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Open Access Retention and HIV seroconversion among drug users on methadone maintenance treatment in Yunnan, China

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Setting:

Thirteen methadone maintenance treatment (MMT) clinics across Yunnan, the province with the highest human immunodeficiency virus (HIV) burden in China.
Objectives:

To determine, among HIV-negative participants on MMT, the proportion lost to follow-up (defined as those who missed the 6-monthly follow-up examination), factors associated with loss to follow-up (LFU), HIV seroconversion rate and factors associated with seroconversion.
Design:

Prospective cohort study from October 2008 to April 2011. All participants were administered a pretested structured questionnaire to capture associated factors and offered HIV testing every 6 months. χ2 test and log-binomial regression were used for data analysis.
Results:

Of 1146 participants, 541 (47%) were lost to follow-up in 2.5 years. Factors associated with higher LFU proportion include <6 months of previous MMT, inconvenient location of the MMT clinic and average methadone dose ≤60 mg/day, with adjusted relative risks (RRs) of respectively 1.4 (95%CI 1.2–1.5), 1.2 (95VCI 1.0–1.4) and 1.1 (95%CI 1.0–1.3). The overall HIV seroconversion rate was 6.6 (95%CI 3.7–11.0) per 1000 person-years. Not living with a partner contributed to higher HIV rates, with an adjusted RR of 3.6 (95%CI 1.0–12.8).
Conclusion:

The retention rate of MMT participants in Yunnan was not satisfactory. Decentralising service delivery in the community and making directly observed treatment more convenient has the potential to improve retention.
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Keywords: clinic; drug users; loss to follow-up; oral substitution treatment; risk factor

Document Type: Research Article

Affiliations: 1: The Red Cross Hospital of Yunnan Province, Kunming, China 2: International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India 3: World Health Organization India Country Office, New Delhi, India 4: HIV/AIDS Asia Regional Programme, Kunming, China 5: REACH, Chennai, India 6: Public Health Foundation of India, New Delhi, India 7: Tianjin Centers for Disease Control and Prevention, Tianjin, China 8: School of Public Health, Fudan University, Shanghai, China

Publication date: 21 March 2014

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