Liang Tao, Liu En-wu, Zhong Hua, Wang Bing, Shen Li-mei, Wu Zheng-lai
School of Nursing, Peking Union Medical College, Beijing 100730, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2009 Feb;30(2):131-5.
To understand the situation of client-retention to methadone maintenance treatment (MMT) program and related factors.
A cohort study was adopted. In total, 1003 heroin addicts who were treated at 8 local MMT clinics with less than one month period, were recruited under nominal informed consent from Guizhou province, southwest part of China, during June to October 2006. Face-to-face interview and questionnaire administered to collect relevant information from the clients who were also followed until June 2007 to understand the situation on retention. Data were analyzed with Kaplan-Meier method to estimate the retention rate at different time spans while factors related to retention were analyzed with Cox proportional hazard regression model.
All the clients were followed-up for 14 months, with an average retention of ten months. The retention rates of the clients were 68.8% and 57.4% at 6th-month and 12th-month of the treatment program, estimated by Kaplan-Meier method. Results of Cox regression analysis showed that factors influencing retention rate on MMT among the clients, including their awareness on MMT, daily dose of methadone intake, and different MMT clinics which they were attached to. Risk influencing the withdrawal from MMT had a 20% decrease along with the increase when the daily dose of methadone intake reached 25 mg, with a hazard ratio of 0.80 (P < 0.01). If the clients were aware that methadone was a life-time treatment when they began the MMT program, the risk for withdrawal would be lower than those who were not and the hazard ratio became 0.66 (P < 0.05).
Our data showed that about half of the clients who were at the MMT program would still stick to it after 12-months, suggesting that the retention rate was not satisfactory and need to be improved. Factors as the MMT clinics themselves that the clients visited, daily methadone dosage they took, and the awareness on MMT etc. were important predictors to the rate of retention on MMT program.
了解美沙酮维持治疗（MMT）项目的患者留存情况及相关因素。
采用队列研究。2006年6月至10月，在中国西南部贵州省，从8家当地MMT诊所招募了1003名治疗时间不足1个月的海洛因成瘾者，在名义知情同意下进行研究。通过面对面访谈和问卷调查收集患者的相关信息，并对其进行随访至2007年6月，以了解留存情况。采用Kaplan-Meier法分析数据，估计不同时间段的留存率，同时用Cox比例风险回归模型分析与留存相关的因素。
所有患者均随访14个月，平均留存时间为10个月。用Kaplan-Meier法估计，治疗项目第6个月和第12个月时患者的留存率分别为68.8%和57.4%。Cox回归分析结果显示，影响患者MMT留存率的因素包括他们对MMT的认知、美沙酮每日服用剂量以及所属的不同MMT诊所。当美沙酮每日服用剂量达到25毫克时，因退出MMT的风险随着剂量增加而降低20%，风险比为0.80（P<0.01）。如果患者在开始MMT项目时知晓美沙酮是终身治疗，其退出风险低于不知晓者，风险比为0.66（P<0.05）。
我们的数据显示，约一半参与MMT项目的患者在12个月后仍会坚持治疗，表明留存率不尽人意，需要改善。患者就诊的MMT诊所本身、美沙酮每日服用剂量以及对MMT的认知等因素是MMT项目留存率的重要预测指标。
