低收入和中等收入国家药物辅助项目中参与者的留存率：一项国际系统评价
Retention of participants in medication-assisted programs in low- and middle-income countries: an international systematic review.
作者信息
Feelemyer Jonathan, Des Jarlais Don, Arasteh Kamyar, Abdul-Quader Abu S, Hagan Holly
机构信息
The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY, USA.
出版信息
Addiction. 2014 Jan;109(1):20-32. doi: 10.1111/add.12303. Epub 2013 Aug 15.
BACKGROUND AND AIMS
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
背景与目的
药物辅助治疗（MAT）是预防药物过量、减少非法阿片类药物使用以及降低血源性病原体感染风险的关键组成部分。通过让参与者在MAT项目中停留更长时间，可以在药物使用、风险行为和生活质量方面实现更显著和持久的改变。许多研究记录了高收入国家MAT项目中的留存情况，将平均12个月随访留存率50%作为MAT项目成功的标志。本研究有助于系统地了解低收入和中等收入国家（LMIC）中成功的项目随着时间推移在留住参与者方面的成效。
方法
我们按照系统评价和Meta分析的首选报告项目（PRISMA）指南，进行了系统的文献检索，以确定记录了LMIC中丁丙诺啡和美沙酮项目参与者留存率随时间变化的MAT项目研究。通过随访时长、MAT类型和治疗剂量来衡量参与者的留存情况。
结果
共有58项MAT项目研究，27047名参与者符合纳入本综述的条件。12个月后的总体平均留存率为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%）的总体平均留存率都处于中等水平。在使用美沙酮的项目中，不同剂量水平的平均留存率没有统计学上的显著差异，12个月后剂量最高和最低的10个项目的平均留存率相似。
结论
低收入和中等收入国家的药物辅助治疗项目在12个月后的平均留存率为50%，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。
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