Study On Risk Factors Of Drop-out Among Patients With Methadone Maintenance Treatment

Objective:1.To study the drop-out of methadone maintenance treatment among the three methadone clinics in Guangxi Zhuang Autonomous Region;2.To explore the influencing factors of methadone maintenance treatment and provide a scientific basis for reducing the drop-out rate and enhance their compliance.Methods:1.This study use cross-sectional survey research.According to the inclusion and exclusion standards,patients who were undergoing treatment at three methadone clinics in the Guangxi Zhuang Autonomous Region were selected as research objects.And Investigators who had undergone rigorous training were got on face-to-face questionnaire surveys of the subjects and consulted relevant medical records to obtain the subjects' related information.Questionnaires include general demographic characteristics(sex,date of birth,marital status,education level,occupation,economic status,etc.),drug use history(drug addiction,first drug use time,etc.).sexual behaviors of recent three months(sexuality,commercial sex,usage of condoms,etc.),methadone maintenance treatment condition(treatment period,drop-out,the number of drop-out,etc.)Medical records information:viral infections(AIDS,Hepatitis B,Hepatitis C,Syphilis).Morphine urine test results among the rencent three years.The morphine urine test was positive in only one of the morphine urine tests.The results are complementary to the survey data "Whether to use other drugs during treatment." If the two are inconsistent,we should based on morphine urine test results.The criteria for the drop-out of this study were determined in strict accordance with the definition of drop in the methadone clinic,"which was accumulatively or within 15 consecutive days if the patients are out of the clinic",it is definited as drop.2.Based on cross-sectional study,according to the methadone maintenance treatment,the patients were divided into the dropout group and the treated group,and then do the cross-control study.Then regard the drop condition(no drop = 0,drop = 1)as a dependent variable,establish an unconditional logistic regression model,to explore the influencing factors of methadone maintenance treatment.Considering that the dropout of methadone maintenance treatment may be caused by multiple factors,and the interaction between factors may increase or decrease the impact on the dropout.Therefore,In this study,based on the above results,the effects of interactions between factors on the drop were analyzed through multiplication and additive interactions.3.Data entry use Epidata 3.1 goiongon dual entry for logic error correction and verification.Using SAS 9.2 for data cleaning and data analysing.Quantitative data which follow the normal distribution using the mean ± standard deviation(sx ±)to describe.Statistical analysis by T-test or analysing of variance.That not obey normal distribution using Interquartile Range(IQR)to describe.Statistical analysis using rank sum test.Qualitative data is represented by the composition ratio or the occurrence rate,Statistical analysis using chi-square test,based on this,use unconditional logistic regression analysis to explore the Influencing factors.Multiplication interactions were analyzed using logistic regression models.And additive interactions were analyzed using Excel software compiled by Andersson.The evaluation indicators include the relative excess risk due to interaction,RERI)=RR11-RR10-RR01+1;the attributable proportion due to interaction,QAP)=RERI/RR11;the synergy index,S)=(RR11-1)/[(RR01-1)+(RR10-1)]?Results:1.The general situation of methadone maintenance treatmentA total of 1031 methadone maintenance treatment patients were investigated in this study.(1)Demographic characteristics:there were 832 males(80.70%)and 199 females(19.30%),with a male to female ratio of 4.13:1,age range 21-72,the average age was(42.15±7.63)year,with the largest number among 35-45 years old(66.15%,682/1031).Marital status is mostly married(58.62%,605/1031).The ethnic group is mainly Han(81.67%,842/1031).The junior high school education level is 634 people,about 61.49%,78.47%(809/1031)of patients are unemployed.(2)Drug use history:the primary drug use method was intravenous drug use(92.73%,965/1031).drug abuse years range from 6 months to 32 years,among them,the largest number was from 10 to 20 years(47.72%,492/1031).47.43%(489/1031)of patients had an average of more than 3 drug abuses per day before treatment.Before the treatment,the average daily drug dose is 0.3g and under 0.3g are 80.50%(930/1031).66.34%(684/1031)of the people have share needle behaviors,drug use is dominated by traditional drugs(91.17%,940/1031),(3)Sexual activity of rencent three month:92.14%(950/1031)of patients have had sex in the last three months,only 120 people(12.63%)used condoms every time when they had sex activities,(4)Viral infection condition:the positive rate of HCV was highest(71.77%,740/1031),and he positive rates of HIV,HBV,and RPR were 15.13%(156/1031),12.42%(128/1031),and 6.01%(62/1031),in the combined infection,the positive rate of HIV/HCV co-infection was the highest(13.09%,135/1031);(5)The treatment of methadone maintenance treatment:the duration of methadone treatment was between 1 month and 21 years,of which 38.89%(401/1031)of patients