Investigation of Repeat Client Drop-Out and Re-Enrolment Cycles in Fourteen Methadone Maintenance Treatment Clinics in Guangdong, China

Lei Zhang, Xia Zou, Di Zhang, Xiaoling Li, Peizhen Zhao, Li Ling

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19 Citations (Scopus)

Abstract

Objective

Client adherence is vital for effective methadone maintenance treatment (MMT). This studyexplores the pattern and associated factors of client adherence, drop-out and re-enrolmentin the Chinese MMT programme over the period of 2006–2013.

Methods

This retrospective study was conducted in 14 MMT clinics in Guangdong Province, China.We employed Kaplan-Meier survival analysis to estimate the rates of drop-out and re-enrolmentof MMT clients and multivariate Cox regression to identify associated factors.

Results

Among 1,512 study participants, 79% have experienced ‘drop-out’ during the 7-year studyperiod. However, 82% ‘dropped-out’ clients resumed treatment at a later time. Low educationlevel (junior high or below versus otherwise, HR = 1.21, 1.05–1.40), low methadonedosage in the first treatment episode (<50 ml versus 50 ml, HR = 1.84, 1.64–2.06) andhigher proportion of positive urine test (50% versus<50%, HR = 3.72, 3.30–4.20) duringthe first treatment episode were strong predictors of subsequent drop-outs of the participants.Among the ‘dropped-out’ clients, being female (HR = 1.40, 1.23–1.60), being married(HR = 1.19, 1.09–1.30), and having a higher proportion of positive urine tests in the firsttreatment episode (50% versus<50%, HR = 1.35, 1.20–1.51) had greater likelihood ofsubsequent re-enrolment in MMT. Clients receiving lower methadone dosage (first treatmentepisode <50 ml versus 50 ml, HR = 1.12, 1.03–1.23; the last intake before drop-out<50 ml versus 50 ml, HR = 1.16, 1.04–1.30) were also more likely to re-enrol.

Conclusion

Persistent cycling in-and-out of clients in MMT programmes is common. Insufficient dosage and higher proportion of positive urine samples in the first treatment episode are the key determinants for subsequent client drop-out and re-enrolment. Interventions should target clients in their early stage of treatment to improve retention in the long term.
Original languageEnglish
Article numbere0139942
Number of pages13
JournalPLoS ONE
Volume10
Issue number10
DOIs
Publication statusPublished - 2015
Externally publishedYes

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