TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa.
Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa.
Addict Sci Clin Pract. 2020 Feb 21;15(1):13. doi: 10.1186/s13722-020-00186-7.
Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa.
We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization's Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar's test was used for comparisons between paired results of categorical variables relating to injecting frequency.
The majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254).
Interim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.
新出现的数据表明，南非可能存在海洛因使用泛滥的问题。尽管如此，获得美沙酮维持治疗和其他基于证据的治疗选择的机会仍然微乎其微。我们旨在评估在南非德班提供的低门槛服务中，接受美沙酮维持治疗 6 个月后的保留率、物质使用变化和生活质量。
我们招募了 54 名阿片类物质使用障碍患者进入研究。我们回顾并描述了基线社会人口统计学特征。使用世界卫生组织酒精、吸烟和物质使用参与筛查测试（ASSIST）评估基线和 6 个月时的物质使用情况，使用 SF-12 评估生活质量。我们使用 Wilcoxon 符号秩检验比较了 6 个月时美沙酮与基线的变化，并分别使用配对检验比较了 ASSIST 和 SF-12 评分的变化。McNemar 检验用于比较与注射频率相关的分类变量的配对结果。
大多数参与者是年轻的黑人男性，有超过 10 年的吸毒史。6 个月后的保留率为 81%。6 个月后，ASSIST 评分中海洛因的中位数从 37 分降至 9 分（p<0.0001），大麻的中位数从 12.5 分增至 21 分（p=0.0003）。SF-12 的心理健康综合评分中位数从 41.4 分增至 48.7 分（p=0.0254）。
中期结果表明，在接受美沙酮维持治疗 6 个月的患者中，保留率高，海洛因使用显著减少，心理健康状况改善。进一步研究长期结果以及导致这些变化的原因，将加强在南非扩大美沙酮维持治疗的建议。
