综合强化干预措施提高美沙酮服用剂量效果分析

Effectiveness of integrated and intensified interventions on increasing methadone dose among clients of methadone maintenance treatment (MMT) in China

目的评估综合强化干预措施提高美沙酮维持治疗(MMT)病人美沙酮服用剂量的效果。方法选取MMT门诊60个,分层配对后,以门诊为单位随机分配到干预组或对照组,在干预组实施综合强化干预措施,对照组为常规防治工作。采用混合效应模型以及多因素Logistic回归分析,评价综合强化干预对提高美沙酮服用剂量的效果。结果共入组6 631人,干预组3 797人,对照组2 834人。干预组美沙酮日均服用剂量从(64.1±35.4)mg/d提高到(68.9±38.2)mg/d,对照组美沙酮日均服用剂量从(61.4±33.6)mg/d提高到(63.3±34.1)mg/d,在控制了社会人口学等因素后,混合效应模型分析结果表明,美沙酮日均服用剂量在两组间的差异有统计学意义(F=48.69,P<0.0001)。干预组和对照组美沙酮日均服用剂量提高者所占比例分别为58.8%和53.5%(χ2=34.78,P<0.0001)。多因素Logistic回归分析表明,综合强化干预是提高美沙酮日均服用剂量有意义的影响因素(OR=1.236,95%CI:1.119～1.364)。结论综合强化干预措施对提高美沙酮服用剂量有一定效果,但是提高幅度有限,需要进一步分析原因。

Objective To evaluate the effectiveness of integrated and intensified interventions on increasing methadone dose among clients of methadone maintenance treatment （MMT） in China. Methods Sixty MMT clinics were selected, stratified by province, and matched by size and HIV prevalence,then were randomly assigned into intervention or control group. Integrated and intensified interventions were implemented in the intervention group and routine MMT services were provided in the control group. Mixed-effect model and multiple logistic regression analysis were used to evaluate the effectiveness of integrated and intensified interventions on increasing methadone dose . Results A total of 6 631 participants were enrolled, of whom 3 797 were in the intervention group and 2 834 were in the control group. Mean daily methadone dose increased from 64. 1＋35.4 （mg/d） to 68. 9±38. 2 （mg/d） in the intervention group, while that increased from 61.4±33. 6 （mg/d） to 63. 3 ± 34. 1 （mg/d） in the control group. Mixed effects model showed significant differences between the two groups when demographic factors were controlled （F= 48. 69, P〈0. 0001）. The proportion of participants who increased mean daily dose of methadone was 58. 8% and 53. 5% in the intervention group and the control group, respectively （χ^2 =34. 78,P〈0. 001）. Multiple logistic regression analysis showed that integrated and intensified interventions were related to the increase of mean daily methadone dose （OR=1. 236,95%CI：1. 119-1. 364）. Conclusion Integrated and intensified interventions exert some effect on increasing mean daily dose of methadone, but not dramatic, and the reason needs further study.