: 0.127-0.975). Distributions of genotypes, alles in the other two SNPs (rs1800497, rs1799978) were not significantly different between groups under different dosages. Conclusion: DRD2 rs6275 was associated with dosage of methadone used for the MMT patients. However, no significant associations were found between rs1800497, rs1799978 and the dosage of methadone.

Similarities and changes between 15- and 24-year survival and retention rates of patients in a large medical-affiliated methadone maintenance treatment (MMT) center

BackgroundEnvironmental and social trends and patients’ characteristics may affect predictors for methadone maintenance treatment (MMT) outcome. MethodsWe have expanded our previous study of predictors for MMT outcome (from 619 to 890 patients) and the study period (from 15 to 24 years). Survival and retention in MMT since admission to the MMT clinic (6/1993–6/2016) and until death or study closure (6/2017) were compiled and analyzed. ResultsOf 890 patients ever admitted (10,146.9 person-years (py)), 237 passed away (116 while in MMT). The mortality rate did not differ between those who stayed or left (2.6 vs. 2.1 per 100 py, p = 0.1), but it was lower among those who stayed ≥1 year during any admission (2.1 vs. 3.3 per 100 py, respectively, p = 0.004). Age <40 years, no hepatitis C or B, no HIV, and no benzodiazepine abuse after one year predicted longer survival (multivariate analyses). No opiate or benzodiazepine abuse after one year, methadone dose ≥100 mg/d, no DSM-IV-TR Axis II diagnosis only, and no direct hospital referral predicted longer retention. Cocaine abuse predicted poor retention and survival among 271 patients admitted during the extended part of the study period. ConclusionsPredictors for retention (associated with MMT outcome) and mortality (associated with pre-treatment comorbidity) after 24 years were similar to those after 15 years. Cocaine abuse as a predictor of both poor retention and poor survival in the later period may reflect the escalating trend for cocaine abuse and should be studied if related to other unmonitored substances.

Quality of Life Among Drug-Dependent and Non-Drug Dependent Individuals in Iran

Background: Drug dependency is one of the most important issues in any society and it is among the most widespread health risk factors. Objectives: This study was conducted to determine quality of life in drug- dependent individuals, who were under methadone treatment, and non-drug dependent persons in Shahroud (northeast of Iran). Methods: In this comparative study, 266 drug dependent participants and 541 non-drug dependent participants were studied in 2014. The Persian version of SF-36 Quality of Life Questionnaire was used to collect data. The data were analyzed using chi square test, t test, and ANOVA. Results: The majority of the participants (77.1%) in both groups were male. The mean age of drug-dependent participants was 37.6 ± 10.7, the mean duration of drug dependency was 12.0 ± 9.3 years, and the mean duration of treatment in methadone maintenance treatment centers (MMT) was 24.6 ± 22.6 months. No significant difference (P > 0.05) was observed between the 2 groups in any aspects of quality of life other than the vitality (P = 0.001). Conclusions: In this study, quality of life scores were not significantly different between drug dependent and non-dependent participants. It seems that treatment with the use of methadone and buprenorphine can play a good role in improving quality of life of addicts.

Addicts' Viewpoint of the Reasons for Relapse (Case Study: Methadone Maintenance Treatment center of Assalouyeh)

Addicts' Viewpoint of the Reasons for Relapse (Case Study: Methadone Maintenance Treatment center of Assalouyeh)

Estimation of Intravenous Drug Users' Population in Kermanshah City, West of Iran in 2016 using Capture-recapture Method.

Drug abuse, particularly intravenous drug use, is one of the most common challenges in human communities so that its negative impact on economic and cultural conditions of society and physical as well as mental health of individuals is evident. We aimed to estimate the IDUs' population in Kermanshah City, West of Iran using Capture-recapture method. A Cross-sectional study. The data in this study were collected from three different sources: Drop in Centers (DICs), Out Reach Teams (ORTs) and Methadone Maintenance Treatment centers (MMTs) in Kermanshah City from Mar 2015 until Mar 2016, and then indirect Capture-recapture was used to estimate the IDUs' population. The number of IDUs registered in DICs, ORTs, and MMTs were 694, 731, and 156 cases, respectively. Having determined the commonalities and removing duplicates, the number of drug users registered were 1,375 cases, after analysis of data, the number of drug users not registered in any center was estimated as 2,042 (95% CI: 1708, 2444). By counting 1,375 cases recorded in these sources, the total number of injection drug users in the Kermanshah City was about 3,417 people, (95% CI: (3083, 3819). The prevalence of IDUs in Kermanshah City is high, which could cause severe economic and social problems in the society. To reduce the negative effects of drug use, awareness and measuring of the drug users population, seem to be necessary overtime.

