| 杨跃诚,尹棉松,段松,项丽芬,叶润华,高洁,杨顺生,杨盈波,龙玉存,李国强,龚渝蓉,杨世江,王继宝,吴尊友,柔克明,何纳.云南省德宏州海洛因成瘾者美沙酮维持治疗保持率及其影响因素[J].中华流行病学杂志,2011,32(2):125-129 |
| 云南省德宏州海洛因成瘾者美沙酮维持治疗保持率及其影响因素 |
| Adherence and related determinants on methadone maintenance treatment among heroin addicts in Dehong prefecture。Yunnan province |
| 收稿日期:2010-08-26 出版日期:2014-09-10 |
| DOI： |
| 中文关键词: 美沙酮维持治疗 依从性 脱失 影响因素 |
| 英文关键词: Methadone maintenance treatment Adherence Withdraw Determinant |
| 基金项目:国家“十一五”科技重大专项(2008Zx10001-016) |
| 作者 | 单位 | | 杨跃诚 | 云南省德宏州疾病预防控制中心, 潞西, 678400 | | 尹棉松 | 梁河县疾病预防控制中心 | | 段松 | 云南省德宏州疾病预防控制中心, 潞西, 678400 | | 项丽芬 | 云南省德宏州疾病预防控制中心, 潞西, 678400 | | 叶润华 | 云南省德宏州疾病预防控制中心, 潞西, 678400 | | 高洁 | 云南省德宏州疾病预防控制中心, 潞西, 678400 | | 杨顺生 | 潞西市疾病预防控制中心 | | 杨盈波 | 瑞丽市疾病预防控制中心 | | 龙玉存 | 陇川县疾病预防控制中心 | | 李国强 | 盈江县疾病预防控制中心 | | 龚渝蓉 | 云南省德宏州疾病预防控制中心, 潞西, 678400 | | 杨世江 | 云南省德宏州疾病预防控制中心, 潞西, 678400 | | 王继宝 | 云南省德宏州疾病预防控制中心, 潞西, 678400 | | 吴尊友 | 中国疾病预防控制中心 | | 柔克明 | 中国疾病预防控制中心 | | 何纳 | 复旦大学公共卫生学院流行病学教研室公共卫生安全教育部重点实验室 |
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| 中文摘要: |
| 目的 了解云南省德宏州2005-2009年间海洛因成瘾者美沙酮维持治疗保持率及其影响因素.方法 以入组治疗时间作为进入队列时间进行动态队列研究,计算不同随访时间美沙酮维持治疗保持率,运用Cox比例风险回归模型分析其影响因素.结果 云南省德宏州2005-2009年间共3758人人组治疗,男性占95.8%;以20～39岁为主,占75.8%;农民和无业者占90.4%;少数民族占57.0%;未婚者占35.0%,已婚有配偶者占55.5%;文盲及小学文化程度者占43.9%.开始吸毒的平均年龄为23.93岁;吸食海洛因占96.3%;有40.6%的吸毒者曾经注射吸毒;有21.7%的吸毒者为HIV感染者.美沙酮服药时间最短者不足1个月,最长61个月;首次服药剂量最小为1 ml,最大为330 ml,中位剂量25 ml.截止观察期末,累计退出治疗1798人,在组治疗1960人;入组治疗后1、3、6、9、12、24、36、48和60个月的累积保持率(%)分别为0.919、0.847、0.756、0.690、0.637、0.519、0.417、0.360和0.321.Cox比例风险回归模型多因素结果显示,研究对象所在治疗点、首次服药年度、婚娴状况、HIV抗体检测结果、首次服药剂量以及最后一次尿检结果与维持治疗保持时间长短有显著关联.结论 德宏州美沙酮维持治疗脱失率较高;应加强对美沙酮维持治疗者相关咨询和宣传教育、加强家庭或社区支持、给予合适的首次美沙酮剂量、并解决好偷吸毒品的问题. |
| 英文摘要: |
| Objective To determine the adherence to and its determinants of methadone maintenance treatment (MMT) among heroin addicts in Dehong prefecture in Yunnan province from 2005 to 2009. Methods A dynamic cohort analysis was conducted with the time of treatment initiation as the time of cohort entry, to calculate the proportion of adhering to the treatment at different time points after initiation of the treatment, and to study the determinants of adherence.Results A total of 3758 had been treated. Among them, 95.8% were males, 75.8% aged between 20-39 years, 90.4% were peasants or unemployed, 57.0% were ethnic minorities, 35.0% were single and 55.5% were married with spouses, 43.9% were illiterate or educated at most primary school. The age of first using drugs averaged at 23.93 years. About 96.3% of the study subjects had used heroin and 21.7% were HIV-infected. The minimum time under MMT was less than 1 month and the maximum 61 months. The median methadone dose at first delivery was 25 ml, with the minimum 1 ml and the maximum 330 ml. By the end of the study or observation period, a total of 1798 patients had withdrawn from treatment and 1960 were still under treatment. The proportions of adherence to or still being under the treatment after 1,3,6,9, 12,24, 36,48 and 60 months treatment were 0.919,0.847,0.756, 0.690, 0.637, 0.519, 0.417, 0.360 and 0.321, respectively. Multiple regression analysis using Cox proportional hazard model indicated that withdraw from the methadone maintenance treatment was significantly associated with location of the treatment clinics, year of treatment initiation, marital status, HIV infection status, methadone dose of first delivery and the result of last urine test for heroin use. Conclusion MMT attendants in Dehong prefecture had a relatively high withdraw rate and low adherence rate. More efforts are needed to provide tailored counseling and education to MMT attendants, to provide family and community support, appropriate methadone dose at first delivery, and to better coordinate with local police department. |
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