| Objectives To reduce drug use and high-risk sexual behaviors among clidents who attend methadone maintenance treatment(MMT)clinics in China.Methods Randomized control trial study design was used.Sixty MMT clinics selected from Yunnan,Sichuan,Guizhou,Guangxi,and Xinjiang,were stratified by province,size of clinic and HIV prevalence and mat-ched in 30 pairs.Each pair was randomly assigned into control or intervention group.Routine services were provided in control group and comprehensive and intensified interventions based on routine service were implemented in intervention group.Interventions include increasing an average of 15 mg dose,strengthening urine morphine detection monthly,promoting family support and help,intensifying counseling and support,strengthening sexual partners notification and HIV testing and strengthening counseling and condom promotion between spouses.Two surveys were conducted to assess drug use and sex behavior pre and post intervention.Further in-depth interviews were conducted among 36 interviewees in 4 MMT ’clinics in Red River State in order to better understand reasons of drug use during treatment.The records were transcribed first and then the transcriptions were coded,summarized and analysed by Atlas.ti software.Results A total of 9544 patients participated in baseline survey,with 5280 and 4264 in the intervention and control group respectively.The rates of knowing the AIDS related knowledge were 74.62%and 71.98%respectively,the rates of drug use in the last 30 days were 26.32%and 31.33%respectively,the rates of positive urine test were 20.45%and 33.20%respectively.66.86%and 66.50%of participants had sex with spouse in the last 30 days respectively,the rates of unprotected sex in the past 30 days were 66.67%and 64.01%respectively,the rate of unprotected sex at last sex were 61.75%and 58.84%respectively;4.91%and 5.06%of participants havd sex with regular sex partner in the last 30 days respectively,the rates of unprotected sex in the past 30 days were 67.83%and 64.02%respectively,the rates of unprotected sex at last sex 62.79%and 59.35%respectively;4.74%and 5.18%of participants had occasional sexual partners in the past 6 months respectively,the rates of unprotected sex in the past 30 days was 46.67%and 44.24%respectively.A total of 6480 patients participated attended the follow-up survey and the drop rate was 32.10%.3783 and 2697 participants were surveyed in intervention and control group at the follow-up.Controlling the confounding factors after the intervention,compared with the control group,the intervention group’s rate of knowing the AIDS related knowledge increased by 55%(P<0.001),the rate of drug-use in the last 30 days decreased by 20%(P<0.01)and the positive urine test rate decreased by 32%(P<0.001),statistical differences were found in the above-mentioned rates.Controlling the confounding factors,compared with the baseline data,after the intervention the rates of unprotected sex with spouse and unprotected sex with regular sex partner in the 30 days significantly decreased by 14%and 37%respectively in the intervention group.While the changes in control group from baseline to follow-up was not statistically significant.The rate of unprotected sex with occasional sexual partners decreased in both groups after the intervention,but all the changes were not statistically significant.Among the 36 interviewees,23 were male,and 13 were female;14 were married,12 had domestic partnership,eight were single,and two were divorced;twenty were unemployed.Doubt about the effects and side effects of the MMT,the improvement of Economic condition,and less supervisions from family due to the relationship improvement between family members and the increasing trust from family members can provide the opportunity for heroin addicts to use drugs.Besides,some subjective factors,such as the physiological and psychological dependence on heroin,lack of ability to deal with adverse events,feeling empty and bored and so on,can lead to use drugs especially when the interviewees have money.Some interviewees reported having used new types of drug,such as Magu,MDMA and so on because of curiosity and temptation by friends.Some interviewees said that they would not use them because new type of drug can’t bring the expected euphoria.Conclusions The comprehensive and intensified intervention can effectively increase the AIDS related knowledge,decrease drug use and unprotected sexual behavior among patients receiving MMT in China and should be promoted in other MMT clinics. |
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