Farley T A, Cartter M L, Wassell J T, Hadler J L
Division of Field Services, Centers for Disease Control, Atlanta, Georgia.
Conn Med. 1994 Mar;58(3):165-71.
To identify predictors of treatment outcomes in methadone maintenance programs and to determine whether HIV counseling and testing influenced these outcomes.
Retrospective record review.
Four methadone maintenance programs in four cities in Connecticut, USA.
Five hundred and ninety-four clients, who began treatment over an 18-month period and for whom records were available, took part.
HIV counseling and testing.
Risk of treatment discontinuation and persistent in-treatment illicit drug use.
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.
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.
确定美沙酮维持治疗项目中治疗结果的预测因素，并确定HIV咨询与检测是否会影响这些结果。
回顾性记录审查。
美国康涅狄格州四个城市的四个美沙酮维持治疗项目。
594名客户参与了研究，他们在18个月的时间内开始接受治疗且有可用记录。
HIV咨询与检测。
治疗中断风险及治疗期间持续使用非法药物的情况。
治疗中断及治疗期间持续使用非法药物的最重要预测因素是自我报告的治疗前可卡因使用情况。在控制了这一因素及人口统计学风险因素后，接受初始HIV咨询的客户与未接受咨询的客户相比，12个月的治疗中断风险相似（54%对59%；P = 0.08），但持续使用非法药物的可能性较小（46%对53%；P = 0.01）。在接受HIV抗体检测的咨询入组者中，检测结果呈阳性者的12个月治疗中断风险与检测结果呈阴性者相似（50%对52%），但更常出现持续使用非法药物的情况（57%对44%），不过这种差异可能是偶然因素所致（P = 0.28）。大多数中断治疗的客户是因为未遵守诊所规定（通常是未支付费用）而被出院。
HIV咨询与检测对美沙酮治疗结果没有实质性的不利影响。在所研究的诊所中，未支付诊所费用是导致治疗中断的一个重要因素。
