Ubuguyu Omary, Tran Olivia C, Bruce Robert Douglas, Masao Frank, Nyandindi Cassian, Sabuni Norman, McCurdy Sheryl, Mbwambo Jessie, Lambdin Barrot H
Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania.
Pangaea Global AIDS, 436 14th St, Suite 920, Oakland, CA 94612, USA.
Int J Drug Policy. 2016 Apr;30:74-81. doi: 10.1016/j.drugpo.2016.03.005. Epub 2016 Mar 11.
Injection of heroin has become widespread in Dar es Salaam, Tanzania and is spreading throughout the country. To prevent potential bridging of HIV epidemics, the Tanzanian government established a methadone maintenance treatment (MMT) clinic in February 2011. We assess the effect of MMT on health-related quality of life (HRQOL) and examine factors, particularly HIV infection and methadone dose, associated with changes in HRQOL.
This study utilized routine data on clients enrolling in methadone from February 2011 to April 2012 at Muhimbili National Hospital. Change in physical (PCS) and mental health (MCS) composite scores, as measured by the SF-12 tool, were the primary outcomes. Backward stepwise linear regression, with a criterion of p<0.2 was used to identify baseline exposure variables for inclusion in multivariable models, while adjusting for baseline scores.
A total of 288 MMT clients received baseline and follow-up assessments. Mean methadone dose administered was 45mg (SD±25) and 76 (27%) were confirmed HIV-positive. Significant improvements were observed in PCS and MCS, with mean increases of 15.7 and 3.3, respectively. In multivariable models, clients who had previous poly-substance use with cocaine [p=0.040] had a significantly higher mean change in PCS. Clients who were living with HIV [p=0.002]; satisfied with current marital situation [p=0.045]; had a history of suicidal thoughts [p=0.021]; and previously experienced cognitive difficulties [p=0.012] had significantly lower mean change in PCS. Clients with shorter history of heroin use [p=0.012] and who received higher methadone doses [p=0.028] had significantly higher mean change in MCS, compared to their counterparts.
Aspects of mental and physical health, risk behaviors and quality of life among drug users are intertwined and complex. Our research revealed positive short-term effects of MMT on HRQOL and highlights the importance of sustained retention for optimal benefits. Comprehensive supportive services in addition to provision of methadone are needed to address the complex health needs of people who inject drugs.
注射海洛因在坦桑尼亚的达累斯萨拉姆已广泛传播，并正在蔓延至全国。为防止艾滋病毒疫情的潜在蔓延，坦桑尼亚政府于2011年2月设立了一家美沙酮维持治疗（MMT）诊所。我们评估美沙酮维持治疗对健康相关生活质量（HRQOL）的影响，并研究与健康相关生活质量变化相关的因素，特别是艾滋病毒感染和美沙酮剂量。
本研究利用了2011年2月至2012年4月在穆希姆比利国家医院登记接受美沙酮治疗的患者的常规数据。主要结局是通过SF-12工具测量的身体（PCS）和心理健康（MCS）综合评分的变化。采用向后逐步线性回归，以p<0.2为标准来确定纳入多变量模型的基线暴露变量，同时对基线评分进行调整。
共有288名接受美沙酮维持治疗的患者接受了基线和随访评估。平均给予的美沙酮剂量为45毫克（标准差±25），76人（27%）被确诊为艾滋病毒阳性。观察到身体和心理健康综合评分有显著改善，平均分别增加了15.7和3.3。在多变量模型中，曾同时使用过可卡因等多种物质的患者[ p = 0.040]，其身体综合评分的平均变化显著更高。感染艾滋病毒的患者[ p = 0.002]；对当前婚姻状况满意的患者[ p = 0.045]；有自杀念头史的患者[ p = 0.021]；以及曾有认知困难经历的患者[ p = 0.012]，其身体综合评分的平均变化显著更低。与对照组相比，海洛因使用史较短的患者[ p = 0.012]和接受较高美沙酮剂量的患者[ p = 0.028]，其心理健康综合评分的平均变化显著更高。
吸毒者的身心健康、风险行为和生活质量等方面相互交织且复杂。我们的研究揭示了美沙酮维持治疗对健康相关生活质量的积极短期影响，并强调了持续治疗以获得最佳效果的重要性。除了提供美沙酮外，还需要全面的支持性服务来满足注射吸毒者复杂的健康需求。
