Methadone Maintenance Treatment Participants Research Articles

Recurrent event analysis for time to dropout of newly-enrolled MMT participants in Guangdong, China: a retrospective study using the Prentice-Williams-Peterson model

Background Recurrent dropout often occurs among participants receiving methadone maintenance treatment (MMT), which negatively affects treatment effectiveness. However, few researchers focused on this phenomenon including those in China. This study examined systematically factors associated with dropout based on recurrent events analysis among Chinese MMT participants. Methods This retrospective study involved participants who firstly enrolled in MMT program between 2006 and 2017 of nine clinics in the Guangdong Province. The factors influencing recurrent dropout were identified using Prentice-Williams-Peterson model with total time (PWP-TT), then a comparison with Cox proportional hazards model was conducted. Results Among a total of 1,319 participants, 1,922 treatment episodes were identified. There were 366 (27.7%) participants remained in MMT at one year follow-up. There was a progressive shortening of the treatment episode duration among participants with multiple treatment episodes. Protective factors included higher average age (≥50 years) before attending MMT, the higher last methadone dosage before each dropout (≥50ml) and higher average dosage (≥60ml) in each episode, while being divorced, arrested in the past 3 months, having contact with drug-using friends more than once per day, and being positive for the first morphine urine test were risk factors. Additionally, higher average dosage (≥60ml) had constant protective effects on subsequential treatment episodes. Conclusions The risk of dropout increased as participants experienced multiple treatment episodes in MMT. The influencing factors for recurrent dropout were variable across all treatment episodes. Greater efforts are needed to provide sufficient methadone dosage for the participants to decrease dropout rate.

The risk assessment of relapse among newly enrolled participants in methadone maintenance treatment: A group-LASSO based Bayesian network study.

Relapse is a great barrier to improving the effectiveness of methadone maintenance treatment (MMT). Participants with different treatment durations could vary in their compliance with MMT, which may lead to different levels of relapse risk. This study aims to identify the risk factors for relapse and assess the relapse risk of MMT participants of different treatment durations. This retrospective study used data collected from seven MMT clinics in Guangdong Province, China, from January 2010 to April 2017. Newly enrolled participants who received 6 (n = 903) and 12 (n = 710) months of consecutive treatment with complete data were included. We selected significant risk factors for relapse through the group lasso regression and then incorporated them into Bayesian networks to reveal relationships between factors and predict the relapse risk. The results showed that participants who received 6-month treatment had a lower relapse rate (32.0%) than those of 12-month treatment (39.0%, P < 0.05). Factors including personal living status and daily methadone dose were only influential to those who received the 6-month treatment. However, age, age at the initial drug use, HIV infection status, sexual behaviors, and continuous treatment days were common factors of both durations. The highest relapse risk for those after the 6-month treatment was inferred as 66.7% while that of the 12-month treatment was 83.3%. Farmers and those who have high accessibility to MMT services may require additional attention. It is necessary to implement targeted interventions and education based on the treatment durations of participants to decrease the relapse rate. Meanwhile, those about HIV/sexually transmitted infection prevention and anti-narcotics should be held in the whole process.

Prospective Memory, Sustained Attention and Response Inhibition in Poly-Substance Users Stable on Methadone Maintenance Treatment

Background: Prospective memory and response inhibition are interrelated constructs, though studied separately in the drug addiction literature. Also, although sustained attention underlies response inhibition, its role in the relation between these functions has been largely neglected. The limited research on the cognitive effects of methadone-maintenance treatment (MMT) further stresses the importance of investigating these effects. Objective: Therefore, the current study focused on possible effects of MMT combined with long-term drug abuse on all these functions. Thirty five long term opiate/poly-substance users in MMT and thirty four drug-free controls were screened for socioeconomic status, anxiety, depression and general, non-verbal intelligence and then tested on a self-report measure of prospective memory and on the Go/No-Go task. Results: Compared to controls, the MMT group scored worse in all functions assessed. Prospective memory scores were also negatively related to Go/NoGo accuracy scores. Conclusion: As predicted, (a) the MMT participants show impairments in prospective memory, sustained attention and response inhibition and (b) prospective memory, response inhibition and sustained attention are related constructs. The results of this study could inform current rehabilitation and relapse prevention cognitive training practices.

