| Background: The methadone maintenance treatment programme in China was established in 2004. Since that time more than 250,000 clients have registered for treatment. The purpose of the present study was five-fold: 1) to describe the Chinese MMT cohort; 2) to estimate the client retention rate and identify client factors associated with longer retention; 3) to estimate the change in the proportion of clients engaging in drug-related HIV-risk behaviours; 4) to estimate the proportion of clients who continue to engage in illicit drug use in treatment and the factors associated with use; and 5) to estimate the change in clients' social functioning in terms of criminal behaviour, their relationships with their families and friends and employment.;Methods: Data on all clients are maintained in a data system managed by the National Centre for AIDS/STD Control and Prevention. The data collected include demographic information and detailed drug use, sexual and criminal history, and tests are performed for HIV and hepatitis C. Data were abstracted from the initiation of the programme, 23 March 2004, to 23 March 2010. A cohort profile was first developed describing the MMT cohort since 2004 and how it has grown and changed with the programme's expansion. Data were then abstracted for the two years from 23 March 2008 to 22 March 2010 for further analysis. Missing values were imputed using the multiply imputed chained equations, ICE, programme available in Stata 11. The median time in treatment was estimated using time-to-event methods, including Kaplan-Meier plots and accelerated failure time models including a frailty term for the clinic attended. Next, the changes in drug-use, HIV risk behaviours and social functioning among clients remaining in treatment at least 6 months were examined using paired t-tests for continuous variables and McNemar's tests for categorical variables. Factors associated with continued drug use were examined using logistic regression models. Variables in the models included those previously identified to be associated with retention or drug use in other MMT programmes.;Results: Some 251,976 clients enrolled in the programme during its first 6 years. As the programme expanded, the types of clients enrolling changed, particularly in terms of their HIV-risk behaviours such as injecting, needle sharing and HIV status, which were less common in subsequent years. Among 107,740 clients enrolled in MMT between 2008 and 2010, the median time spent in MMT among clients was 155 days and the majority (69%) did not attend every day. Longer time in treatment was associated with doses ≥60mg (TR=2.1, 95%CI=2.03-2.22), daily attendance (TR=2.9, 95%CI=2.80-3.07) and having a positive opiate test in last month of treatment (TR=0.25, 95%CI=0.24-0.26). Clients remaining in treatment 6 months or more (n=55,214) with a 6-month evaluation record (n=19,026), reported reduced drug use and related risk behaviours, but little change in safe sex behaviours. There were more clients reporting no crimes, good family relationships and employment than at baseline. Factors associated with continued drug use in treatment included percent adherence (OR=0.05, 95%CI=0.03-0.07), the frequency a client saw his/her drug using friends (OR=0.28 for never v daily, 95%CI=0.24-0.33) and the client's relationship with his/her family (OR=1.96 for difficult v good, 95%CI=1.59-2.46).;Conclusions: The Chinese MMT programme suffers from average durations of treatment far short of that needed to recover from addiction. Moreover, a majority of clients do not attend on a daily basis suggesting significant barriers to access that need further investigation. Increasing accessibility of the programme is urgently needed to recognise improvements in clients, as it was clear that those who did remain in treatment reduced their drug-related HIV risk and socially undesirable behaviours. It was not possible to examine several important covariates, such as the use of ancillary services by clients, incentives for adherence, and the treatment goals of clients and staff. Further work is needed to understand why and how clients cycle in and out of treatment. |
