Determinants Of Entering MMT Among HIV-positive IDUs In Five Counties Or Cities Of Yunnan Province

ObjectivesTo investigate the high-risk behavior characteristics of HIV positive IDUs from 5 counties or cities in Yunan province; to analyze the determinants of entering MMT among HIV-positive IDUs. MethodsQualitative research and quantitative research were combined to analyze the problems. In cross-sectional study, research objects were recruited from Mangshi, Ruili, Mengzi, Gejiu and Jianshui in Yunnan province. Sociodemographic characteristics, general health status, information about MMT and ART was collected. Univariate and multivariate logistic regression analysis were conducted to explore the factors. Mediation effect of attitude to MMT was carried out. In the qualitative study, patients, their family members and related workers were interviewed to understand the reasons of not entering MMT. The recording was transferred into text, and analyzed by software of ATLAS.ti.5.0. Results 1. Quantitative research293 patients were investigated, of which, 103(35.2%) had entered MMT, 190(64.8%) had not. The average age was 40.0±6.9. The number of Han nationality was 205(70.0%). 129(44.0%) patients had jobs. 174(56.7%) patients’ HIV diagnosis years were more than 8. 174(56.7%) patients had entered ART. 159(54.3%)patients got depressed. 150(51.2%)infected hepatitis C. 52(17.7%)patients had shared needles with others in the last year. 262(89.4%) used drug in the last year. 124(42.3%)patients had fixed sex partners, of which, 29(23.3%,29/124)never used condoms. 48(16.4%)patients had casual sex partners, of which, 8(16.6%,8/48)patients never used condoms. 17(5.8%)patients had more than one sex partners.The results of general analysis stated: “having job”(OR=0.26, 95%CI:0.13-0.50), “using drug in the last year”(OR=0.17, 95%CI:0.05-0.54), and “high estimated score of attitudes to MMT”(OR=0.81, 95%CI:0.75-0.89) were the barriers to enter MMT; “ support to enter MMT from families”(OR=6.92, 95%CI:3.20-14.98), “ support to enter MMT from friends”( OR=2.14, 95%CI:1.06-4.33) and “taking part in ART”( OR=2.19, 95%CI:1.13-4.22)were motivators to enter MMT. “estimated scores of attitude to MMT” was the mediation variable between “support to enter MMT from friends” and entering MMT, whose mediation effect was 38.5%.The results of subgroup analysis among patients from ART clinics stated: “having job”(OR=0.24, 95%CI:0.08-0.73), “using drug in the last year”(OR=0.24, 95%CI:0.07-0.83), and “high estimated score of attitude to MMT”(OR=0.80, 95%CI:0.72-0.89) were the barriers to enter MMT; “suppor to enter ART from families”(OR=6.17, 95%CI:1.59-23.97)and “support to enter MMT from friends”(OR=3.59, 95%CI:1.61-8.00)were motivators to enter MMT. “estimated scores of attitude to MMT” was the mediation variable between “support to enter MMT” and entering MMT, whose mediation effect was 20.7%.The results of subgroup analysis among patients from communities stated: “having job”(OR=0.24, 95%CI:0.08-0.73)and “high estimated score of attitude to MMT”(OR=0.75, 95%CI:0.64-0.89)were the barrier to enter MMT; “support to enter MMT”(OR=3.41, 95%CI:1.05-11.09) and “infected hepatitis C”( OR=2.98, 95%CI:1.03-8.65) were motivators to enter MMT. “estimated scores of attitude to MMT” was the mediation variable between “support to enter MMT” and entering MMT, whose mediation effect was 45.2%.2. Qualitative ResearchThe qualitative interview included 30 patients, whose median age was 40, and median year of injecting drug was 9. 11 patients had entered MMT, 19 ones had never entered MMT. 5 family members were interviewed. 9 related workers were recruited, of which, 2 from ART clinics, 5 from MMT clinics and 2 from centers for disease control and prevention. The interview results among patients and their families stated: “misapprehension to MMT”, “fear of being captured”, “affording to buy heroin” were the reasons of not entering MMT. The interview results from related workers pointed out: “simple propaganda and low coverage rate”, “lacking cooperation with the police”, “lack deterrent to patients’ drug using” and “negative feeling from the workers of MMT clinics” were barriers of entering MMT. ConclusionsThe rates of sharing the same needles among some patients without entering MMT were still very high. Participating in the ART, family’s supporting for MMT, family’s supporting for ART, backing up MMT from the friends of injecting drug users, and infected hypertitis C were the enhancing factor for entering MMT; having jobs, injecting drugs in the last year, and negative attitude to MMT from patients were the obstructive factor; patients’ attitude to MMT is the mediation variable. The effect degree of these factors were different among two subgroups who were patients from ART clinics and communities respectively.