Decision tree model based prediction of the efficacy of acupuncture in methadone maintenance treatment.

BackgroundPatients with MMT often face difficulties such as sleep disturbance, headaches, and difficulty in complete abstinence from drugs. Research has shown that acupuncture can mitigate side effects while attenuating methadone dependence. It also has a synergistic and attenuated effect on methadone maintenance treatment (MMT). Exploring the predictors of the efficacy of acupuncture intervention in MMT might help clinicians and patients promote acupuncture-assisted participation in MMT, and improve clinical treatment strategies for MMT.ObjectiveTo describe the effect of potential predictors on MMT after acupuncture intervention by building a decision-tree model of data from A Clinical Study of Acupuncture-assisted MMT.Design, setting, and participantsIn this randomized controlled trial, 135 patients with MMT underwent acupuncture at the Substance Dependence Department of Guangzhou Huiai Hospital in Guangzhou, Guangdong Province, China.InterventionA total of 135 patients were 1:1 randomly assigned to either an acupuncture plus routine care group (acupuncture plus methadone) or a routine group (methadone only) for 6 weeks, and followed up for 10 weeks. Sex, age, education level, route of previous opioid use, years of opioid use, and MMT time were recorded before the trial.Outcome measurements and statistical analysisAll analyses were based on the intention-to-treat (ITT) population. The two decision tree models used the change of methadone dosage and the VAS score for opioid desire as response variables, respectively, and the evaluation criteria were positive effect (decreased by ≥20%) and no effect (decreased by <20%, or increased). We generated the respective feature weights for the decision tree and evaluated the model's accuracy and performance by Precision-Recall.ResultsThe overall accuracy of methadone reduction and psychological craving VAS scoring decision trees were 0.63 and 0.74, respectively. The Methadone Dosage Efficacy decision tree identified years of opioid use (weight = 0.348), acupuncture (weight = 0.346), and route of previous opioid use (weight = 0.162) as key features. For the VAS Score decision tree, acupuncture (weight = 0.618), MMT time (weight = 0.235), and age (weight = 0.043) were the important features.ConclusionExploratory decision tree analysis showed that acupuncture, years of opioid use, route of previous opioid use, MMT time, and age were key predictors of the MMT treatment. Thus, acupuncture-assisted MMT strategy should consider the relevant influencing factors mentioned above.Patient summaryUnderstanding patient characteristics and the impact of acupuncture regimens on methadone dosage reduction in MMT patients may help physicians determine the best treatment regimen for patients. An analysis of data from our clinical trial showed that acupuncture, years of opioid use, route of previous opioid use, age, and MMT time were key predictors of progressive recovery in patients with MMT. Eligible patients may benefit most from the MMT rehabilitation that reduces consumption and psychological cravings for methadone.Clinical trial registrationhttp://www.chictr.org.cn/index.aspx, identifier: ChiCTR1900026357.

The Association between Living Status Transitions, Behavior Changes and Family Relationship Improvement among Methadone Maintenance Treatment Participants in Guangdong, China.

The quality of family relationships is important for individual and family well-being. Improving family relationships is also an important goal in methadone maintenance treatment (MMT). Little is known about factors associated with the improvement of family relationships among MMT clients. This study aimed to identify factors associated with family relationship improvement in MMT. We retrospectively analyzed existing data from 2006 to 2014 at 15 MMT clinics in Guangdong, China, including 2171 subjects with 4691 follow-ups. Generalized estimating equations were used to investigate the association between living status transitions, behavior changes and family relationship improvement, with covariates controlled for. Family relationship improvement was found in 23.1% of all follow-up intervals. Participants who began living with family, living on a regular wage, and gained employment were more likely to have improved family relationships. The quality of family relationships also improved among participants who ceased contact with drug-addicted fellows, ceased drug use, and those who were sexually active. These results suggest that improvement in living status, positive changes in drug use, and sexual activity are associated with family relationship improvement and corresponding interventions may be developed to facilitate clients’ recovery.

Dose Tapering Strategy for Heroin Abstinence among Methadone Maintenance Treatment Participants: Evidence from A Retrospective Study in Guangdong, China.

