IMPACT OF METHADONE MAINTENANCE THERAPY ON HIV INCIDENCE IN PERAK, 2008 - 2017: A COX REGRESSION ANALYSIS
DOI:
https://doi.org/10.37268/mjphm/vol.19/no.1/art.39Keywords:
Methadone, Cox regression, HIV seroconversion, survival analysisAbstract
In 2005, Ministry of Health introduced the Needle Syringe Exchange Program (NSEP) and Methadone Maintenance Therapy (MMT) program as a part of Harm Reduction program to combat HIV infection in Malaysia among people who inject drug (PWIDs). Expenditures were estimated approximately RM10 millions per year to establish and sustain the NSEP and MMT centres. This study examined the impact of MMT program on preventing HIV seroconversion among registered MMT clients that are people who inject drug (PWIDs), and to identify other predictors of HIV seroconversion among this group. This was a retrospective cohort study done in the state of Perak involving a total of 212 randomly selected MMT clients registered between 2008-2017 in 6 clinics. This study looks at data collected from the last ten-year cohort from baseline to follow-up. A questionnaire was used to obtain socio-demographic data, sexual and drugs abuse history. Test results for HIV were obtained from medical records. Cox regression analysis was performed to examine factors associated with seroconversion and Kaplan-Meier analysis to estimate HIV survival time. This study displayed that both Methadone take home supply (HR 10.4, 95% CI: 1.6 – 68.8) and unprotected sexual practice (HR 5.9, 95%CI: 1.1 – 31.5) shown higher risks of HIV seroconversion compared to DOTS and condom practice among MMT clients respectively. Mean survival for HIV seroconversion among MMT clients was 104.44 (95%CI: 101.85 – 107.04) months. This study provides reliable evidence that MMT program markedly reduces incidence of HIV infection among people who inject drug (PWIDs).
References
Malaysian Psychiatric Association. Drug Addiction 2006. www.psychiatry-malaysia.org/article.php?aid=90 (accessed 14 February 2016
Malaysian AIDS Council. Annual Report 2006. www.mac.org.my/v3/pdf/report2006.pdf (accessed 14 February 2016)
Malaysian AIDS Council. Annual Report 2013. www.mac.org.my/v3/wp-content/uploads/2014/05/Annual-Report-2013_A4_FA_22052013-web.pdf (accessed 14 February 2016)
Gill JS, Rusdi AR, Ong Hui K, and Jawan R. History of Illicit Drug Use In Malaysia-A Review. International Journal of Addiction Sciences 2010; 1(1): 1-6
Kaur S, Mohd HB and Mohamed MN. Projek perintis program rawatan terapi gantian (RTG) menggunakan methadone di Pusat Khidmat AADK. Journal Antidadah Malaysia 2009, 5(1): 1-30.
Metzger DS, Woody GE, McLellan AT et al. Human immunodeficiency virus seroconversion among intravenous drug users in-and out-of-treatment: an 18-month prospective follow-up. JAIDS Journal of Acquired Immune Deficiency Syndromes 1993; 6(9):1049-1056.
Dupont WD and Plummer WD. Power and Sample Size Calculation tool version 3.1.2. http://biostat.mc.vanderbilt.edu/wiki/Main/PowerSampleSize (Downloaded on 1st February 2016)
Kaplan EH, Heimer R. A model-based estimate of HIV infectivity via needle sharing. J Acquir Immune Deffici Syndr 1992; 5(11): 1116-1118
Hudgens MG, Longini Jr. IM, Halloran ME et al. Estimating the transmission probability of human immunodeficiency virus in injecting drug users in Thailand. Appl Statist 2001; 50(1): 1-14
Varenbut M, Teplin D, Daiter J et.al. Tampering by office-based methadone maintenance patients with methadone take home privileges: a pilot study. Harm Reduction Journal 2007; 4: 15. www.ncbi.nlm.nih.gov/pmc/articles/PMC2134923 (accessed 12 December 2017)
Zou X, Ling L and Zhang L. Trends and risk factors for HIV, HCV and syphilis seroconversion among drug users in a methadone maintenance treatment programme in China: a 7-year retrospective cohort study. BMJ open 2015; 5(8). bmjopen.bmj.com/content/5/8/e008162 (accessed 12 December 2017)
Bruce RD. Methadone as HIV Prevention: High Volume Methadone sites to decrease HIV Incidence rates in Resource limited Settings. International Journal of Drug Policy 2010; 21(2): 122-124
alencia La Rosa J, Ryan P, Alvaro-Meca A et al. HCV Seroconversion in a cohort of people who use drugs followed in a mobile harm reduction unit in Madrid: Breaking barriers for HCV elimination. PLoS ONE 2018: e0204795. (accessed 15 November 2018)
Woody GE, Bruce D, Korthuis PT et al. HIV risk reduction with buprenorphine-naloxone or methadone: findings from a randomized trial. Journal of Acquired Immune Deficiency Syndromes 1999; 66(3): 288-293
Thiede H, Hagan H and Murrill CS. Methadone treatment and hiv and hepatitis band C risk reduction among injectiors in the Seattle area. Journal of Urban Health 2000; 77(3): 331-345
Mohamad N, Abu Bakar NH, Musa N et al. Better retention of Malaysia opiate dependents treated with high dose methadone in methadone maintenance therapy. Harm Reduction Journal 2010; 7: 30. www.harmreductionjournal.com/content/7/1/30 (accessed 12 December 2017)
Kelly SM, O’Grady KE, Mitchell SG et al. Predictors of Methadone treatment retention from a multi-site study: A Survival analysis. Drug and Alcohol Dependence 2011; 117(2-3): 170-175
Gerra G, Saenz E, Busse A et al. Supervised daily consumption, contingent take-home incentive and non-contingent take-home in methadone maintenance. Progress in Neuro-psychopharmacology & Biological Psychiatry 2011; 35(2): 483-489
MOH Malaysia. Integrated Biological and Behavioural Surveillance Survey (IBBS) 2012. www.moh.gov.my (accessed 12 July 2017)
Lollis CM, Strothers HS, Chitwood DD et al. Sex, Drugs and HIV: Does Methadone Maintenance Reduce Drug Use and Risky Sexual Behavior? Journal of Behavioral Medicine 2000; 23(6): 545-557
