New Community-Based Methadone Maintenance Treatment Programs in Guangdong, China, and Their Impact on Patient Quality of Life

Abstract

A cohort of 516 patients at two community-based methadone maintenance treatment (MMT) clinics in Guangdong province, China, was interviewed at initiation of treatment and at 1, 3, and 6 months of follow-up to collect demographic information, drug use experience, social support, and changes of quality of life (QOL) over treatment. Covariance analysis and generalized estimation equation model were used to compare the QOL scores over time and to identify factors possibly influencing QOL scores. The results suggested that MMT is effective at improving QOL scores in physical, psychological, and social domains. Being currently employed, having good family relationships, job as the source of income, and particularly a longer time in treatment were significantly associated with QOL improvements in at least one domain. The study's limitations are noted.

RÉSUMÉ

Nouveaux programmes communautaires de traitement de maintien à la méthadone et leurs impacts sur la qualité de vie des patients, à Guangdong, Chine.

Une cohorte de 516 patients provenant de deux cliniques communautaires de traitement de maintien à la méthadone (TMM) dans la province de Guangdong a été interviewée en début de traitement, après un, trois et six mois de suivi afin de collecter des informations démographiques, ainsi que sur la consommation de drogues, le support social et les changements de la qualité de vie (QDV) durant le traitement. Des analyses de covariance et des modèles d’équations d’estimation généralisée ont été utilisés afin de comparer les scores de QDV dans le temps et d’identifier les facteurs pouvant les influencer. Les résultats suggèrent que le TTM est efficace pour améliorer les scores de QDV dans les domaines physiques, psychologiques et sociaux. Avoir présentement un emploi, de bonnes relations familiales, un emploi comme source principale de revenu, et particulièrement, avoir été sous traitement plus longtemps étaient tous des facteurs associés de façon significative avec l’amélioration de la QDV dans au moins un domaine.

Mots-clés: traitement de maintien à la méthadone (TMM); dépendance aux opioïdes; qualité de vie (QDV); évaluation de programme; Chine

RESUMEN

Nuevos Programas Comunitarios sobre Tratamiento de Mantenimiento con Metadona en Guangdong, China, y su Impacto en la Calidad de Vida del Paciente

Se realizaron entrevistas en dos clínicas comunitarias de tratamiento de mantenimiento con metadona (MMT) en la provincia de Guangdong a un cohorte de 516 pacientes al inicio del tratamiento y a 1, 3 y 6 meses de seguimiento para recolectar información demográfica, experiencias en el uso de drogas, sostén social y cambios en la calidad de vida (QOL) a lo largo del tratamiento. Se utilizaron análisis de covarianza y ecuación de estimación generalizadas para comparar los resultados de QOL a lo largo del tiempo e identificar factores que posiblemente influyan en estos resultados. Los resultados obtenidos sugirieron que el MMT es efectivo en el mejoramiento de los resultados de QOL en los aspectos físicos, psicológicos y sociales. Poseer actualmente un empleo, tener buenas relaciones familiares, un trabajo como la fuente de ingresos, y especialmente una mayor duración del tratamiento fueron asociados significativamente con mejoramientos en QOL en al menos uno de los aspectos mencionados.

Palabras clave: tratamiento de mantenimiento con metadona (MMT); dependencia de opio; calidad de vida (QOL); evaluación de programa; China

Keywords :

• methadone maintenance treatment (MMT)
• opioid dependence
• quality of life (QOL)
• program evaluation
• China

THE AUTHORS

Qun He completed his Ph.D. in epidemiology and biostatistics at the Sun Yat-sen University. He has been working on HIV/AIDS prevention and control since 1997 and currently is a professor of epidemiology at the Institute of HIV/AIDS, Center for Disease Prevention and Control of Guangdong province, China. His interests in this research field include interventions to substance use and other risk behaviors related to HIV/AIDS.

Xiaorong Wang completed her Ph.D. in China in 1989 and accepted postdoctoral training at the Tokyo University in 1995 and Harvard School of Public Health in 1998. She is currently an associate professor at the School of Public Health and Primary Care, Chinese University of Hong Kong. Her research area mainly lies in environmental and occupational epidemiology and cancer epidemiology. She is also interested in working on epidemiologic study on HIV infection/drug abuse in China.

Yinghua Xia is a Ph.D. candidate at the Sun Yat-sen University. She has been studying on methadone maintenance treatment programs since 2007. Her present research interest is related to process evaluation of substitution treatment.

Jeffrey S. Mandel, Ph.D., M.P.H., is Director of International Training at the Institute of Global Health and Codirector of the Global Response Core, Center for AIDS Prevention Studies, University of California, San Francisco. He is a clinical psychologist who has been involved in HIV/AIDS prevention and care since 1983.

Ang Chen completed his master's degree in epidemiology and biostatistics at the Sun Yat-sen University. His master's thesis was related to retention time of methadone maintenance. He is currently working as a researcher in a general hospital in Zhonshan city, Guangdong province.

Lili Zhao, having completed her master's degree at the Sun Yat-sen University in 2008, now is working in Nansha Entry–Exit Inspection and Quarantine Bureau, Guangdong. Her master's thesis was related to evaluation of effectiveness of methadone maintenance treatment in Guangdong province.

Lu Han completed her master's degree in 2003 at the School of Public Health, Sun Yat-sen University, Guangzhou. Her main areas of research and teaching expertise are in substance use and abuse, epidemiology, and health policy. She is currently a doctoral student at the Sun Yat-sen University and has worked on projects involving the migrant health policy and intervention of drug abusers.

Li Ling, Ph.D., is a professor of medical statistics and epidemiology at the School of Public Health, Sun Yat-sen University, since 2004. Her main research interests are evaluation of methadone maintenance treatment program and health policies on the migrant population.