Around half of methadone maintenance treatment (MMT) participants choose the tapering phase, however, the guidelines on tapering differ between countries and only include the tapering rate. Physicians need more evidence to guide clinical practice. We aimed to explore a specific tapering strategy to improve heroin abstinence among MMT participants. We conducted a retrospective study from 2006 to 2017 at nine MMT clinics in Guangdong, China, involving 853 participants with 961 treatment episodes. We performed two-level hierarchical logistic regression models to identify tapering phase characteristics associated with heroin abstinence. Among all treatment episodes, 419 (43.6%) were heroin abstinent. Participants who started tapering after 52 weeks, had a taper start dose of less than 60 mg and a taper ratio of less than 5%/week, while a dose reduction in 75%–89% of the tapering weeks provided the highest odds of heroin abstinence. This study highlights the need for a more gradual taper than current guidelines recommend and strongly suggests the inclusion of other tapering phase characteristics. Those who start the tapering phase later, have a lower dose of methadone, with a more gradual rate of taper, and a dose reduction in 75%–89% of the tapering phase increased the odds of heroin abstinence.

Decreased Level of Blood MicroRNA-133b in Men with Opioid Use Disorder on Methadone Maintenance Therapy

Although previous animal studies have indicated that certain micro ribonucleic acids (microRNAs) play a part in the pathway of opioid addiction, whether such findings extend to human models is yet unknown. This study aims to investigate the important microRNA expressions in patients with opioid use disorder (OUD) on methadone maintenance treatment (MMT) compared to healthy controls and analyze the correlation between microRNAs and opioid characteristics among the patients. We recruited 50 patients and 25 controls, and both groups were matched regarding gender, age, and body mass index. Serum microRNAs (miR-133b, miR-23b, miR-190, miR-206, miR-210, and miR-21) were measured. The age of OUD onset, duration of MMT participation, and recent daily methadone dosage were considered the opioid characteristics. We adopted the t-test to compare the difference between patients and controls and Pearson’s correlation to evaluate the association between microRNAs and opioid profiles. Only the level of miR-133b in OUD patients on MMT was significantly lower than that in healthy controls. We did not detect differences of any other microRNA expressions between the two groups. Furthermore, we found no evidence to support the association between microRNAs and opioid characteristics. This study indicates that miR-133b values may be decreased in OUD patients on MMT.

Outcomes of compulsory detention compared to community-based voluntary methadone maintenance treatment in Vietnam

IntroductionIn Vietnam, like many countries in East and Southeast Asia, the government has invested heavily in center-based compulsory treatment (CCT) as the mainstay demand reduction strategy for illicit drug use. This approach has been criticised on human rights grounds. Meanwhile, community-based voluntary methadone maintenance treatment (MMT) has been implemented for nearly a decade with promising results. To date, there have been no comparative Vietnamese studies of these approaches. Material and methodsThe study, involving 208 CCT participants and 384 MMT participants with heroin dependence, was a combined retrospective and prospective observational study conducted over three years between 2012 and 2014 (with data at five time-points). The primary outcome was: self-report heroin use (confirmed by urinalysis). The four secondary outcomes were: illegal behaviours, overdose, blood-borne virus (BBV) risk behaviours, and monthly drug expenditure. Mixed effects regression analyses, which took into account baseline differences between the groups, were used to analyse the data. This study is registered with ClinicalTrials.gov, number NCT03071315. ResultsThe study found MMT was more strongly associated with four outcome measures compared to CCT (reduction in heroin use (β = 3.39, SE = 0.31, p < .0001) (equivalent to an odds ratio of 29.67 (95% CI 21.76–40.45)), reduction in illegal behaviours (β = 0.94, SE = 0.39, p < .0001), (equivalent to an odds ratio of 2.56 (95% CI 1.79–3.78)), reduction in BBV risk behaviours (β = 1.08, SE = 0.17, p < .0001), (equivalent to an odds ratio of 2.94 (95% CI 2.48–3.49)), and reduction in monthly drug spending (β = −VND1,515,200 (equivalent to US$72.00), SE = VND452,900, p < .0001)). The analyses did not support the hypothesis that MMT was associated with better outcomes pertaining to overdose (β = −0.27, SE = 0.30, p = .62), probably due to the infrequency of these self-reported events. ConclusionsOur observational study suggests that MMT is associated with greater reductions in heroin use, BBV risk behaviours, drug-related illegal behaviours, and monthly drug spending compared with CCT. In the context that the CCT approach has been criticized for human rights violations, this study provides evidence to support the scale up of MMT and the transition of CCT to voluntary community based treatment.

