武汉市社区美沙酮维持治疗脱失现状及其影响因素

Dropout status and associated factors of community-based methadone maintenance treatment in Wuhan

目的了解武汉市美沙酮维持治疗门诊患者脱失现状,并探讨其影响因素,为提高维持治疗保持率提供参考。方法采用随机整群抽样,对武汉市6家门诊的556名美沙酮维持治疗患者进行问卷调查,运用SPSS 24.0对社会人口学特征、药物滥用、违法犯罪、社会家庭功能以及门诊治疗相关数据进行χ~2检验和多因素Logistic回归分析。结果 556名美沙酮维持治疗患者,治疗脱失率为62.4%;脱失者中无业占52.4%,高中以下占71.8%,个人月收入≥1 000元占73.5%;78.4%的脱失者有吸毒相关传染性疾病;91.3%的脱失者与家人关系一般/较差,51.9%的脱失者与非吸毒朋友没有交往;脱失者中日均服药剂量> 60 mL占73.2%,在民营门诊治疗占70.3%,维持治疗时间> 5年占94.5%。经单因素χ~2分析,上述变量对是否脱失有显著性影响(P <0.05)。经多因素Logistic回归分析,无业、高中以下、个人月收入≥1 000元、有吸毒相关传染性疾病、吸食≥2种毒品、维持治疗时间> 5年是其危险因素,公立门诊治疗是其保护因素。结论武汉市美沙酮维持治疗脱失率较高,应根据患者的不同特征给予针对性的指导和干预,重点关注维持治疗中的社会弱势群体。

Objective To explore the dropout status and associated factors of methadone maintenance treatment(MMT) outpatients in Wuhan, and to provide reference for improving maintenance retention rate. Methods We conducted a questionnaire survey on 556 outpatients in 6 community-based MMT clinics by random cluster sampling, and we used chi-square test and multivariate logistic regression to analyze the data of their general demographic characteristics, drug abuse, illegal crimes, social family functions and treatment. Results There were 556 MMT outpatients, and the dropout rate was 62.4%. Among the dropout outpatients, 52.4% were unemployed, 71.8% received education below high-school, and 73.5% had their monthly income less than 1000 yuan. 78.4% had drug-related infectious diseases, and 10.4% took two or more drugs. 91.3% had normal/bad family relationship, and 51.9% had no contact with non-drug friends. 73.2% had a dose over 60 ml/d;70.3% were treated in private clinics;94.5% had been treated more than 5 years. The single factor analysis-chi-square test showed that the above variables had a significant effect on dropout(P < 0.05). The multivariate logistic regression analysis showed that the risk factors included the unemployed, lower education, monthly income ≥ 1000 yuan, drug-related infectious diseases, take-up of two or more drugs, dosage over 60 ml/d and 5-year treatment. The protective factor was receipt of private MMT services. Conclusion The MMT has a high dropout rate in Wuhan. It’s necessary to pay importance to this and provide intervention based on the various characteristics of patients to improve adherence of medication, especially the socially disadvantaged groups.