Impact of blended treatment literacy and psychoeducation on methadone maintenance treatment outcomes in Yunnan, China

Factors associated with concurrent heroin use among patients on methadone maintenance treatment in Vietnam: A 24-month retrospective analysis of a nationally representative sample

BACKGROUND

Methadone maintenance treatment (MMT) is highly effective for reducing heroin use and HIV transmission among people who inject opioids. We sought to measure and understand factors associated with continued heroin use, a critical factor affecting treatment outcome among MMT patients in Vietnam.

METHOD

We collected data from medical charts of a nationally representative sample of patients who were on MMT from May 2008 to December 2013. We selected 10 MMT clinics using probability proportional to size and 50 patients/clinic by systematic random sampling. Concurrent heroin use was defined by self-report/positive urine test recorded in patient charts during month 3, 6, 12, and 24 after MMT initiation. We used multivariable logistic regression to identify factors associated with concurrent heroin use over the first 24 months in treatment.

FINDINGS

All clients used heroin at baseline; concurrent heroin use was 55% at month 3; 19%, 14.6% and 15.2% at month 6, 12, and 24, respectively. Having no family emotional/financial support at baseline versus having this support (AOR = 2.03; 95% confidence interval [CI] = 1.17-3.53); using heroin for <15 years versus ≥15 years at baseline (AOR = 1.55; 95% CI = 1.01-2.38); being HIV-infected/not on antiretroviral treatment (ART; AOR = 1.79; 95% CI = 1.07-2.98) or being HIV infected/on ART (AOR = 2.39; 95% CI = 1.61-3.55), versus not being HIV infected; baseline methamphetamine use versus non-use (AOR = 2.68; 95% CI = 1.08-6.65), were associated with increased odds of concurrent heroin use among patients.

CONCLUSION

The association between concurrent heroin use among MMT patients and lack of family emotional/financial support, highlights the critical importance of these types of support for successful treatment. Association with shorter heroin use history suggests motivational enhancement may reduce concurrent heroin use. Living with HIV, whether on ART or not, is associated with increased concurrent heroin use and suggests safe injection commodities and education, and drug-drug interaction management, are needed for this subgroup. Though few MMT clients reported baseline methamphetamine use, its association with later heroin use suggests the need for effective methamphetamine use interventions.

Opioid users with comorbid hepatitis C spent more time in agonist therapy: A 6-year observational study in Taiwan

BACKGROUND

Hepatitis C virus (HCV) infection is highly prevalent among opioid agonist therapy (OAT) patients, but little is known about long-term OAT use among this population.

METHODS

Subjects diagnosed as opioid dependence were recruited from Mar. 2006 to Jul. 2008 in a psychiatry center in southern Taiwan with the OAT censored in 2012, and their socio-demographics, drug use characteristics, and markers of blood-borne infection were assessed at entry. Correlates with HCV infection and OAT retention were analyzed by multivariate logistic regression. Retention (OAT utilization) was defined as the in-treatment period of OAT during the 6-year observation period.

RESULTS

A total of 983 patients (88.3% men) were included. The prevalences of HCV and HIV infection were 91.4% and 17.9%, respectively. The mean duration of OAT during the study period was 2.3±0.8years. Significant correlates with HCV infection were retention of at least three years in OAT (AOR: 4.24, 95%CI: 1.49-12.03), ever sharing injection equipment (AOR: 227.04, 95%CI: 57.22-900.87), not living with family (AOR: 5.54, 95%CI: 1.45-21.16), lower educational attainment (AOR: 2.10, 95%CI: 1.15-3.82) and previous drug offense (AOR: 6.35, 95%CI: 1.69-23.83). Significant correlates with retention were HCV infection (AOR: 2.53, 95%CI: 1.30-4.93) and divorced or separation in marriage (AOR: 0.65, 95%CI: 0.44-0.96).

CONCLUSIONS

This six-year observational study revealed a better retention in OAT if opioid-dependent individuals had comorbid hepatitis C. This provided opportunities for OAT patients with HCV infection to obtain medical treatment while staying in an OAT program. Further research could explore the possibility of eradicating comorbid HCV infection among these long-term treatment cases.

Factors related to client satisfaction with methadone maintenance treatment in China

BACKGROUND

This study examined clients' treatment satisfaction with the services provided by methadone maintenance treatment (MMT) in China and explored relevant factors that are directly or indirectly associated with treatment satisfaction.

METHODS

The study used baseline data from a randomized controlled trial conducted among 2,448 clients from 68 MMT clinics in five provinces of China. The participants reported their demographic characteristics, treatment-related factors, depressive symptoms, treatment progression, counseling rapport, and treatment satisfaction. Structural equation modeling (SEM) was used to test the direct and indirect relationships among various factors and treatment satisfaction.

RESULTS

Clients' demographic characteristics, such as older age, had both a direct effect on treatment satisfaction and an indirect effect mediated by counseling rapport. Depressive symptoms and a lack of social support had a direct negative impact on treatment satisfaction and an indirect effect mediated by treatment progression and counseling rapport. Both mediators: treatment progression (estimate=0.227, p<0.01) and counseling rapport (estimate=0.229, p<0.01), showed positive associations with treatment satisfaction.

CONCLUSION

The findings reiterate the complex nature of MMT clients' treatment satisfaction and its interrelationship with multidimensional factors. The study has implications for evaluating the quality of care provided by MMT programs and suggests several strategies that can potentially improve MMT clients' level of treatment satisfaction.

Barriers to community-based drug dependence treatment: implications for police roles, collaborations and performance indicators

Introduction

Worldwide, people who use drugs (PWUD) are among the populations at highest risk for HIV infection. In China, PWUD are primarily sentenced to compulsory detainment centres, in which access to healthcare, including HIV treatment and prevention services, is limited or non-existent. In 2008, China's 2008 Anti-Drug Law encouraged the development and use of community-based drug dependence rehabilitation, yet there is limited evidence evaluating the efficacy and challenges of this model in China. In this study, we explore these challenges and describe how cooperation between law enforcement and health departments can meet the needs of PWUD.

Methods

In 2015, we conducted semi-structured, in-depth interviews with all four staff members and 16 clients of the Ping An Centre No. 1 for community-based drug treatment, three local police officers and three officials from the local Centre for Disease Control. Interviews explored obstacles in implementing community-based drug dependence treatment and efforts to resolve these difficulties. Transcripts were coded and analyzed with qualitative data analysis software (MAXQDA 11).

Results

We identified three challenges to community-based drug treatment at the Ping An Centre No. 1: (1) suboptimal coordination among parties involved, (2) a divergence in attitudes towards PWUD and harm reduction between law enforcement and health officials and (3) conflicting performance targets for police and health officials that undermine the shared goal of treatment. We also identified the take-home methadone maintenance treatment model at the Ping An Centre No. 1 as an example of an early successful collaboration between the police, the health department and PWUD.

Conclusions

To overcome barriers to effective community-based drug treatment, we recommend aligning the goals of law enforcement and public health agencies towards health-based performance indicators. Furthermore, tensions between PWUD and police need to be addressed and trust between them fostered, using community-based treatment centres as mediators. The preliminary success of the take-home methadone maintenance treatment pilot can serve as an example of how collaboration with the police and other government agencies can meet the needs of PWUD and contribute to the success of community-based treatment.