Strategies to control HIV and HCV in methadone maintenance treatment in Guangdong Province, China: a system dynamic modeling study

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.

Tobacco and alcohol use among drug users receiving methadone maintenance treatment: a cross-sectional study in a rural prefecture of Yunnan Province, Southwest China

ObjectiveTo estimate the prevalence of ever, current and heavy tobacco and alcohol use and their correlates among patients undergoing methadone maintenance treatment (MMT).DesignCross-sectional study.SettingThe study was conducted in all of...

Factors associated with illicit opioid use in methadone maintenance treatment clients in 5 Provinces, China.

To investigate factors associated with illicit opioid use among methadone maintenance treatment (MMT) population. Participants were recruited from Beijing (2 clinics), Shanghai (2 clinics), Guangdong (2 clinics), Chongqing (2 clinics) and Gansu (1 clinic) provinces. Information about heroin use and MMT was obtained from a self-reported questionnaire, illicit opioid use was obtained from monthly medical records. Binary logistic regression was used to investigate factors associated with illicit opioid use. Five hundred ninety-eight eligible MMT participants were used for data analysis. Variables such as age, gender, route of heroin use and daily MMT dosages were associated with illicit opioid use. Compared with MMT participants aged <40years, participants aged 40-44years (P=0.027, OR=0.57, 95% CI 0.35-0.94), 45-49years (P<0.001, OR=0.41, 95% CI 0.24-0.67) and ≥50years (P=0.008, OR=0.52, 95% CI 0.33-0.85) were more likely not to have illicit opioid use. Compared with male participants, females were more likely to have illicit opioid use (P=0.044, OR=1.53, 95% CI 1.01-2.32). Compared with inhalation heroin abusers, abusers with route of inhalation+injection heroin use were more likely to have illicit opioid use (P=0.009, OR=2.00, 95% CI 1.19-3.36). Compared with daily MMT dosages <60mg participants, participants with daily MMT dosages >80mg were more likely to have illicit opioid use (P=0.003, OR=2.37, 95% CI 1.35-4.15). Age, gender, route of heroin use and daily MMT dosages were associated with illicit opioid use. A tailored intervention is needed for a promotion of MMT.

Cost-effectiveness of center-based compulsory rehabilitation compared to community-based voluntary methadone maintenance treatment in Hai Phong City, Vietnam

IntroductionIn Vietnam, two dominant approaches for heroin treatment are center-based compulsory rehabilitation (CCT), funded by the Vietnamese government and community-based voluntary methadone maintenance treatment (MMT), funded primarily by international donors. Recent reduction in international funding requires more efficient allocation of government funding for public health programs. A cost-effectiveness analysis comparing two approaches provides a useful source of evidence to inform the government about funding reallocation. MethodsThe study was a combined retrospective and prospective, non-randomized cohort comparison over three years of CCT and MMT in Vietnam, conducted between 2012 and 2014, involving 208 CCT participants and 384 MMT participants with heroin dependence. The primary end-point was drug-free days over three years. Total costs, including both program and participant personal costs were measured and cost-effectiveness compared. Mixed effects regression analyses were used to analyze effectiveness data and non-parametric bootstrapping method was used to compare cost-effectiveness. ResultsOver three years, MMT costed on average VND85.73 million (US$4108) less than CCT (95% CI: -VND76.88 million, -VND94.59 million). On average, a MMT participant had 344.20 more drug-free days compared to a CCT participant (p<0.001). The incremental cost-effectiveness ratio for MMT was -VND0.25 million (US$11.99) (95% CI: -VND0.34 million, -VND0.19 million) per drug-free day suggesting MMT is the more cost effective alternative. ConclusionsCompared to CCT, MMT is both less expensive and more effective in achieving drug-free days. If the government of Vietnam invests in MMT instead of CCT, it is potentially a cost-saving strategy for reducing illicit drug use among heroin dependent individuals.

