Predictors of continued HIV-risk behaviors among drug users in methadone maintenance therapy program in China—A prospective study

Abstract

BackgroundTo examine the predictors of continued drug- and sex-related HIV-risk behaviors among drug users in methadone maintenance therapy (MMT) programs in China.MethodsWe followed a sample of 5,035 drug users enrolled for the first time in MMT programs at baseline, 6 months, and 12 months utilizing a longitudinal prospective study design. Drug users’ HIV-risk behaviors, MMT characteristics, and drug use, were assessed at all three waves using a structured interview and HIV/HCV status was assessed at baseline and 12-month follow-up using biological specimens.ResultsThe point prevalence of HIV was 7.6% and 78.4% for HCV at baseline. Results of generalized linear mixed logistic regression models revealed that HIV-positive MMT clients were more likely to engage in drug injection (aOR = 1.70) and syringe sharing (aOR = 4.73). HCV-positive clients were more likely to inject drugs (aOR = 2.58), share syringes (aOR = 1.97), and have multiple sexual partners (aOR = 1.47). Adherence to MMT was the most significant predictor of reduced HIV-risk behaviors.ConclusionsOur data confirmed the positive effects of MMT on HIV prevention and underscored the urgency for programs to reduce HIV risk in HIV- and HCV-positive clients. There is a pressing need to strengthen existing counseling services for HIV-positive drug users to reduce their drug-related risk behaviors and to provide counseling for HCV-positive drug users. Further studies are needed to explore interventions to address high dropout rates and low adherence among MMT clients.

Risk behaviour determinants among people who inject drugs in Stockholm, Sweden over a 10-year period, from 2002 to 2012

“…Those who began using drugs at a very young age, before age 14, were the ones with the most hazardous injection risk behaviour, emphasising the importance of very early prevention interventions against drug use. Previous studies from Karachi [ 27 ], China [ 28 ], and Ukraine [ 29 ] have also found that young people and female PWID [ 25 ] are most vulnerable and at highest risk to engage in unsafe injection behaviour. Therefore, we believe that early prevention and harm reduction services should expand and improve their efforts to target young people, and for those who already inject, tailor-make programs, specifically NEPs in the Swedish case, to attract more female PWID.…”

Illicit Heroin and Methamphetamine Use among Methadone Maintenance Treatment Patients in Dehong Prefecture of Yunnan Province, China

“…In order to address the growing IDU-driven HIV epidemic, the methadone maintenance treatment (MMT) was initiated as a pilot program in 8 clinics in 2004 in China and scaled up to 756 clinics nationwide cumulatively treating more than 384,500 drug users with 208 450 clients still receiving treatment by the end of 2012 [ 3 , 4 ]. There has been a growing body of literature indicating that MMT is effective in reducing heroin use, drug-related criminal activities, and HIV transmission as well as improving social well-being [ 5 – 8 ]. Nevertheless, many MMT patients continue using heroin while in treatment [ 9 – 11 ].…”

Rapid Implementation of Service Delivery Changes to Mitigate COVID-19 and Maintain Access to Methadone Among Persons with and at High-Risk for HIV in an Opioid Treatment Program

“…Medication treatment for opioid use disorder with methadone and buprenorphine is a key HIV prevention strategy [1][2][3][4][5]. Enrollment in medication treatment for opioid use disorder is associated with reductions in injection drug use [6][7][8], syringe/equipment sharing [6][7][8][9], and risky sexual behavior [6,9]. Among people living with HIV, engagement in medication treatment for opioid use disorder is associated with HIV-risk behavior reductions [10,11], and higher rates of initiating and adhering to antiretroviral treatment (ART) [12][13][14][15].…”