Methadone maintenance treatment participant retention and behavioural effectiveness in China: a systematic review and meta-analysis

Lei Zhang, Eric P F Chow, Xun Zhuang, Yanxian Liang, Yafei Wang, Caiyun Tang, Li Ling, Joseph D Tucker, David P Wilson, Lei Zhang, Eric P F Chow, Xun Zhuang, Yanxian Liang, Yafei Wang, Caiyun Tang, Li Ling, Joseph D Tucker, David P Wilson

Abstract

Background: Methadone 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.

Method: Chinese 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.

Results: A 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.

Conclusion: MMT 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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Retention of participants of MMT…
Figure 1. Retention of participants of MMT clinics in China.
Figure 2. Major reasons of dropping-out from…
Figure 2. Major reasons of dropping-out from MMT clinics among 20,873 participants.
Figure 3. Changes in injecting behaviours among…
Figure 3. Changes in injecting behaviours among retained MMT participants.
(a) Likelihood of injecting drug use in the past one month of Chinese MMT participants at six and twelve months follow-up. (b) Likelihood of sharing injection equipment in the past one month among Chinese MMT-participating IDUs at six and twelve months follow-up. (c) Likelihood of having consistent condom use during in all sexual intercourses in the past one month among Chinese MMT participants at 6 months follow-up. (d) Likelihood of selling sex for drugs in the past three months among Chinese MMT participants at six and twelve months follow-up.

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Source: PubMed

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