Suicidal Ideation Among Heroin-Abusing Mothers in Methadone Maintenance Treatment.

There is a dearth of information about mothers in methadone maintenance treatment (MMT), their parental stress, and suicidal ideation. To evaluate parenting stress and suicidal ideation among heroin-dependent mothers in MMT. The study was conducted at an MMT center. Inclusion criteria were mothers with at least one child between 6-12 years of age. Mothers (n = 41) were interviewed about their background characteristics, drug use, parenting stress, and suicide ideation. The mothers' median age was 44 (27-63 years), 35% were single, 20% married or with a partner, 45% separated or divorced, 83% were Jewish, and about one-third completed elementary school only. Among the study participants, 52% reported ever thinking about suicide, 28% reported past-year ideation, and 15% indicated they were likely to complete suicide someday. Mothers who have used heroin and cannabis reported high levels of parenting stress. Mothers with high parenting stress levels were more likely to report suicidal ideation. Country of origin status did not differentiate those interviewed. This study provides insight into a hard-to-reach population of mothers needing treatment, parental skills training, and mental stress reduction. Further research is needed to generalize the findings for treatment, education, and training purposes.

Retention and Relapse in Methadone Maintenance Treatment: A Descriptive Analytical Study

&lt;p&gt;&lt;strong&gt;BACKGROUND:&lt;/strong&gt; Despite the considerable efforts made in Iran to treat people with addiction, relapse is still common. This study was designed to determine retention and relapse rates and related factors at Yasin Methadone Maintenance Treatment Center.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;PATIENTS &amp;amp; METHODS:&lt;/strong&gt; In this study, retention rate, relapse rate, and related factors were examined in 74 cases using a descriptive-analytical method. Information about 20 variables were gathered from patient medical records using an information form and a checklist and data was analyzed by the chi-square, Fisher’s exact, and Mann-Whitney tests using SPSS software.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;FINDINGS:&lt;/strong&gt; The retention and relapse rates were 24.3% and 75.7%, respectively. Only three factors showed a significant difference (p&amp;lt;0.50) between the retention and relapse groups: (1) financial status, (2) motivation for treatment, and (3) cooperation during counseling (p=0.04, p=0.001, p=0.026, respectively). No significant differences were observed between groups for the other factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;CONCLUSION:&lt;/strong&gt; Because it is clear that financial status, motivation, and counseling can affect retention rate, it is recommended to study the effect of these factors on retention using methods such as a randomized clinical trial.&lt;/p&gt;

Hepatitis C Virus Treatment Access Among Human Immunodeficiency Virus and Hepatitis C Virus (HCV)-Coinfected People Who Inject Drugs in Guangzhou, China: Implications for HCV Treatment Expansion.

Background. Hepatitis C virus (HCV) treatment access among human immunodeficiency virus (HIV)/HCV-coinfected people who inject drugs is poor, despite a high burden of disease in this population. Understanding barriers and facilitators to HCV treatment uptake is critical to the implementation of new direct-acting antivirals.Methods. We conducted in-depth interviews with patients, physicians, and social workers at an HIV treatment facility and methadone maintenance treatment centers in Guangzhou, China to identify barriers and facilitators to HCV treatment. We included patients who were in various stages of HCV treatment and those who were not treated. We used standard qualitative methods and organized data into themes.Results. Interview data from 29 patients, 8 physicians, and 3 social workers were analyzed. Facilitators and barriers were organized according to a modified Consolidated Framework for Implementation Research schematic. Facilitators included patient trust in physicians, hope for a cure, peer networks, and social support. Barriers included ongoing drug use, low HCV disease knowledge, fragmented reimbursement systems, HIV exceptionalism, and stigma.Conclusions. Expanding existing harm reduction programs, HIV treatment programs, and social services may facilitate scale-up of direct-acting antivirals globally. Improving integration of ancillary social and mental health services within existing HIV care systems may facilitate HCV treatment access.