Haiphong University of Medicine and Pharmacy, 72A, Nguyen Binh Khiem, Ngo Quyen, Haiphong, Vietnam.
The State Council for Professor Title of Vietnam, 1, Dai Co Viet, Bach Khoa, Hai Ba Trung, Hanoi, Vietnam.
Harm Reduct J. 2017 Aug 30;14(1):59. doi: 10.1186/s12954-017-0185-7.
Vietnam began providing methadone maintenance therapy (MMT) in 2008; as of June 2016, 44,479 persons who inject drugs (PWID) were in treatment in 57 provinces. However, 10-23% of patients were estimated to have dropped out of treatment during the first 2 years. We evaluated dropout and factors associated with quitting treatment.
We followed clients ≥ 18 years old enrolled in five MMT clinics in Haiphong for 3 years. Persons who missed a consecutive month of methadone treatment were considered to have dropped out and were not allowed to return; those who missed greater than five consecutive doses were considered to be non-compliant but were allowed to restart treatment at their initial dose. Clients who dropped out or who were non-compliant during their third year of MMT (cases) were traced and matched with two clients who remained in treatment (controls) by gender, age, and length of time in the program. Cases and controls were interviewed. Additional data on levels of yearly retention were abstracted from clinic records.
Among the 1055 patients initially enrolled in MMT, dropout and non-compliance combined was 13.6% during the first year, 16.5% during the second year, and 22.3% during the third year. By 36 months, 33.3% of clients had dropped out, of whom 10.6% had died and 24% had been arrested. We traced and interviewed 81 clients who dropped out or who were non-compliant during year 3 as well as 161 controls. The primary reasons for dropping out included claiming no dependence on heroin (22.2%), conflict with work (21.0%), health problems (16.0%), and inability to afford the methadone co-payment of approximately 0.5 USD/day (14.8%). Independent factors associated with non-compliance included continuing to use heroin (aOR = 12.4, 95% CI 4.2-36.8) and missing greater than three doses during the previous 3 months (aOR = 18.5, 95% CI 7.4-47.1); receiving a daily dose of > 120 mg of methadone was associated with a lower odds ratio of dropping out (aOR = 0.3, 95% CI 0.1-0.9).
By 3 years, one third of all patients in treatment had permanently dropped out. Ensuring that methadone dosing is adequate and reducing or eliminating the co-payment fee for those who cannot afford it could improve retention.
越南于 2008 年开始提供美沙酮维持治疗（MMT）；截至 2016 年 6 月，57 个省共有 44479 名注射吸毒者（PWID）接受治疗。然而，据估计，在前 2 年内，有 10-23%的患者退出了治疗。我们评估了脱落率和与退出治疗相关的因素。
我们对在海防的五个 MMT 诊所接受治疗的年龄在 18 岁及以上的患者进行了为期 3 年的随访。连续一个月未接受美沙酮治疗的患者被认为已退出治疗，不允许返回；连续错过 5 剂以上的患者被认为是不遵守治疗方案，但可以在初始剂量重新开始治疗。在 MMT 的第三年期间退出或不遵守治疗方案的患者（病例）与治疗期间仍留在治疗中的两名患者（对照）按性别、年龄和方案持续时间进行匹配。对病例和对照组进行了访谈。从诊所记录中提取了每年保留率的额外数据。
在最初接受 MMT 的 1055 名患者中，第一年的脱落和不遵守率合计为 13.6%，第二年为 16.5%，第三年为 22.3%。到 36 个月时，33.3%的患者已经退出治疗，其中 10.6%死亡，24%被捕。我们追踪并采访了在第 3 年期间退出或不遵守治疗方案的 81 名患者以及 161 名对照。退出的主要原因包括声称对海洛因无依赖（22.2%）、与工作冲突（21.0%）、健康问题（16.0%）和无力支付每天约 0.5 美元的美沙酮自付费用（14.8%）。不遵守治疗方案的独立因素包括继续使用海洛因（OR=12.4，95%CI 4.2-36.8）和在过去 3 个月内错过 3 剂以上（OR=18.5，95%CI 7.4-47.1）；每天接受大于 120 毫克美沙酮的剂量与较低的退出几率相关（OR=0.3，95%CI 0.1-0.9）。
到 3 年时，所有接受治疗的患者中有三分之一已永久退出。确保美沙酮剂量充足，并为那些无力支付费用的人减少或免除自付费用，可能会提高保留率。
