Improvements in Health-Related Quality of Life among Methadone Maintenance Clients in Dar Es Salaam, Tanzania
BACKGROUND:
Injection
of heroin has become widespread in Dar es Salaam, Tanzania and is spreading
throughout the country. To prevent potential bridging of HIV epidemics, the
Tanzanian government established a methadone maintenance treatment (MMT) clinic
in February 2011. We assess the effect of MMT on health-related quality of life
(HRQOL) and examine factors, particularly HIV infection and methadone dose,
associated with changes in HRQOL.
METHODS:
This
study utilized routine data on clients enrolling in methadone from February
2011 to April 2012 at Muhimbili National Hospital. Change in physical (PCS) and
mental health (MCS) composite scores, as measured by the SF-12 tool, were the
primary outcomes. Backward stepwise linear regression, with a criterion of
p<0.2 was used to identify baseline exposure variables for inclusion in
multivariable models, while adjusting for baseline scores.
RESULTS:
A total
of 288 MMT clients received baseline and follow-up assessments. Mean methadone
dose administered was 45mg (SD±25) and 76 (27%) were confirmed HIV-positive.
Significant improvements were observed in PCS and MCS, with mean increases of
15.7 and 3.3, respectively. In multivariable models, clients who had previous
poly-substance use with cocaine [p=0.040] had a significantly higher mean
change in PCS. Clients who were living with HIV [p=0.002]; satisfied with
current marital situation [p=0.045]; had a history of suicidal thoughts
[p=0.021]; and previously experienced cognitive difficulties [p=0.012] had
significantly lower mean change in PCS. Clients with shorter history of heroin
use [p=0.012] and who received higher methadone doses [p=0.028] had
significantly higher mean change in MCS, compared to their counterparts.
CONCLUSION:
Aspects
of mental and physical health, risk behaviors and quality of life among drug
users are intertwined and complex. Our research revealed positive short-term
effects of MMT on HRQOL and highlights the importance of sustained retention
for optimal benefits. Comprehensive supportive services in addition to
provision of methadone are needed to address the complex health needs of people
who inject drugs.
- 1Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania.
- 2Pangaea Global AIDS, 436 14th St, Suite 920, Oakland, CA 94612, USA.
- 3Yale University, New Haven, CT 06520, USA.
- 4Tanzania Ministry of Health and Social Welfare, 6 Samora Machel Ave, Dar es Salaam, Tanzania.
- 5University of Texas School of Public Health, 7000 Fannin St, Houston, TX, USA.
- 6RTI-International, 351 California St, Suite 500, San Francisco, CA 94104, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. Electronic address: blambdin@rti.org.
- Int J Drug Policy. 2016 Mar 11. pii: S0955-3959(16)30065-2. doi: 10.1016/j.drugpo.2016.03.005
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