received methadone treatment for 5 years or more,methadone doses ranged from 4 to 260 mg/d,of which 929 patients were below 100 mg/d,accounting for 90.11%(929/1031).16.68%(172/1031)of maintenance patients use other drugs during the treatment.40.64%(419/1031)had been droped after receiving methadone treatment.2.Analysis the factors which affect the drop of methadone maintenance treatment2.1 Univariate analysis of factors affecting the drop of methadone maintenance treatment Regard the drop condition(no drop = 0,drop = 1)as a dependent variable,Univariate analysis analysis show that occupational,commercial sex behavior,HIV positive,HCV positive,duration of methadone treatment,methadone dosage,and use of other drugs during treatment were statistically significant(P<0.05).2.2 Multivariate analysis of factors influencing the dropout of methadone maintenance treatmentAfter controlling univariate analysis of meaningful variables and literature-relevant variables,unconditional logistic regression analysis shows that HIV-positive individuals were prone to dropout(OR=1.958,95%CI:1.335~2.872);unemployed were prone to dropout(OR=1.448,95 % CI : 1.053~1.993),the risk of dropout of methadone dosage <100 mg/d was 3.053 times to the dosage?100 mg/d(95%CI:1.850~5.039),the risk of dropout of use other drugs during treatment was 2.146 times(95% CI: 1.518 to 3.036)to that who without other drugs.3.Interaction analysis resultsThe results show that HIV-positive,unemployed,dosage of methadone <100 mg/d,and other drugs used during treatment were risk factors for methadone maintenance treatment.According to the literature review,methadone maintenance treatment was not caused by a single factor,may be caused by the interaction of two or more factors.Therefore,the assumption is made to explore whether there are interactions(coordination or antagonism)among the influencing factors to the increase or decreaser risk of dropout?The following research will be an in-depth analysis of the interactions between factors.3.1 Results of interaction between HIV positive and dose <100 mg/dHIV positive and dosage <100 mg/d have multiplication and additive interactions(OR=2.735,95%CI: 1.876~3.986),The three evaluation indicators in the additive model were:RERI=187.507(95 % CI : 42.977~417.992)? AP= 0.863(95%CI: 0.823~0.903)? S=7.526(95%CI: 5.537~10.229),all three indicators were statistically significant(P<0.05).that is,HIV-positive and dosage<100mg/d more likely to dropout(OR = 5.543,95% CI: 1.601 ~ 19.187).86.30% of the total dropout was attributed to HIV positive and dosage <100 mg/d.3.2 Results of interaction between unemployed and other drug use during treatmentUnemployed and other drugs during treatment have additive and multiplicative interactions(OR=2.735,95% CI: 1.876 to 3.98),The three evaluation indicators in the additive model are:RERI=21.029(95 % CI : 9.044~33.015)? AP= 0.749(95%CI: 0.614~0.884)?S=4.447(95%CI: 2.447~8.190),all three indicators were statistically significant(P<0.05).That is those who were unemployed and used other drugs during treatment were more likely to dropout(OR=3.333,95% CI: 2.078 to 5.344).74.90% of the total dropout was attributed to the unemployed and other drug interactions during treatment.3.3 Results of interaction between the dosage is less than 100 mg/d and the results of other drug interactions during treatmentThe dosage was less than 100 mg/day and other drugs used during the treatment have additive and multiplicative interactions(OR=2.446,95%CI:1.714 to 3.489),The three evaluation indicators in the additive model are:RERI=256.458(95 % CI :84.566~428.350)? AP=0.873(95%CI: 0.789~0.957)? S=8.051(95%CI: 4.107~15.781),all three indicators were statistically significant(P<0.05).That is,the risk of dropout was increased when the dosage was less than 100 mg/d and other drugs were used during treatment(OR=6.121,95% CI: 3.201 to 11.705),Of the total loss,87.30% was attributed to the dosage<100 mg/d and interaction with other drugs during the treatment period.Conclusion1.The drop-out rate of methadone maintenance treatment in this study was 40.64%(419/1031).Those who lost one to two times accounted for 33.56%(346/1031),and those who lost three or more times accounted for 7.08%(73/1031).Compared with other domestic methadone clinics,the drop-out rate is at a medium level.2.Logistic regression results showed that unemployed,HIV-positive,dosage of methadone <100 mg/d,and use of other drugs during treatment were risk factors for dropout.3.The result of the interaction confirms that,there were synergistic effects between HIV positive and methadone dosage <100 mg/d,unemployed and other drugs used during treatment,methadone dosage<100mg/d,and other drugs used during treatment,that is,the presence of two factors at the same time will increase the risk of dropout.4.The results of this study suggest that large dosage of methadone(?100mg/d)are recommended below safety condition;especially for HIV-infected people who participated in antiviral treatment,they must increase their methadone dose in time;strengthen health education and psychological interventions to reduce the use of other drugs during treatment;establish a good family and social support system;provide more employment opportunities,improve the family and social value of patients,thereby improving their compliance.