The Evaluation of Methadone Maintainence Treatment Program in Taiwan
Date Issued
2015
Date
2015
Author(s)
Huang, Yen-Fang
Abstract
Background: The related social and health issues of illegal drug use continue to attract great international concern. An epidemic of HIV among people who inject drugs (PWID) bagan to spread rapidly since 2003 in Taiwan. In response to this problem, the government developed harm reduction programs in 2005. The first person was not enrolled in Methadone maintentence treatment (MMT) until February 2006. However, large-scale studies that incorporated sensitive measurements of HIV incidence and intervention exposures in defined cohorts such as these was much needed but rare worldwide. Therefore, the aims of this dissertation were: first, to determine the dominate predictors of enrollment for MMT and MMT retention; and then, to evaluate the outcome impacts of MMT programs on HIV incidence, employment, and re-incarceration. Methods: We enrolled in a prospective study a cohort of 4,357 individuals who were released from prison via an amnesty on July 16, 2007. Within, a total of 2,737, among the 3,153 participants who had completed the interview were used for the analysis of the predictors of MMT enrollment and retention, and the association between MMT and re-incarceration. In the analysis of the association of harm reduction strategies with HIV seroconversion, 2,473 individuals who were HIV negative before 2006 were used. In addition, 1,510 individuals who held current employment status were included in the analysis of the association of MMT with employment. Results: 1. Mutivariate logistic regression models revealed that positive factors associated with enrolling in MMT included older age (adjusted Odds Ratio per 1 year [aOR]=1.01; 95% CI: 1.00-1.02), without chewing betal nuts (aOR 1.31；95% CI: 1.07-1.60), free MMT treatment (aOR 2.72；95% CI: 2.05-3.61), and family support (aOR 1.45；95% CI: 1.23-1.72). People who were re-incarceration (aOR 0.62；95% CI: 0.51-0.76) or spent more transportation time (aOR per 1 minute 0.98； 95% CI: 0.97-0.98) were less likely to be enrolled. 2. In 1,708 MMT cases, four trajectory groups, including drop-out-early, treatment late, drop-out-late and keep on treatment, were identified. A total of 581 (34%) of them continued MMT. At the same time, the percentage of continue on MMT was 73% in no-incarceration group. In multivariate generalized logistic regression models, others three group compared with the Keep-on-Treatment group, re-incarceration were associated with lesser medication adherence (aOR 35; 5, and 9, respectively); higher dosages were associated with lesser drop-out-early and treatment late (aOR 0.98; and 0.98, respectively); family support was associated with lesser early failure (aOR 0.71); more transportation time was associated with more failure late (aOR per 1 minute 1.01); male was associated with lesser late failure (aOR 0.50). 3. A total of 51 HIV seroconverted cases occurred between 2006 and 2010. Time-varying Cox regression model and Weighted time-varying Cox regression model reveals that attendance at methadone clinics was associated with a significantly lower HIV incidence (adjusted hazard ratio [aHR] 0.13, 95%CI: 0.06–0.67; 0.12, 95%CI: 0.03-0.41; respectively), adjusting for other characteristics. 4. GEE models found that attendance at methadone clinics was associated with a significantly higher full-time employment (aOR 1.3), adjusting for other characteristics. Other significant predictor variables included male, younger, and HIV negative. Compared to those receiving a low dose (<45mg), clients receiving a medium (45-75mg) dose had a higher likelihood of attrition,but high (>75mg) dose had no difference 5. MMT coverage peaked at 45% one and half years after amnesty and later re-incarceration rate alsp peak two years after amnesty. GEE models found that attendance at methadone clinics was associated with a significantly lower reincarceration (aOR=0.74, 95%CI: 0.66-0.83), adjusting for other characteristics. Conclusion and Suggestion: It is concluded that MMT was associated with lower HIV seroconverted, lower re-incarceration, and higher full-time employment among PWID. In addition, that no re-incarceration was associated with high rate of MMT enrollment and retention. Increase accessibility, free treatment and case management, as well as higher methadone dosage are potent strategies that can increase both MMT emrollment and retention rate.
Subjects
People who inject drugs
Injection drug users
heroin
harm reduction
methadone maintainence treatment
HIV
HIV incidence
employment
incarceration
evaluation
SDGs
Type
thesis
File(s)![Thumbnail Image]()
Loading...
Name
ntu-104-D97845003-1.pdf
Size
23.32 KB
Format
Adobe PDF
Checksum
(MD5):38df5ead7236bbf0932e22115b9919fc