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Open Access Retention and HIV seroconversion among drug users on methadone maintenance treatment in Yunnan, China

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Setting:

Thirteen methadone maintenance treatment (MMT) clinics across Yunnan, the province with the highest human immunodeficiency virus (HIV) burden in China. Objectives:

To determine, among HIV-negative participants on MMT, the proportion lost to follow-up (defined as those who missed the 6-monthly follow-up examination), factors associated with loss to follow-up (LFU), HIV seroconversion rate and factors associated with seroconversion. Design:

Prospective cohort study from October 2008 to April 2011. All participants were administered a pretested structured questionnaire to capture associated factors and offered HIV testing every 6 months. χ2 test and log-binomial regression were used for data analysis. Results:

Of 1146 participants, 541 (47%) were lost to follow-up in 2.5 years. Factors associated with higher LFU proportion include <6 months of previous MMT, inconvenient location of the MMT clinic and average methadone dose ≤60 mg/day, with adjusted relative risks (RRs) of respectively 1.4 (95%CI 1.2–1.5), 1.2 (95VCI 1.0–1.4) and 1.1 (95%CI 1.0–1.3). The overall HIV seroconversion rate was 6.6 (95%CI 3.7–11.0) per 1000 person-years. Not living with a partner contributed to higher HIV rates, with an adjusted RR of 3.6 (95%CI 1.0–12.8). Conclusion:

The retention rate of MMT participants in Yunnan was not satisfactory. Decentralising service delivery in the community and making directly observed treatment more convenient has the potential to improve retention.

Keywords: clinic; drug users; loss to follow-up; oral substitution treatment; risk factor

Document Type: Research Article

Affiliations: 1: The Red Cross Hospital of Yunnan Province, Kunming, China 2: International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India 3: World Health Organization India Country Office, New Delhi, India 4: HIV/AIDS Asia Regional Programme, Kunming, China 5: REACH, Chennai, India 6: Public Health Foundation of India, New Delhi, India 7: Tianjin Centers for Disease Control and Prevention, Tianjin, China 8: School of Public Health, Fudan University, Shanghai, China

Publication date: 21 March 2014

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  • Public Health Action (PHA), The Union's quarterly Open Access journal, welcomes the submission of articles on operational research. It publishes high-quality scientific research on health services, providing new knowledge on how to improve access, equity, quality and efficiency of health systems and services.

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