A longitudinal and case-control study of dropout among drug users in methadone maintenance treatment in Haiphong, Vietnam

Abstract

BackgroundVietnam began providing methadone maintenance therapy (MMT) in 2008; as of June 2016, 44,479 persons who inject drugs (PWID) were in treatment in 57 provinces. However, 10–23% of patients were estimated to have dropped out of treatment during the first 2 years. We evaluated dropout and factors associated with quitting treatment.MethodsWe followed clients ≥ 18 years old enrolled in five MMT clinics in Haiphong for 3 years. Persons who missed a consecutive month of methadone treatment were considered to have dropped out and were not allowed to return; those who missed greater than five consecutive doses were considered to be non-compliant but were allowed to restart treatment at their initial dose. Clients who dropped out or who were non-compliant during their third year of MMT (cases) were traced and matched with two clients who remained in treatment (controls) by gender, age, and length of time in the program. Cases and controls were interviewed. Additional data on levels of yearly retention were abstracted from clinic records.ResultsAmong the 1055 patients initially enrolled in MMT, dropout and non-compliance combined was 13.6% during the first year, 16.5% during the second year, and 22.3% during the third year. By 36 months, 33.3% of clients had dropped out, of whom 10.6% had died and 24% had been arrested. We traced and interviewed 81 clients who dropped out or who were non-compliant during year 3 as well as 161 controls. The primary reasons for dropping out included claiming no dependence on heroin (22.2%), conflict with work (21.0%), health problems (16.0%), and inability to afford the methadone co-payment of approximately 0.5 USD/day (14.8%). Independent factors associated with non-compliance included continuing to use heroin (aOR = 12.4, 95% CI 4.2–36.8) and missing greater than three doses during the previous 3 months (aOR = 18.5, 95% CI 7.4–47.1); receiving a daily dose of > 120 mg of methadone was associated with a lower odds ratio of dropping out (aOR = 0.3, 95% CI 0.1–0.9).ConclusionBy 3 years, one third of all patients in treatment had permanently dropped out. Ensuring that methadone dosing is adequate and reducing or eliminating the co-payment fee for those who cannot afford it could improve retention.

Struggling to achieve a ‘normal life’: A qualitative study of Vietnamese methadone patients

“…This concern explained the attempt by some participants to get the lowest dose possible by asking to be tapered off even when they had no immediate plan to quit treatment. While this practice has not been commonly reported, it remains worrisome, as an inadequately low dose is a risk factor for abandoning treatment in many programmes (Khue et al, 2017;Proctor et al, 2015).…”

“…Of the government's 2015 target of 80,000 patients (estimated at 40% of all opioid users), only 52,054 were following treatment in July 2017, a 5,600 increase from the previous year (Social Republic of Vietnam, 2014;Vietnam Administration of AIDS Centre, 2016, 2017a. Meanwhile, overdose deaths, police arrests for drug-related crimes, side effects, and lack of motivation to continue with treatment raised dropout rates as high as 33.3% at 36 months (Khue et al, 2017). While this figure is similar in other countries (Huissoud, Rousson, & Dubois-Arber, 2012;Zhang et al, 2013), it is important to understand why participants decide to drop out in the specific context of Vietnam, where MMT has received strong support from the government.…”

Contemporary Asian Drug Policy: Insights and Opportunities for Change

“…Stigma and lack of access to sufficient MT have limited patient recovery. Studies evaluating MT patient dropouts and utilization in injection drug-using populations in several countries have shown that high levels of social stigma and insufficient doses of methadone correlate with incomplete treatment adherence, early termination, or low levels of program utilization Tran et al, 2018;Khue et al, 2017). This is especially true outside major urban areas (Van Nguyen et al, 2017;Pham et al, 2017).…”

Association Between User Fees and Dropout from Methadone Maintenance Therapy: Results of a Cohort Study in Vietnam

“…This indicates that user fees may be a cause of dropout, as has been found in a previous casecontrol study set in Haiphong. 32 However, considering that about 5.6% of patients in provinces with user fees dropped out of MMT, user fees possibly were the primary cause of less than 1% of all patients at baseline to drop out. Patients retained in care stated that user fees were a contributing factor to stopping MMT in fewer than 15% of people they knew who stopped MMT, again suggesting that user fees were a contributing factor to stopping MMT in less than 1% of baseline patients.…”