Multifaceted impairments in impulsivity and brain structural abnormalities in opioid dependence and abstinence

Chronic opioid exposure, as a treatment for a variety of disorders or as drug of misuse, is common worldwide, but behavioural and brain abnormalities remain under-investigated. Only a small percentage of patients who receive methadone maintenance treatment (MMT) for previous heroin misuse eventually achieve abstinence and studies on such patients are rare. The Cambridge Neuropsychological Test Automated Battery and T1 weighted magnetic resonance imaging (MRI) were used to study a cohort of 122 male individuals: a clinically stable opioid-dependent patient group receiving MMT (n = 48), an abstinent previously MMT maintained group (ABS) (n = 24) and healthy controls (n = 50). Stable MMT participants deliberated longer and placed higher bets earlier in the Cambridge Gambling Task (CGT) and showed impaired strategic planning compared with healthy controls. In contrast, ABS participants showed impairment in choosing the least likely outcome, delay aversion and risk adjustment on the CGT, and exhibited non-planning impulsivity compared with controls. MMT patients had widespread grey matter reductions in the orbitomedial prefrontal cortex, caudate, putamen and globus pallidus. In contrast, ABS participants showed midbrain-thalamic grey matter reductions. A higher methadone dose at the time of scanning was associated with a smaller globus pallidus in the MMT group. Our findings support an interpretation of heightened impulsivity in patients receiving MMT. Widespread structural brain abnormalities in the MMT group and reduced brain structural abnormality with abstinence suggest benefit of cessation of methadone intake. We suggest that a longitudinal study is required to determine whether abstinence improves abnormalities, or patients who achieve abstinence have reduced abnormalities before methadone cessation.

Predictors of accessing antiretroviral therapy among HIV-positive drug users in China's National Methadone Maintenance Treatment Programme.

The objective of this study was to examine factors that predict antiretroviral therapy (ART) access among eligible, HIV-positive methadone maintenance treatment (MMT) clients. We also tested the hypothesis that sustained MMT participation increases the likelihood of accessing ART. A nation-wide cohort study conducted from 1 March 2004 to 31 December 2011. MMT clients were followed from the time of their enrolment in China's national MMT programme until their death or the study end date. Our cohort comprised 7111 ART-eligible, HIV-positive MMT clients, 49.2% of whom remained ART-naive and 50.8% of whom received ART. Demographic variables, drug use history, MMT programme participation and HIV-related clinical characteristics of study participants who remained naive to ART and those who accessed ART were compared by univariate and multivariable analysis. Predictors of accessing ART among this cohort included being retained in MMT at the time of first meeting ART eligibility [adjusted odds ratio (AOR)=1.84, confidence interval (CI)=1.54-2.21, P<0.001] compared to meeting ART eligibility before entering MMT (AOR=0.98, CI=0.80-1.21, P=0.849) or previously entering MMT and dropping out before meeting ART eligibility. Additional predictors were CD4≤200 cells/μl when ART-eligibility requirement was first met (AOR=1.81, CI=1.61-2.05, P<0.001 compared to CD4=201-350 cells/μl), and being in a stable partner relationship (married/cohabitating: AOR=1.14, CI=1.01-1.28, P=0.030). Retained participation in methadone maintenance treatment increases the likelihood that eligible clients will access antiretroviral therapy. These results highlight the potential benefit of colocalization of methadone maintenance treatment and antiretroviral therapy services in a 'one-stop-shop' model.

OR09-1 * COGNITIVE IMPULSIVITY AND CHRONIC OPIOID USE

Introduction. Previous studies have provided inconsistent evidence that chronic exposure to opioid drugs, including heroin and methadone, may be associated with impairments in executive neuropsychological functioning, specifically cognitive impulsivity. Methods. Participants with validated histories of illicit heroin use (n = 24), former heroin users stabilised on prescribed methadone maintenance treatment (MMT) (n = 29), licit opioid prescriptions for chronic pain without history of abuse or dependence (n = 28) and healthy controls (n = 28) were recruited and tested on measures of cognitive impulsivity, motor impulsivity and non-planning impulsivity. Results. Stable illicit heroin users showed increased motor impulsivity and impaired strategic planning. Additionally, they placed higher bets earlier and risked more. MMT participants deliberated longer and placed higher bets earlier but did not risk more. Chronic opiate exposed pain participants did not differ from healthy controls on any measures on any tasks. Conclusion. These data support the hypothesis that different aspects of neuropsychological measures of impulsivity appear to be associated with exposure to different opioids and also to the syndrome of opioid dependence. This could reflect either a neurobehavioural consequence of opioid exposure, or may represent an underlying trait vulnerability to opioid dependence.

