Investigation of Repeat Client Drop-Out and Re-Enrolment Cycles in Fourteen Methadone Maintenance Treatment Clinics in Guangdong, China

Client adherence is vital for effective methadone maintenance treatment (MMT). This study explores the pattern and associated factors of client adherence, drop-out and re-enrolment in the Chinese MMT programme over the period of 2006–2013.

This retrospective study was conducted in 14 MMT clinics in Guangdong Province, China. We employed Kaplan-Meier survival analysis to estimate the rates of drop-out and re-enrolment of MMT clients and multivariate Cox regression to identify associated factors.

Among 1,512 study participants, 79% have experienced ‘drop-out’ during the 7-year study period. However, 82% ‘dropped-out’ clients resumed treatment at a later time. Low education level (junior high or below versus otherwise, HR = 1.21, 1.05–1.40), low methadone dosage in the first treatment episode (<50 ml versus ≥50 ml, HR = 1.84, 1.64–2.06) and higher proportion of positive urine test (≥50% versus<50%, HR = 3.72, 3.30–4.20) during the first treatment episode were strong predictors of subsequent drop-outs of the participants. Among the ‘dropped-out’ clients, being female (HR = 1.40, 1.23–1.60), being married (HR = 1.19, 1.09–1.30), and having a higher proportion of positive urine tests in the first treatment episode (≥50% versus<50%, HR = 1.35, 1.20–1.51) had greater likelihood of subsequent re-enrolment in MMT. Clients receiving lower methadone dosage (first treatment episode <50 ml versus ≥50 ml, HR = 1.12, 1.03–1.23; the last intake before drop-out <50 ml versus ≥50 ml, HR = 1.16, 1.04–1.30) were also more likely to re-enrol.

Persistent cycling in-and-out of clients in MMT programmes is common. Insufficient dosage and higher proportion of positive urine samples in the first treatment episode are the key determinants for subsequent client drop-out and re-enrolment. Interventions should target clients in their early stage of treatment to improve retention in the long term.

Below: Geographical location, HIV prevalence and 12-month retention rates of study participants in 14 MMT clinics in Guangdong province in 2013

Below:  Kaplan-Meier failure curve for (a) probability of drop-out after first enrolment; (b) probability of re-enrolment from the onset of first drop-out

Below:  Duration of MMT participation and gaps between dropout and re-enrolment events

Below:  Associated factors of drop-out and re-enrolments of MMT participants based on multivariate Cox regression

Full article at: http://goo.gl/KGwNKp

By: 

Lei Zhang, Xia Zou, Di Zhang, Xiaoling Li, Peizhen Zhao, Li Ling

Sun Yat-sen Centre for Migrant Health Policy, Sun Yat-sen University, #74, Zhongshan Road II, Guangzhou, 510080, P.R. China

Lei Zhang

The Kirby Institute, University of New South Wales, Sydney, NSW, Australia

Xia Zou, Di Zhang, Xiaoling Li, Peizhen Zhao, Li Ling

Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, #74, Zhongshan Road II, Guangzhou, 510080, P.R. China

Di Zhang

Office of Medical Science, Sun Yat-sen University, Guangzhou, P. R. China

  

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