河南省美沙酮维持治疗患者脱失情况及影响因素分析

Status and influencing factors of drop-out from methadone maintenance treatment in Henan Province

目的了解河南省美沙酮维持治疗(MMT)门诊患者脱失情况及相关影响因素,为今后降低脱失率、开展针对性干预工作提供参考。方法选取自河南省2008年9月开设MMT门诊工作以来至2021年12月31日,各MMT门诊入组治疗并有完整基线调查资料的阿片类物质成瘾者,收集其基本人口学特征、既往注射吸毒情况、吸食毒品种类、吸毒年龄、美沙酮维持治疗时间、戒毒情况及脱失原因等信息。采用χ2检验进行单因素分析,Cox比例风险回归模型分析可能的影响因素。结果共纳入4323名吸毒者,男女比3.93∶1,保持治疗时间为0~12.58年,中位时间为3.244(95%CI:3.138~3.349)年。其中脱失者4040人(93.45%),因再次偷吸被强制隔离戒毒导致脱失的比例最高(35.02%)。Cox比例风险回归模型分析结果显示,目前没有工作(HR=1.305,95%CI:1.189~1.433)、初次吸毒年龄为40~<50岁(与<30岁组相比,HR=1.220,95%CI:1.098~1.355)、近一个月与毒友交往(HR=1.387,95%CI:1.295~1.484)、HCV阴性(HR=1.198,95%CI:1.080~1.328)的MMT入组者脱失风险较高;汉族(HR=0.840,95%CI:0.743~0.951)、高中(含中专)(与初中及以下组相比,HR=0.885,95%CI:0.822~0.952)、经济来源为社会福利(与家庭供给组相比,HR=0.596,95%CI:0.491~0.724)、既往入组2次及以上(HR=0.531,95%CI:0.496~0.569)的MMT入组者脱失风险较低。结论河南省MMT者治疗脱失率较高,应针对影响因素加大对入组者的宣传及随访干预,提高其维持治疗率。

Objective To understand the status and influencing factors of drop-out from methadone maintenance treatment(MMT)in Henan Province,so as to provide a reference for reducing the dropout rates and targeting specific interventions in the future.Methods Patients with opioid addiction who were enrolled in MMT clinics in Henan Province and had complete baseline data from September 2008,when MMT outpatient services started in Henan,to December 31,2021 were included in this study.Information on basic demographic characteristics,history of injection drug use,type of drug use,age of drug use,duration of MMT treatment,detoxification status and reasons for dropping out were collected.χ2 test was used for univariate analysis,and Cox proportional hazards regression model was used for multivariate analysis.Results A total of 4323 drug abusers were included in the study,with a male to female ratio of 3.93:1.The MMT duration was between 0-12.58 years,with a median of 3.244(95%CI:3.138-3.349)years.Of them,4040(93.45%)dropped out,and the highest proportion was due to forced isolation and detoxification(35.02%).Cox proportional hazards regression model analysis showed that the participants with no job(HR=1.305,95%CI:1.189-1.433),age of initial drug use between 40 and<50 years(HR=1.220,95%CI:1.098-1.355),contact with drug-use friends during the past month(HR=1.387,95%CI:1.295-1.484),and HCV negative(HR=1.198,95%CI:1.0801.328)were more likely to drop out of MMT;the participants with Han ethnicity(HR=0.840,95%CI:0.743-0.951),having high school education(including technical secondary school)(HR=0.885,95%CI:0.822-0.952),having social welfare as the income source(HR=0.596,95%CI:0.491-0.724),and having been enrolled twice or more than twice in the past(HR=0.531,95%CI:0.496-0.569)were less likely to drop out of MMT.Conclusions The rate of drop-out from MMT was high in Henan Province.Education publicity and follow-up interventions for the participants based on influencing factors should be enhanced for improving the retention rate of MMT.