The impact of methadone maintenance therapy on hepatitis C incidence among illicit drug users.

To determine the relationship between methadone maintenance therapy (MMT) and hepatitis C (HCV) seroconversion among illicit drug users. A generalized estimating equation model assuming a binomial distribution and a logit-link function was used to examine for a possible protective effect of MMT use on HCV incidence. Data from three prospective cohort studies of illicit drug users in Vancouver, Canada between 1996 and 2012. A total of 1004 HCV antibody-negative illicit drug users stratified by exposure to MMT. Baseline and semi-annual HCV antibody testing and standardized interviewer-administered questionnaire soliciting self-reported data relating to drug use patterns, risk behaviors, detailed socio-demographic data and status of active participation in an MMT program. One hundred and eighty-four HCV seroconversions were observed for an HCV incidence density of 6.32 [95% confidence interval (CI) = 5.44-7.31] per 100 person-years. After adjusting for potential confounders, MMT exposure was protective against HCV seroconversion [adjusted odds ratio (AOR) = 0.47; 95% CI = 0.29-0.76]. In subanalyses, a dose-response protective effect of increasing MMT exposure on HCV incidence (AOR = 0.87; 95% CI = 0.78-0.97) per increasing 6-month period exposed to MMT was observed. Participation in methadone maintenance treatment appears to be highly protective against hepatitis C incidence among illicit drug users. There appears to be a dose-response protective effect of increasing methadone exposure on hepatitis C incidence.

Retention and HIV seroconversion among drug users on methadone maintenance treatment in Yunnan, China.

Thirteen methadone maintenance treatment (MMT) clinics across Yunnan, the province with the highest human immunodeficiency virus (HIV) burden in China. To determine, among HIV-negative participants on MMT, the proportion lost to follow-up (defined as those who missed the 6-monthly follow-up examination), factors associated with loss to follow-up (LFU), HIV seroconversion rate and factors associated with seroconversion. Prospective cohort study from October 2008 to April 2011. All participants were administered a pre-tested structured questionnaire to capture associated factors and offered HIV testing every 6 months. χ(2) test and log-binomial regression were used for data analysis. Of 1146 participants, 541 (47%) were lost to follow-up in 2.5 years. Factors associated with higher LFU proportion include <6 months of previous MMT, inconvenient location of the MMT clinic and average methadone dose ⩽60 mg/day, with adjusted relative risks (RRs) of respectively 1.4 (95%CI 1.2-1.5), 1.2 (95%CI 1.0-1.4) and 1.1 (95%CI 1.0-1.3). The overall HIV seroconversion rate was 6.6 (95%CI 3.7-11.0) per 1000 person-years. Not living with a partner contributed to higher HIV rates, with an adjusted RR of 3.6 (95%CI 1.0-12.8). The retention rate of MMT participants in Yunnan was not satisfactory. Decentralising service delivery in the community and making directly observed treatment more convenient has the potential to improve retention.

Methadone maintenance treatment participant retention and behavioural effectiveness in China: a systematic review and meta-analysis.

