Retention of people who inject drugs enrolled in a ‘medications for opioid use disorder’ (MOUD) programme in Uganda

IF 3.7 2区医学 Q1 SUBSTANCE ABUSE

Addiction Science & Clinical Practice Pub Date : 2024-05-15 DOI:10.1186/s13722-024-00468-4

Peter Mudiope, Brian Byamah Mutamba, Liz Komuhangi, Joan Nangendo, Stella Alamo, Bradley Mathers, Fredrick Makumbi, Rhoda Wanyenze

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引用次数: 0

Abstract

Injection Drug use is associated with increased HIV risk behaviour that may result in the transmission of HIV and poor access to HIV prevention and treatment. In 2020, Uganda introduced the ‘medication for opioid use disorder (MOUD) treatment’ for People who inject drugs (PWID). We analysed the 12-month retention and associated factors among PWID enrolled on MOUD treatment in Kampala, Uganda. We conducted a retrospective analysis of 343 PWID with OUD who completed 14 days of methadone induction from September 2020 to July 2022. Retention was defined as the number of individuals still in the programme divided by the total number enrolled, computed at 3-, 6-, 9-, and 12 months using lifetable and Kaplan-Meier survival analyses. Cox proportional regression analyses were conducted to assess factors associated with retention in the programme in the first 12 months. Overall, 243 (71%) of 343 participants stabilized at a methadone dose of 60 mg or more. The majority of participants were males (n = 284, 82.8%), and the median (interquartile range, IQR) age was 31 (26–38) years. Most participants (n = 276, 80.5%) lived 5 km or more away from the MOUD clinic. Thirty (8.8%) were HIV-positive, 52 (15.7%) had a major mental illness and 96 (27.9%) had a history of taking alcohol three months before enrollment. The cumulative retention significantly declined from 83.4% (95%CI = 79.0–87.0) at 3months to 71.9% (95%CI = 67.2–76.6) at 6months, 64% 95%CI = 58.7–68.9) at 9months, and 55.2%; 95% CI (49.8–60.3% at 12months. The 12-month retention was significantly higher for participants on methadone doses of 60 mg or more (adj.HR = 2.1, 95%CI = 1.41–3.22), while participants resident within 5 km of the MOUD clinic were 4.9 times more likely to be retained at 12 months, compared to those residing 5 km or more, (adj. HR = 4.81, 95%CI = 1.54-15). Other factors, including predisposing, need, and enabling factors, were not associated with retention. Our study demonstrates acceptable 12-month retention rates for people who inject drugs, comparable to previous studies done in both developing and developed countries. Sustaining and improving retention may require enhanced scaling up of MOUD dose to an optimal level in the first 14 days and reducing the distance between participant locale and MOUD clinics.

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乌干达参加 "阿片类药物使用失调"（MOUD）计划的注射吸毒者的留用情况

注射吸毒与艾滋病毒风险行为的增加有关，可能导致艾滋病毒的传播，并使人们难以获得艾滋病毒的预防和治疗。2020 年，乌干达为注射吸毒者（PWID）引入了 "阿片类药物使用障碍（MOUD）治疗"。我们分析了乌干达坎帕拉接受 MOUD 治疗的注射吸毒者的 12 个月保留率和相关因素。我们对 2020 年 9 月至 2022 年 7 月期间完成 14 天美沙酮诱导治疗的 343 名患有 OUD 的吸毒者进行了回顾性分析。留存率的定义是仍在接受治疗的人数除以注册总人数，使用生命表和卡普兰-米尔生存分析法计算3个月、6个月、9个月和12个月的留存率。我们还进行了 Cox 比例回归分析，以评估与前 12 个月继续参与计划相关的因素。总体而言，343 名参与者中有 243 人（71%）的美沙酮剂量稳定在 60 毫克或以上。大多数参与者为男性（284 人，82.8%），年龄中位数（四分位数间距，IQR）为 31（26-38）岁。大多数参与者（n = 276，80.5%）的居住地距离 MOUD 诊所 5 公里或更远。30人（8.8%）为艾滋病病毒阳性，52人（15.7%）患有重大精神疾病，96人（27.9%）在入组前三个月有饮酒史。累计保留率从 3 个月时的 83.4% (95%CI = 79.0-87.0) 明显下降到 6 个月时的 71.9% (95%CI = 67.2-76.6)、9 个月时的 64% (95%CI = 58.7-68.9)和 12 个月时的 55.2%; 95% CI (49.8-60.3%)。美沙酮剂量为60毫克或以上的参与者12个月的保留率明显更高（adj.HR = 2.1, 95%CI = 1.41-3.22），而居住在距离MOUD诊所5公里以内的参与者12个月的保留率是居住在5公里或以上的参与者的4.9倍（adj.HR = 4.81, 95%CI = 1.54-15）。其他因素，包括倾向因素、需求因素和有利因素，与保留率无关。我们的研究表明，注射吸毒者的 12 个月保留率是可以接受的，与之前在发展中国家和发达国家进行的研究结果相当。要维持和提高保留率，可能需要在最初的 14 天内将 "谅解备忘录 "的剂量提高到最佳水平，并缩短参与者所在地与 "谅解备忘录 "诊所之间的距离。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction Science & Clinical Practice Psychology-Clinical Psychology

CiteScore

3.90

自引率

10.80%

发文量

审稿时长

28 weeks

期刊介绍： Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings. Addiction Science & Clinical Practice accepts articles of clinical relevance related to the prevention and treatment of unhealthy alcohol, tobacco, and other drug use across the spectrum of clinical settings. Topics of interest address issues related to the following: the spectrum of unhealthy use of alcohol, tobacco, and other drugs among the range of affected persons (e.g., not limited by age, race/ethnicity, gender, or sexual orientation); the array of clinical prevention and treatment practices (from health messages, to identification and early intervention, to more extensive interventions including counseling and pharmacotherapy and other management strategies); and identification and management of medical, psychiatric, social, and other health consequences of substance use. Addiction Science & Clinical Practice is particularly interested in articles that address how to improve the quality of care for people with unhealthy substance use and related conditions as described in the (US) Institute of Medicine report, Improving the Quality of Healthcare for Mental Health and Substance Use Conditions (Washington, DC: National Academies Press, 2006). Such articles address the quality of care and of health services. Although the journal also welcomes submissions that address these conditions in addiction speciality-treatment settings, the journal is particularly interested in including articles that address unhealthy use outside these settings, including experience with novel models of care and outcomes, and outcomes of research-practice collaborations. Although Addiction Science & Clinical Practice is generally not an outlet for basic science research, we will accept basic science research manuscripts that have clearly described potential clinical relevance and are accessible to audiences outside a narrow laboratory research field.