Methadone Maintenance Treatment Participant Retention and Behavioural Effectiveness in China: A Systematic Review and Meta-Analysis

Abstract

BackgroundMethadone maintenance treatment (MMT) has been scaled up by the Chinese government alongside persistent compulsory drug user detention, but the extent to which detention interferes with MMT is unknown. The study systematically reviews Chinese MMT retention rates, reasons for drop out, and behavioural changes.MethodChinese and English databases of literature are searched for studies reporting retention rates, drug use and sexual behaviours among MMT participants in China between 2004 and 2013. The estimates are summarized through a systematic review and meta-analysis.ResultsA total of 74 studies representing 43,263 individuals are included in this analysis. About a third of MMT participants drop out during the first three months of treatment (retention rate 69.0% (95% CI 57.7-78.4%)). Police arrest and detention in compulsory rehabilitation was the most common cause of drop out, accounting for 22.2% of all those not retained. Among retained participants, changing unsafe drug use behaviours was more effective than changing unsafe sexual behaviours. At 12 months following MMT initiation, 24.6% (15.7-33.5%) of MMT participants had a positive urine test, 9.3% (4.7-17.8%) injected drugs and only 1.1% (0.4-3.0%) sold sex for drugs. These correspond to 0.002 (<0.001-0.011), 0.045 (0.004-0.114) and 0.209 (0.076-0.580) times lower odds than baseline. However, MMT participants did not have substantial changes in condom use rates.ConclusionMMT is effective in drug users in China but participant retention is poor, substantially related to compulsory detention. Reforming the compulsory drug user detention system may improve MMT retention and effectiveness.

Retention and HIV seroconversion among drug users on methadone maintenance treatment in Yunnan, China

“…7,16 Overall, the observed HIV seroconversion rate was low in our study group (0.7/100 py), compared to a 4-year MMT cohort in Dehong Prefecture, Yunnan, China (4.1/100 py) 24 and a 20-year MMT cohort in Amsterdam (1.7/100 py). 1 Of the 13 seroconverted cases, 12 seroconverted during the first 6 months.…”

“…16 In general, low retention rates (50% in 2 years) have been reported across the world due to the unstable nature of drug users in general and barriers posed by drug control policies. 7,17,18 Yang et al treated participants who had been lost but returned to MMT as being retained in their cohort by study end point. 16 Wang et al defined LFU as missing 15 days of MMT within a 90-day time frame.…”

“…The adoption of 6-month intervals to measure LFU was in accordance with the standard definition of LFU in HIV cohorts recommended by Chi et al 20 Nearly half of those lost to follow-up were lost during the first 6 months of the follow-up period in our study, a fact reported across many studies. [7][8][9][10][11]16 Retention improved progressively after the first 6 months; this was due to timely intervention by programme managers. The interim findings of the study were used to raise awareness about the problem of LFU, and to sensitise and motivate the MMT staff to perform better and train them in 'soft' skills, including better communication with participants and proactive follow-up (by telephone or home visits) of participants who missed doses.…”

“…5,6 Several studies on MMT retention and its associated factors from China and other countries have limitations related to short follow-up period, small sample size, limited representativeness and the retrospective nature of the study designs. [7][8][9][10][11] Information on HIV seroconversion rates among participants on MMT is scarce. The present study was conducted in a large cohort of HIV-negative persons enrolled into the MMT programme and followed for 2 and a half years across 13 clinics in Yunnan.…”

Re-entry and related predictors among HIV-infected clients receiving methadone maintenance treatment in Guangdong province, China

“…(14,15). In the past decade, MMT has effectively reduced heroin use (14,16,17) and curbed the spread of HIV/AIDS among heroin addicts (17)(18)(19). According to official statistics, HIV incidence among clients has decreased from 0.95% in 2006 to 0.12% in 2014 since the implementation of the MMT program (15).…”