BackgroundMethadone maintenance treatment (MMT) has been scaled up by the Chinese government alongside persistent compulsory drug user detention, but the extent to which detention interferes with MMT is unknown. The study systematically reviews Chinese MMT retention rates, reasons for drop out, and behavioural changes.MethodChinese and English databases of literature are searched for studies reporting retention rates, drug use and sexual behaviours among MMT participants in China between 2004 and 2013. The estimates are summarized through a systematic review and meta-analysis.ResultsA total of 74 studies representing 43,263 individuals are included in this analysis. About a third of MMT participants drop out during the first three months of treatment (retention rate 69.0% (95% CI 57.7-78.4%)). Police arrest and detention in compulsory rehabilitation was the most common cause of drop out, accounting for 22.2% of all those not retained. Among retained participants, changing unsafe drug use behaviours was more effective than changing unsafe sexual behaviours. At 12 months following MMT initiation, 24.6% (15.7-33.5%) of MMT participants had a positive urine test, 9.3% (4.7-17.8%) injected drugs and only 1.1% (0.4-3.0%) sold sex for drugs. These correspond to 0.002 (<0.001-0.011), 0.045 (0.004-0.114) and 0.209 (0.076-0.580) times lower odds than baseline. However, MMT participants did not have substantial changes in condom use rates.ConclusionMMT is effective in drug users in China but participant retention is poor, substantially related to compulsory detention. Reforming the compulsory drug user detention system may improve MMT retention and effectiveness.

Methadone maintenance treatment in China: perceived challenges from the perspectives of service providers and patients

China has recently adopted methadone maintenance treatment (MMT) as a national strategy to address the problem of drug abuse and related public health issues such as HIV and HCV infections. However, low enrollment and retention rates suggest that barriers may exist in MMT utilization. This study examined both patients' perceptions and service providers' perceptions of challenges in MMT implementation in China. Four focus groups were conducted in two Chinese cities, Shanghai and Kunming, to explore the perceived and experienced barriers in MMT participation in China. All focus group discussions with participants were audio taped and transcribed. Atlas.ti 5.1 was used to analyze data. Service providers and patient participants reported positive experiences (e.g. effects of MMT in curbing withdrawal symptoms) but also expressed concerns about side effects and continued heroin use during MMT. They also identified barriers in participating and remaining in MMT, including affordability (fee requirement), acceptability (methadone as a substitution, dose, long-term nature), accommodation and accessibility (inconvenient operation hours, lack of transferability to other MMT clinics during travel) and competition between public health and public security. The present findings have implications for reconsidering the current MMT policies and practices in order to improve access, utilization and, ultimately, the effectiveness of MMT in China.

Risk factors associated with HIV/HCV infection among entrants in methadone maintenance treatment clinics in China: A systematic review and meta-analysis

Background: Methadone maintenance treatment (MMT) has rapidly expanded in China, from 8 pilot sites to 696 clinics covering 27 provinces, during 2004–2010. This study evaluates the demographic characteristics and drug use behaviors associated with Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) infections among MMT entrants through a systematic review and meta-analysis of published literature. Methods: Thirty-nine eligible articles (1 in English and 38 in Chinese) were selected for this review. We extracted the relevant indicator information from all eligible studies and performed meta-analyses, by stratifying according to sex of the participants, age groups and drug use behaviors. Five provinces (i.e., Yunnan, Guizhou, Sichuan, Guangxi and Xinjiang) with the population size of HIV-infected drug users greater than 10,000 were defined as high transmission areas (HTAs) for HIV infection; whereas the remaining twenty-six Chinese provinces were considered as low transmission areas (LTAs). Results: The odds of being infected by HIV among male drug users were significantly higher than for females in high transmission areas (OR=1.49, 95% CI: 1.11–1.99, k=9), while the opposite results were observed in low transmission areas (OR=0.46, 0.27–0.79, k=11). In comparison, no significant differences in risk behaviors were found between sexes in HTAs and LTAs. Younger age was not associated with risk of HIV infection, but was associated with higher risk of HCV infection (<30 years OR=1.88; 30–40 years OR=2.21, compared with >40 years, k=17). Risk of HIV infection was higher among injectors than non-injectors (OR=4.29, 2.70–6.79, k=14) and for those who inject, there was greater risk among sharers than non-sharers (OR=2.47, 1.44–4.23, k=4). Similar patterns were also observed in HCV infection (injectors: OR=10.82, 7.60–15.40; sharers: OR=3.41, 2.56–4.54, k=7). Conclusions: Characteristics of MMT entrants positive for HIV or HCV in China vary by disease types, geographical region, sex, age, and injecting behavior. These factors need to be considered in targeted interventions for MMT participants, such as age-specific health education and psychological treatment, antiretroviral therapy and needle-syringe exchange programs.