云南省德宏州美沙酮维持治疗的社会效应分析

Analysis on social effects of methadone maintenance treatment in Dehong Prefecture,Yunnan Province

目的评价云南省德宏州美沙酮维持治疗(methadone maintenance treatment,MMT)工作开展6年来的社会效应。方法将2005年6月1日～2011年1月4日德宏州所有参加MMT且有随访记录者作为研究对象,以首次入组治疗时建立的"基线调查"作为本次研究的"基线"资料,以最近1次随访评估作为"随访",并按其服药时间分层分析研究对象治疗前后相关指标的变化。结果共有4 306人参加MMT,将其中有随访记录的2 562人(59.5%)作为研究对象。通过MMT,过去1月使用毒品的比例由基线时100.0%下降至随访的13.7%;过去1个月注射毒品者的比例由基线时24.4%下降至随访的9.7%;最近1次性行为安全套使用率由基线时27.9%上升至随访的38.5%;过去3个月发生过违法犯罪行为的比例由基线时11.5%下降至随访的3.9%;目前有工作的比例由基线时24.9%上升至随访的34.1%;HIV感染者的安全套使用率由基线时49.2%上升到随访的73.5%。结论 MMT在促进研究对象减少艾滋病相关高危行为、降低毒品危害、回归社会等方面具有良好的公共卫生意义和社会效应。

Objective To evaluate the social effects of methadone maintenance treatment（MMT） in the past 6 years in Dehong Prefecture,Yunnan Province.Methods All MMT clinic attendants who had been followed-up for at least once from June 2005 to January 2011 in Dehong Prefecture were included for the present study.The first time of entry into MMT was regarded as the baseline.Related indices were compared between the baseline and the follow-up visits by stratification on the length of being treated.Results A total of 4 306 attended MMT,of whom 2 562（59.5%） were included in the study according to subject selection criteria.After MMT,the rate of drug use in the past month decreased from 100.0% at the baseline to 13.7% at the follow-up;the rate of injection drug use in the past month decreased from 24.4% at the baseline to 9.7% at the follow-up;the rate of condom use in the last sexual act increased from 27.9% at the baseline to 38.5% at the follow-up;the rate of criminal engagement in the past 3 month decreased from 11.5% at the baseline to 3.9% at the follow-up;the proportion of having a job increased from 24.9% at the baseline to 34.1% at the follow-up;and the rate of condom use among HIV positives increased from 49.2% at the baseline to 73.5% at the follow-up.Conclusions MMT had significant social effects and public health impacts in terms of reducing HIV-related risk and drug-related harm,and promoting societal returning of MMT attendants.