Methadone maintenance treatment participant retention and behavioural effectiveness in China: a systematic review and meta-analysis.
Methadone maintenance treatment participant retention and behavioural effectiveness in China: a systematic review and meta-analysis.
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中国美沙酮维持治疗参与者的保留率和行为有效性：系统回顾和荟萃分析
DOI：
10.1371/journal.pone.0068906
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Wilson DP
中科院分区：
文献类型：
--
作者：
Zhang L;Chow EP;Zhuang X;Liang Y;Wang Y;Tang C;Ling L;Tucker JD;Wilson DP
背景美沙酮维持治疗（MMT）已经被中国政府在持续强制吸毒者拘留的同时扩大规模，但拘留对MMT的干扰程度尚不清楚。该研究系统地回顾了中国MMT的保留率，辍学原因和行为变化。方法检索2004 - 2013年中国大陆美沙酮维持治疗（MMT）参与者的保持率、药物使用和性行为的中英文文献数据库。通过系统综述和荟萃分析总结了估计值。结果本次分析共纳入74项研究，代表43，263名受试者。大约三分之一的MMT参与者在治疗的前三个月内退出（留存率69.0%（95% CI 57.7-78.4%））。警察逮捕和拘留强制康复是辍学的最常见原因，占所有未保留者的22.2%。在保留的参与者中，改变不安全的吸毒行为比改变不安全的性行为更有效。在MMT开始后12个月，24.6%（15.7-33.5%）的MMT参与者尿检阳性，9.3%（4.7-17.8%）注射毒品，只有1.1%（0.4-3.0%）为毒品出卖性。这些对应于比基线低0.002（<0.001-0.011）、0.045（0.004-0.114）和0.209（0.076-0.580）倍的优势。然而，MMT参与者在安全套使用率方面没有实质性变化。结论MMT对我国吸毒人群的干预效果较好，但参与者保留率较低，与强制性拘留密切相关。改革强制吸毒者拘留制度可以提高MMT的保留率和有效性。
Background Methadone 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. Method Chinese 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. Results A 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. Conclusion MMT 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.