Barcelona 2013
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| Abstract #192 - Drugs and Alcohol | ||||
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Session: 22.7: Drugs and Alcohol (Parallel) on Monday @ 16.30-18.30 in Mirador Chaired by Sam Friedman, Rosa Mansilla Authors: Presenting Author: Dr Jing Gu - Sun Yat-sen University, China |
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| Additional Authors: Dr. Patricia Solomon, Mr. Larry Baxter, Dr. Alan Casey, Mr. Will Chegwidden, Mr. Duncan MacLachlan, Dr. Joy MacDermid, Ms. Anne-Marie Tynan, Dr. Greg Robinson, Dr. Barry Trentham, Ms. Janet Wu, Ms. Elisse Zack, | ||||
| Aim: Methadone maintenance treatment (MMT) is a key risk reduction measure for controlling HIV transmission among injecting drug users. While some successes have been claimed, high drop-out rate and poor adherence are serious problems compromising its effectiveness. Studies using traditional methods exist to distinguish between drop-outs and non-drop-outs. However, many non-drop-outs use MMT discontinuously and no study has identified contextual factors predicting their showing or not showing up. This study used a special epidemiological method, the case crossover design comparing characteristics appearing on the last episode of attendance versus those of the last episode of non-attendance, hence controlling for all within-individual characteristics and resulting confounding bias. | ||||
| Method / Issue: Using the case crossover design, a total of 133 participants of 3 MMT centers in Guangzhou China that did not attend the clinic everyday in the last month, despite the requirement of daily attendance, were anonymously and face-to-face interviewed. They were asked separately whether various types of contextual factors (e.g. emotional problem, financial problem, bad weather) exist in the last episode of non-attendance to the MMT clinic and in the last episode of attendance (today). Paired odds ratios (OR) based on conditional logistic regression analysis were presented. | ||||
| Results / Comments: Of the participants, 88.1% were males. They attended the MMT clinics on average for 23 days in the last month. Five types of contextual risk factors were found to be significant in predicting attendance over non-attendance, including (1) mental and physical health factors: bad mood (paired OR=7.5, p<0.001), occurrence of an unhappy event (paired OR=18, p<0.001), conflict with family members (OR not estimated with a zero cell) and illness (paired OR=33, p<0.001), (2) financial difficulty (paired OR=16.5, p=0.004), (3) other engagements: work (paired OR=40, p<0.001), work trips (paired OR not estimated with a zero cell), and social activities (paired OR=10, p=0.012), (4) negative peer influence: interaction with peer drug users (paired OR=7, p=0.07) and being asked by someone not to go (OR not estimated by a zero cell) and (5) worry about police arrest (paired OR=13, p=0.003). Family reminder is a strong protective factor. Non-significant factors include bad weather, poor relationship with doctor, and reduced dosage (p>0.05). | ||||
| Discussion: It is seen that interventions promoting MMT adherence need to consider contextual factors. Enhancement of psychological and social support is potentially important. Policy issues on financial requirement (10 RMB per day) and coordination with police department needs to be addressed. Self-efficacy to resist from negative peer influence is also required. Occasional non-attendance may develop into drop-out. Early interventions taking these factors into account are greatly warranted. | ||||
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