Retention of participants in medication-assisted programs in low- and middle-income countries: an international systematic review.
Retention of participants in medication-assisted programs in low- and middle-income countries: an international systematic review.
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DOI：
10.1111/add.12303
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发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
Hagan H
中科院分区：
文献类型：
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作者：
Feelemyer J;Des Jarlais D;Arasteh K;Abdul-Quader AS;Hagan H
药物辅助治疗（MAT）是预防过量、减少非法阿片类药物使用和血液传播病毒感染风险的关键组成部分。通过在MAT项目中保留参与者更长的时间，可以实现药物使用，风险行为和生活质量的更明显和永久的变化。许多研究记录了高收入国家MAT课程的保留率，使用50%的平均12个月随访留存率作为MAT课程成功的标志。这项研究有助于系统地了解随着时间的推移，成功的计划如何留住中低收入国家（LMIC）的参与者。使用系统性综述和荟萃分析（PRISMA）指南的首选报告项目，我们进行了系统的文献检索，以确定MAT项目研究，这些研究记录了LMIC中丁丙诺啡和美沙酮项目参与者随时间的保留变化。通过随访时间、MAT类型和治疗剂量来测量参与者的保留。共有58项MAT项目研究，27047名参与者符合纳入审查的条件。12个月后的总体平均保留率为54.3% [95%置信区间（CI）= 46.2，63.7%]。治疗12个月后，丁丙诺啡（48.3%，95% CI = 22.1，74.6%）和美沙酮（56.6%，95% CI = 45.9%，67.3%）的总体平均保留率中等良好。在使用美沙酮的方案中，剂量水平的平均保留没有统计学显著差异，10个最高和最低剂量方案在12个月后获得了相似的平均保留水平。低收入和中等收入国家的药物辅助治疗项目在12个月后达到平均50%的留存率，各项目之间差异很大，但使用丁丙诺啡与美沙酮的项目之间差异不大。
Medication-assisted treatment (MAT) is a key component in overdose prevention, reducing illicit opiate use and risk of blood-borne virus infection. By retaining participants in MAT programs for longer periods of time, more noticeable and permanent changes in drug use, risk behavior and quality of life can be achieved. Many studies have documented retention in MAT programs in high-income countries, using a 50% average 12-month follow-up retention rate as a marker for a successful MAT program. This study contributes to a systematic understanding of how successful programs have been in retaining participants in low- and middle-income countries (LMIC) over time. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature search to identify MAT program studies that documented changes in retention over time for participants in buprenorphine and methadone programs in LMIC. Retention was measured for participants by length of follow-up, type of MAT and treatment dosage. There were 58 MAT program studies, with 27 047 participants eligible for inclusion in the review. Overall average retention after 12 months was 54.3% [95% confidence interval (CI) = 46.2, 63.7%]. Overall average retention was moderately good for both buprenorphine (48.3%, 95% CI = 22.1, 74.6%) and methadone (56.6%, 95% CI = 45.9%, 67.3%) after 12 months of treatment. Among programs using methadone there was no statistically significant difference in average retention by dosage level, and the 10 highest and lowest dosage programs obtained similar average retention levels after 12 months. Medication-assisted treatment programs in low- and middle-income countries achieve an average 50% retention rate after 12 months, with wide variation across programs but little difference between those using buprenorphine versus methadone.