Factors Associated With Mortality of HIV-Positive Clients Receiving Methadone Maintenance Treatment in China.
Factors associated with mortality of HIV-positive clients receiving methadone maintenance treatment in China.
J Infect Dis. 2013 Apr 16;
Liu E, Rou K, McGoogan JM, Pang L, Cao X, Wang C, Luo W, Sullivan SG, Montaner J, Bulterys M, Detels R, Wu Z,
Background.?Little is known about mortality of opiate users attending methadone maintenance treatment (MMT), we sought to investigate mortality and its predictors among HIV-positive MMT clients.Methods.?Records of 306,786 clients enrolled in China’s MMT program from 24 March 2004 to 30 April 2011 were abstracted. Mortality rates were calculated for all clients, HIV-positive antiretroviral treatment (ART)-naïve and ART-experienced clients. Risk factors were examined using stratified proportional hazard ratios.Results.?The observed mortality rate for all clients was 11.8 per 1,000 person-years (PY, 95% confidence interval [CI]=11.5-12.1) and for HIV-positive clients (n=18,193) 57.2 per 1,000 PY (CI=54.9-59.4). An increase in average methadone doses to >75 mg/day was associated with a 24% reduction in mortality (HR=0.76, CI=0.70-0.82) and a reduction of 48% for ART-naïve HIV-positive clients (HR=0.52, CI=0.42-0.65) and 47% for ART-experienced HIV-positive clients (HR=0.53, CI=0.46-0.62). Among ART-experienced clients, initiating ART at a CD4(+) T cell counts >300 cells/mm(3) (HR=0.64, CI=0.43-0.94) was also associated with decreased risk of death.Conclusion.?We found high mortality rates among HIV-positive MMT clients, yet decreased risk of death with earlier ART initiation and higher methadone doses. Higher daily methadone dose was associated with reduced mortality in both HIV-infected and uninfected clients, independent of ART.
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Trends and predictors in methadone maintenance treatment dropout in Shanghai, China: 2005-2011.
Curr Med Res Opin. 2013 Apr 16;
Ren J, Ning Z, Asche CV, Zhuang M, Kirkness CS, Ye X, Fu J, Pan Q
Abstract Background: The methadone maintenance treatment (MMT) program has been implemented in Shanghai since 2005. This study aims to portray the trend of MMT dropout and identify predictive factors that may influence dropout in Shanghai MMT clinics, which could assist in the intervention strategy development. Methods: A retrospective evaluation was used in the Shanghai component of the National MMT data management system between January 1, 2005 and December 31, 2011. Cox model for recurrence events was employed to estimate hazard ratio (HR) predicting dropout during the follow-up period. Results: Of all 6169 participants, 63% dropped out of the program at least once (ranging from 0 to 10 times), and 74% of them did not return by the end of this study. The average monthly incidence rate of dropout was 4.4% with a range from 0 to 9.3%. Adjusted analyses demonstrated that the individuals with methadone tapering didn’t have a more probability of dropping out compared to those with stable dosage (HR=1.07, 95%CI: 0.90-1.27). However, there was a higher dropout rate among younger individuals (<30 years vs. ?50 years old; HR=1.41, 95%CI: 1.16-1.71), among those who were less educated (HR=1.48, 95%CI: 1.17-1.87), among those who shared needles with others (HR=1.29, 95%CI: 1.06-1.58), among those whose urine tested positive for opiates (HR=1.69, 95%CI: 1.51-1.89), and among those who had a low average methadone dose at the initial stable stage of treatment (?35mg/day vs. >65mg/day; HR=1.39, 95%CI: 1.19-1.63). Conclusions: Shanghai has been facing the challenge of keeping a high MMT retention rate. Methadone tapering after the stable treatment stage with sufficient dosage could be attempted to popularize in the MMT program, aside from considering comprehensive interventions among specific populations, such as the young, poorly educated, opiate-positive and needle sharing individuals.
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