Shah N G, Celentano D D, Vlahov D, Stambolis V, Johnson L, Nelson K E, Strathdee S A
Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore 21205, Maryland, USA.
AIDS. 2000 Sep 8;14(13):2035-43. doi: 10.1097/00002030-200009080-00020.
To identify correlates of enrollment in methadone maintenance treatment programs (MMTP) among a prospective cohort of injection drug users (IDUs) in Baltimore, Maryland.
A total of 1480 IDUs undergoing semi-annual HIV tests and interviews were studied between 1994 and 1998, during which time a needle exchange program was introduced. Longitudinal analysis using generalized estimating equations was used to identify correlates of MMTP participation over time.
Although similar proportions of HIV-seropositive and -seronegative IDUs enrolled in MMTP during follow-up (26 versus 22%, respectively), correlates of enrollment differed by HIV-serostatus. Among HIV-seropositive participants, older age [adjusted odds ratio (AOR, 1.37)] was associated with enrollment in MMTP. Among HIV-seronegative IDUs, factors associated with not enrolling in MMTP were being African American (AOR, 0.22) and having been recently incarcerated (AOR, 0.62) or homeless (AOR, 0.72). In both groups, females were twice as likely to be enrolled in MMTP, and those with Medicaid were 1.5 times more likely to be enrolled. When behavioral factors were lagged one visit, needle exchange program attendance was positively associated with MMTP enrollment among HIV-negative IDUs (AOR, 2.10); however, this association diminished significantly over time as dedicated treatment slots for needle exchange program participants became saturated.
These findings underscore the need to improve access to MMTP, especially to certain subgroups such as African-Americans, the homeless, incarcerated and uninsured. Our data suggest that health care providers and needle exchange programs can facilitate enrollment into MMTP provided that adequate treatment slots are consistently available to this particularly vulnerable population.
在马里兰州巴尔的摩市的一个注射吸毒者（IDU）前瞻性队列中，确定美沙酮维持治疗项目（MMTP）入组的相关因素。
1994年至1998年间，对1480名接受半年一次HIV检测和访谈的注射吸毒者进行了研究，在此期间引入了一个针头交换项目。使用广义估计方程进行纵向分析，以确定随时间推移MMTP参与的相关因素。
尽管在随访期间，HIV血清阳性和血清阴性的注射吸毒者入组MMTP的比例相似（分别为26%和22%），但入组的相关因素因HIV血清状态而异。在HIV血清阳性参与者中，年龄较大[调整后的优势比（AOR，1.37）]与入组MMTP相关。在HIV血清阴性的注射吸毒者中，未入组MMTP的相关因素包括非裔美国人（AOR，0.22）、近期被监禁（AOR，0.62）或无家可归（AOR，0.72）。在两组中，女性入组MMTP的可能性是男性的两倍，有医疗补助的人入组的可能性高1.5倍。当行为因素滞后一次访视时，针头交换项目的参与与HIV阴性注射吸毒者的MMTP入组呈正相关（AOR，2.10）；然而，随着针头交换项目参与者的专用治疗名额饱和，这种关联随着时间的推移显著减弱。
这些发现强调了改善MMTP可及性的必要性，尤其是对某些亚组，如非裔美国人、无家可归者、被监禁者和未参保者。我们的数据表明，只要始终为这一特别脆弱的人群提供足够的治疗名额，医疗保健提供者和针头交换项目就能促进MMTP的入组。
