Sullivan Sheena G, Wu Zunyou, Detels Roger
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Department of Epidemiology, University of California, Los Angeles 90095, United States.
Drug Alcohol Depend. 2013 Dec 1;133(2):427-32. doi: 10.1016/j.drugalcdep.2013.06.021. Epub 2013 Jul 26.
Methadone maintenance treatment (MMT) in China was established in 2004. The purpose of the present study was to estimate client retention and identify client factors associated with longer times in treatment.
Data were abstracted from the MMT Data System from April 2008 to March 2010. Clients were considered to have interrupted treatment when they missed 30+ days of treatment. The median time in treatment was estimated using Kaplan-Meier methods and factors associated with the duration of treatment were evaluated using accelerated failure time models.
Among 107,740 clients enrolled in MMT between 2008 and 2010, the median time spent in MMT among clients was 155 days but the majority (69%) did not attend every day. Estimated probabilities for treatment interruption were 53% at 6 months, 66% at 12 months and 77% at 24 months. Longer time in treatment was associated with doses ≥ 60 mg (Time ratio (TR)=2.12, 95%CI=1.96-2.30) and having tested negative on their last urine opiate test (TR=2.15, 95%CI=2.03-2.27). The effect of continued drug use was significantly modified by attendance. Sensitivity analyses indicated a dose-response relationship.
Irregular attendance suggests there are barriers to accessing services that need further attention. The Chinese MMT programme needs effective strategies to improve its treatment durations.
中国的美沙酮维持治疗（MMT）始于2004年。本研究的目的是评估治疗留存率，并确定与更长治疗时间相关的患者因素。
数据取自2008年4月至2010年3月的MMT数据系统。当患者错过30天以上的治疗时，被视为治疗中断。使用Kaplan-Meier方法估计治疗的中位时间，并使用加速失效时间模型评估与治疗持续时间相关的因素。
在2008年至2010年期间登记接受MMT治疗的107,740名患者中，患者接受MMT治疗的中位时间为155天，但大多数（69%）并非每天都接受治疗。6个月时治疗中断的估计概率为53%，12个月时为66%，24个月时为77%。治疗时间较长与剂量≥60毫克相关（时间比（TR）=2.12，95%置信区间=1.96-2.30），且上次尿液阿片类药物检测呈阴性（TR=2.15，95%置信区间=2.03-2.27）。持续吸毒的影响因就诊情况而有显著改变。敏感性分析表明存在剂量反应关系。
就诊不规律表明获得服务存在障碍，需要进一步关注。中国的MMT项目需要有效的策略来提高其治疗持续时间。
