Predictors of outcome in methadone programs: effect of HIV counseling and testing.

OBJECTIVE

To identify predictors of treatment outcomes in methadone maintenance programs and to determine whether HIV counseling and testing influenced these outcomes.

DESIGN

Retrospective record review.

SETTING

Four methadone maintenance programs in four cities in Connecticut, USA.

PARTICIPANTS

Five hundred and ninety-four clients, who began treatment over an 18-month period and for whom records were available, took part.

INTERVENTIONS

HIV counseling and testing.

MAIN OUTCOME MEASURES

Risk of treatment discontinuation and persistent in-treatment illicit drug use.

RESULTS

The most important predictor of treatment discontinuation and of persistent in-treatment illicit drug use was self-reported pretreatment cocaine use. After controlling for this and demographic risk factors, clients who received initial HIV counseling, when compared with clients who did not, had a similar 12-month discontinuation risk (54% vs 59%; P = 0.08) but were less likely to show persistent illicit drug use (46% vs 53%; P = 0.01). Among counseled entrants who were tested for HIV antibodies, those receiving positive results had a 12-month discontinuation risk similar to those receiving negative results (50% vs 52%), but more often showed persistent illicit drug use (57% vs 44%), although this difference may have been due to chance (P = 0.28). The majority of clients who discontinued treatment did so because they were discharged for noncompliance with clinic rules, usually for failing to pay fees.

CONCLUSIONS

HIV counseling and testing do not have a substantial adverse effect on methadone treatment outcomes. In the clinics under study, failure to pay clinic fees was an important factor contributing to discontinuation of treatment.