Methadone Treatment for HIV Prevention-Feasibility, Retention, and Predictors of Attrition in Dar es Salaam, Tanzania: A Retrospective Cohort Study
Methadone Treatment for HIV Prevention-Feasibility, Retention, and Predictors of Attrition in Dar es Salaam, Tanzania: A Retrospective Cohort Study
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DOI：
10.1093/cid/ciu382
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发表时间：
2014-09-01
影响因子：
11.8
通讯作者：
Bruce, R. Douglas
中科院分区：
文献类型：
--
作者：
Lambdin, Barrot H.;Masao, Frank;Bruce, R. Douglas
背景资料。在坦桑尼亚达累斯萨拉姆注射毒品(PWID)的人估计人类免疫缺陷病毒(HIV)流行率为42%-50%，而普通人群的流行率为6.9%。广泛的证据支持美沙酮的维持，以降低艾滋病毒和其他传染病在PWID中的发病率、死亡率和传播。2011年，坦桑尼亚政府在穆亨比利国立医院推出了撒哈拉以南非洲大陆第一家由公共资金资助的美沙酮诊所。我们对接受美沙酮维持治疗的美沙酮初治患者进行了一项回顾性队列研究。构建Kaplan-Meier生存曲线以评估保留概率。使用比例风险回归模型评估特征与美沙酮计划中的磨耗之间的关联。总体而言，在研究期间，629名PWID患者接受了美沙酮治疗。在12个月时，保留在护理中的客户比例为57%(95%可信区间[CI]，53%-62%)。与接受低剂量(85毫克)(AHR，0.41[95%CI，0.29-0.59])美沙酮相比，调整其他特征后，剂量美沙酮的磨耗可能性较低。老年客户(AHR，每10年0.53[95%CI，0.42-0.69])和女性客户(AHR，0.50[95%CI，0.28-0.90])发生自然流失的可能性显著较低，而有性虐待病史的客户(AHR，2.84[95%CI，1.24-6.51])发生自然流失的可能性显著较高。患者在美沙酮维持治疗中的保留率与北美、欧洲和亚洲项目的估计值相当。未来的实施策略应该侧重于更高的剂量和灵活的剂量策略，以优化计划保留和加强对具有较高自然减员风险的客户的努力。
Background. People who inject drugs (PWID) in Dar es Salaam, Tanzania, have an estimated human immunodeficiency virus (HIV) prevalence of 42%-50% compared with 6.9% among the general population. Extensive evidence supports methadone maintenance to lower morbidity, mortality, and transmission of HIV and other infectious diseases among PWID. In 2011, the Tanzanian government launched the first publicly funded methadone clinic on the mainland of sub-Saharan Africa at Muhimbili National Hospital.Methods. We conducted a retrospective cohort study of methadone-naive patients enrolling into methadone maintenance treatment. Kaplan-Meier survival curves were constructed to assess retention probability. Proportional hazards regression models were used to evaluate the association of characteristics with attrition from the methadone program.Results. Overall, 629 PWID enrolled into methadone treatment during the study. At 12 months, the proportion of clients retained in care was 57% (95% confidence interval [CI], 53%-62%). Compared with those receiving a low dose (85 mg) (aHR, 0.41 [95% CI,.29-.59]) dose of methadone had a lower likelihood of attrition, adjusting for other characteristics. Older clients (aHR, 0.53 per 10 years [95% CI,.42-.69]) and female clients (aHR, 0.50 [95% CI,.28-.90]) had a significantly lower likelihood of attrition, whereas clients who reported a history of sexual abuse (aHR, 2.84 [95% CI, 1.24-6.51]) had a significantly higher likelihood of attrition.Conclusions. Patient retention in methadone maintenance is comparable to estimates from programs in North America, Europe, and Asia. Future implementation strategies should focus on higher doses and flexible dosing strategies to optimize program retention and strengthened efforts for clients at higher risk of attrition.