Heroin addiction is chronic relapsed encephalopathy and so far there is no treatment to cure. International evidence-based practices have proved that Methadone maintenance treatments (MMTs) are effective to reduce heroin use and high-risk behaviors, as well as to prevent transmission of HIV and HCV[1–4]. Since the appearance of HIV infection, MMTs have been pushed forward, and they have been proved helpful in reducing both drug use and the transmission of infectious diseases, such as HIV or viral hepatitis.
In consideration of epidemic of HIV among drug users, China initiated MMT in Yunnan, Sicuan, Zhejiang, Guizhou and Guangxi provinces in 2004 with 8 MMT clinics established .With the success of the pilot MMT clinics, 680 MMT clinics were established by the end of 2009 nationwide, 241975 patients were recruited accumulatively, and the retention rate was 65%. Meanwhile, 56 MMT clinics were established by the end of 2009 in Guangdong,19442 patients were recruited accumulatively, and the retention rate was 57.4%.The retention rate in Guangdong was low and a lot of patients had dropped out.
According to the Chinese Implementation Protocol for Community-Based Methadone Maintenance Treatment for Opiate Addicts, the eligibility criteria to participate in MMT were: (i) clients who are addicted to opiate according to addiction protocol; (ii) at least 20 years of age; (iii) the number of allowable missing treatment days was 7 consecutive days; and (iv) capable of complete civil liability.
Drug users testing HIV-positive needed only to fulfil requirement (i). Furthermore, a detailed clinical guideline for methadone treatment was added to the protocol to support clinical practice and comprehensive interventions were highlighted in the new protocol which suggested clinics offering ancillary services. These included counseling, psychosocial support, testing for HIV, syphilis, hepatitis C and tuberculosis, referrals for antiretroviral treatment, peer education, health education, group activities, social support and skills training for employment. The treatment fee for MMT services was not specified, as in some areas where heroin is easily obtained at low cost, the fee is reduced or even waived.
One principal target of MMT was to keep patients under treatment, by which, patients can receive treatment concerning psychology, behavior and personality. The patients dropped out are more likely to relapse or engage in high-risk behaviors contracting HIV.
The aim of this paper was to employ generalized survival in the analysis of MMT retention, to explore the factors associated with retention in MMT among drug users in Pearl River Delta region, Guangdong province.