中国首批8个社区美沙酮维持治疗门诊5年治疗效果分析

Evaluation on the long-term effectiveness among the first set eight methadone maintenance treatment clinics in China

目的分析中国首批8个社区美沙酮维持治疗（MMT）门诊的长期治疗效果。方法在MMT门诊开诊（基线）及运行5年后（5年评估）两个时间点，采用一对一问卷调查的方法，比较分析研究对象的人口学特征、HIV感染危险行为、毒品滥用相关违法犯罪、家庭社会功能恢复等。结果基线与5年评估调查的研究对象分别为252人和195人，其中66人参加了2次调查。基线与5年评估时研究对象在民族、文化程度、职业、婚姻状况、居住状况等特征差异无统计学意义（P〉0．05）。参加MMT后，研究对象在毒品滥用（100．0％VS．24．1％，P〈0．001）、共用注射器吸毒（19．4％US．0．0％，P〈0．001）及凶毒品而与他人发生性行为（34．5％V．S．0．0％，P〈0．001）等HIV感染危险行为方面有显著降低。在安全套使用率（10．6％VS．25．0％，P=0．004）、有工作的比例（27．8％VS．47．7％，P〈0．001）、吸毒相关违法犯罪发生率（15．1％阮1．5％，P〈0．001）及与吸毒人员交往比例（88．9％VS．31．3％，P〈0．001）均有明显改善。结论MMT在降低HIV感染危险行为、恢复社会功能、减少违法犯罪等方面具有显著作用。应通过加强培训等措施，提高工作人员能力及服务质量，尽可能减少脱失、延长治疗时间。

Objective To evaluate the long-term effectiveness of the first set 8 methadone maintenance treatment （MMT） clinics in China. Methods Repeated cross-sectional surveys were conducted on the first month after the enrollment and 5 years later, among drug users who received MMT, using a standard questionnaire. Data on demographic characteristics, HIV-related high-risk behaviors, criminal records associated with drug use and related family/social functions were collected and analyzed. Results There were 252 and 195 participants being interviewed at the baseline and the 5-year surveys, respectively. Of them, 66 participants were involved in both surveys. There was no significant differences on factors as ethnicity, level of education, working status, marital status and living status （P〉0.05） between the baseline and the 5-year surveys. Compared with data from the baseline survey, participants＇ behavior on drug abuse （100.0% vs. 24.l%, P〈0.001 ）, needle sharing behavior （ 19.4% vs. 0.0%,P〈0.001 ）, and exchanging sex for drugs （34.5% vs. 0.0%,P＇〈0.001 ） had significant decreases at the 5-year survey. Rates on condom use （10.6% vs. 25.0%, P--0.004）, and having jobs （27.8% vs. 47.7%, P〈0.001） had been improved significantly, while self-reported criminal cases related to drug use （15.1% vs. 1.5%, P〈0.001） and the contacts with drug users （88.9% vs. 31.3% , P〈0.001） had been significantly reduced after joining the MMT program. Conclusion MMT could play an active role in reducing the HIV-related high-risk behaviors, criminal cases associated with drug abuse as well as enhancing the family and social functions of the MMT patients. Providing high quality service to the MMT clinic and trying to keep the drug users stick to the program remain difficult. It was also important to improve the training programs for staff working at the MMT clinics.