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Implementation of the Chinese methadone maintenance treatment program: Analysis of national data.

机译：中国美沙酮维持治疗方案的实施：国家数据分析。

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摘要

Background: The methadone maintenance treatment programme in China was established in 2004. Since that time more than 250,000 clients have registered for treatment. The purpose of the present study was five-fold: 1) to describe the Chinese MMT cohort; 2) to estimate the client retention rate and identify client factors associated with longer retention; 3) to estimate the change in the proportion of clients engaging in drug-related HIV-risk behaviours; 4) to estimate the proportion of clients who continue to engage in illicit drug use in treatment and the factors associated with use; and 5) to estimate the change in clients' social functioning in terms of criminal behaviour, their relationships with their families and friends and employment.;Methods: Data on all clients are maintained in a data system managed by the National Centre for AIDS/STD Control and Prevention. The data collected include demographic information and detailed drug use, sexual and criminal history, and tests are performed for HIV and hepatitis C. Data were abstracted from the initiation of the programme, 23 March 2004, to 23 March 2010. A cohort profile was first developed describing the MMT cohort since 2004 and how it has grown and changed with the programme's expansion. Data were then abstracted for the two years from 23 March 2008 to 22 March 2010 for further analysis. Missing values were imputed using the multiply imputed chained equations, ICE, programme available in Stata 11. The median time in treatment was estimated using time-to-event methods, including Kaplan-Meier plots and accelerated failure time models including a frailty term for the clinic attended. Next, the changes in drug-use, HIV risk behaviours and social functioning among clients remaining in treatment at least 6 months were examined using paired t-tests for continuous variables and McNemar's tests for categorical variables. Factors associated with continued drug use were examined using logistic regression models. Variables in the models included those previously identified to be associated with retention or drug use in other MMT programmes.;Results: Some 251,976 clients enrolled in the programme during its first 6 years. As the programme expanded, the types of clients enrolling changed, particularly in terms of their HIV-risk behaviours such as injecting, needle sharing and HIV status, which were less common in subsequent years. Among 107,740 clients enrolled in MMT between 2008 and 2010, the median time spent in MMT among clients was 155 days and the majority (69%) did not attend every day. Longer time in treatment was associated with doses ≥60mg (TR=2.1, 95%CI=2.03-2.22), daily attendance (TR=2.9, 95%CI=2.80-3.07) and having a positive opiate test in last month of treatment (TR=0.25, 95%CI=0.24-0.26). Clients remaining in treatment 6 months or more (n=55,214) with a 6-month evaluation record (n=19,026), reported reduced drug use and related risk behaviours, but little change in safe sex behaviours. There were more clients reporting no crimes, good family relationships and employment than at baseline. Factors associated with continued drug use in treatment included percent adherence (OR=0.05, 95%CI=0.03-0.07), the frequency a client saw his/her drug using friends (OR=0.28 for never v daily, 95%CI=0.24-0.33) and the client's relationship with his/her family (OR=1.96 for difficult v good, 95%CI=1.59-2.46).;Conclusions: The Chinese MMT programme suffers from average durations of treatment far short of that needed to recover from addiction. Moreover, a majority of clients do not attend on a daily basis suggesting significant barriers to access that need further investigation. Increasing accessibility of the programme is urgently needed to recognise improvements in clients, as it was clear that those who did remain in treatment reduced their drug-related HIV risk and socially undesirable behaviours. It was not possible to examine several important covariates, such as the use of ancillary services by clients, incentives for adherence, and the treatment goals of clients and staff. Further work is needed to understand why and how clients cycle in and out of treatment.
机译：背景：美沙酮维持治疗计划于2004年在中国建立。自那时以来，已有25万名客户注册接受治疗。本研究的目的有五个方面：1）描述中国MMT队列； 2）估算客户保留率，并确定与较长保留相关的客户因素； 3）估计从事与毒品有关的艾滋病毒高危行为的服务对象比例的变化； 4）估计继续从事非法药物治疗的服务对象的比例以及与使用有关的因素； 5）从犯罪行为，与家人，朋友的关系以及就业等方面评估服务对象社会功能的变化。方法：所有服务对象的数据都保存在由国家艾滋病/性病中心管理的数据系统中控制与预防。收集的数据包括人口统计信息和详细的毒品使用情况，性和犯罪史，并对艾滋病毒和丙型肝炎进行了检测。数据从该计划的启动（2004年3月23日至2010年3月23日）中提取。阐述了自2004年以来的MMT队列及其随着计划的扩展而发展和变化的过程。然后提取了从2008年3月23日到2010年3月22日这两年的数据，以进行进一步分析。缺失值使用Stata 11中可用的多重插补链式方程ICE进行插补。使用事件发生时间的方法（包括Kaplan-Meier图和加速故障时间模型（包括脆弱点））估算了治疗的中位时间。诊所参加了。接下来，使用配对t检验的连续变量和McNemar的分类变量检验，对至少在治疗六个月以上的患者中吸毒，HIV危险行为和社会功能的变化进行了检查。使用逻辑回归模型检查了与持续吸毒相关的因素。模型中的变量包括先前确定与其他MMT计划中的保留或吸毒相关的变量。结果：在该计划的前6年中，有251,976位客户注册了该计划。随着该计划的扩展，注册客户的类型发生了变化，特别是在注射，针头共享和HIV状况等艾滋病毒高危行为方面，这在随后的几年中不那么普遍。在2008年至2010年期间，参加MMT的107,740个客户中，客户在MMT中花费的中位时间为155天，大多数（69％）没有每天参加。更长的治疗时间与剂量≥60mg（TR = 2.1，95％CI = 2.03-2.22），每日出勤（TR = 2.9，95％CI = 2.80-3.07）有关，并且在治疗的最后一个月鸦片测试呈阳性（TR ＝ 0.25，95％CI ＝ 0.24-0.26）。那些在治疗6个月或更长时间（n = 55,214）且有6个月评估记录（n = 19,026）的患者报告减少了药物使用和相关的风险行为，但安全性行为并未改变。报告没有犯罪，良好的家庭关系和就业的客户多于基线。与继续使用药物治疗相关的因素包括依从性百分比（OR = 0.05，95％CI = 0.03-0.07），来访者使用朋友看他/她的药物的频率（OR = 0.28表示从不每天服用v，95％CI = 0.24 -0.33）以及客户与其家人的关系（困难状况为OR = 1.96，95％CI = 1.59-2.46）。；结论：中国的MMT计划遭受的平均治疗时间远远少于康复所需的时间从成瘾。此外，大多数客户没有每天参加会议，这表明访问障碍很大，需要进一步调查。迫切需要增加该计划的可及性，以认可客户的进步，因为很明显，那些仍在接受治疗的人减少了与毒品有关的艾滋病毒风险和社会上不良的行为。不可能检查几个重要的协变量，例如客户对辅助服务的使用，坚持的动机以及客户和员工的治疗目标。需要进一步的工作，以了解服务对象为何以及如何循环进入和退出治疗。

著录项

  • 作者

    Sullivan, Sheena Geraldine.;

  • 作者单位

    University of California, Los Angeles.;

  • 授予单位 University of California, Los Angeles.;
  • 学科 Health Sciences Epidemiology.
  • 学位 Ph.D.
  • 年度 2011
  • 页码 193 p.
  • 总页数 193
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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