Expanding gender-sensitive and equitable substance use care models: treatment retention analysis of the women's drug dependent treatment program (PROMUD) replication in psychosocial units in Brazil.

Purpose: This study examines the challenges and opportunities of implementing gender-equitable substance use disorder (SUD) treatment models in Brazil by revisiting a public policy initiative carried out between 2004 and 2006. During this initiative, a structured model of care, the Women's Drug Dependent Treatment Program (PROMUD), was replicated in two additional psychosocial care units in São Paulo. The study seeks to contribute to the visibility of a historically hidden population of women with SUD by comparing treatment retention across the three centers and identifying risk factors associated with dropout.

Method: This observational, non-randomized post hoc analysis examined clinical data from 200 women who enrolled in PROMUD-based programs across three distinct psychosocial care centers-CAPS-AD Centro (DT), CAPS-AD Jardim Nélia (JN), and the original PROMUD site. All centers implemented the model concurrently using a standardized protocol. Treatment retention was defined as weeks between program admission and dropout (max follow-up: 104 weeks). Drop-out was defined as leaving treatment for reasons other than referral, improved discharge, administrative discharge, or death. Kaplan-Meier survival curves were used to estimate retention, and Cox proportional hazards models identified predictors of dropout.

Results: 200 women were included, PROMUD had a higher percentage of white, educated and employed participants. DT had the highest prevalence of unstable housing and prostitution history. PROMUD and JN showed comparable retention at 104 weeks (44.8% and 42.4%), whereas DT exhibited the lowest retention (17.3%). Age was a protective factor (HR = 0.94, p < 0.001), substance of choice was not significantly associated with dropout.

Conclusion: Gender-specific care models can be effectively implemented in resource-limited, community-responsive care units, though their success depends on local population characteristics and territorial dynamics. Despite the time gap since the original project, the challenges remain similar or have intensified.