Zhang Lei, Zou Xia, Zhang Di, Li Xiaoling, Zhao Peizhen, Ling Li
Sun Yat-sen Centre for Migrant Health Policy, Sun Yat-sen University, #74, Zhongshan Road II, Guangzhou, 510080, P.R. China; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Sun Yat-sen Centre for Migrant Health Policy, Sun Yat-sen University, #74, Zhongshan Road II, Guangzhou, 510080, P.R. China; Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74, Zhongshan Road II, Guangzhou, 510080, P.R. China.
PLoS One. 2015 Oct 20;10(10):e0139942. doi: 10.1371/journal.pone.0139942. eCollection 2015.
Client adherence is vital for effective methadone maintenance treatment (MMT). This study explores the pattern and associated factors of client adherence, drop-out and re-enrolment in the Chinese MMT programme over the period of 2006-2013.
This retrospective study was conducted in 14 MMT clinics in Guangdong Province, China. We employed Kaplan-Meier survival analysis to estimate the rates of drop-out and re-enrolment of MMT clients and multivariate Cox regression to identify associated factors.
Among 1,512 study participants, 79% have experienced 'drop-out' during the 7-year study period. However, 82% 'dropped-out' clients resumed treatment at a later time. Low education level (junior high or below versus otherwise, HR = 1.21, 1.05-1.40), low methadone dosage in the first treatment episode (<50 ml versus ≥50 ml, HR = 1.84, 1.64-2.06) and higher proportion of positive urine test (≥50% versus<50%, HR = 3.72, 3.30-4.20) during the first treatment episode were strong predictors of subsequent drop-outs of the participants. Among the 'dropped-out' clients, being female (HR = 1.40, 1.23-1.60), being married (HR = 1.19, 1.09-1.30), and having a higher proportion of positive urine tests in the first treatment episode (≥50% versus<50%, HR = 1.35, 1.20-1.51) had greater likelihood of subsequent re-enrolment in MMT. Clients receiving lower methadone dosage (first treatment episode <50 ml versus ≥50 ml, HR = 1.12, 1.03-1.23; the last intake before drop-out <50 ml versus ≥50 ml, HR = 1.16, 1.04-1.30) were also more likely to re-enrol.
Persistent cycling in-and-out of clients in MMT programmes is common. Insufficient dosage and higher proportion of positive urine samples in the first treatment episode are the key determinants for subsequent client drop-out and re-enrolment. Interventions should target clients in their early stage of treatment to improve retention in the long term.
患者依从性对于美沙酮维持治疗（MMT）的有效性至关重要。本研究探讨了2006 - 2013年期间中国MMT项目中患者依从性、退出及重新入组的模式和相关因素。
本回顾性研究在中国广东省的14家MMT诊所进行。我们采用Kaplan - Meier生存分析来估计MMT患者的退出率和重新入组率，并使用多变量Cox回归来确定相关因素。
在1512名研究参与者中，79%在7年研究期间经历过“退出”。然而，82%的“退出”患者后来恢复了治疗。低教育水平（初中及以下与其他情况相比，HR = 1.21，1.05 - 1.40）、首次治疗时美沙酮剂量低（<50毫升与≥50毫升相比，HR = 1.84，1.64 - 2.06）以及首次治疗期间尿检测阳性比例较高（≥50%与<50%相比，HR = 3.72，3.30 - 4.20）是参与者随后退出的有力预测因素。在“退出”患者中，女性（HR = 1.40，1.23 - 1.60）、已婚（HR = 1.19，1.09 - 1.30）以及首次治疗期间尿检测阳性比例较高（≥50%与<50%相比，HR = 1.35，1.20 - 1.51）的患者随后重新入组MMT的可能性更大。接受较低美沙酮剂量的患者（首次治疗<50毫升与≥50毫升相比，HR = 1.12，1.03 - 1.23；退出前最后一次摄入量<50毫升与≥50毫升相比，HR = 1.16，1.04 - 1.3）也更有可能重新入组。
MMT项目中患者持续反复进出治疗很常见。首次治疗时剂量不足和尿样阳性比例较高是随后患者退出和重新入组的关键决定因素。干预措施应针对治疗早期的患者，以长期提高留存率。
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