重庆市美沙酮维持治疗患者脱失情况及影响因素分析

摘要

Objective To analyze the reasons of dropping out in the patients with methadone maintenance treatment and the population characteristics in order to adopt the corresponding intervention measures for increasing the retention rate and re-ducing the risk of HIV and HCV infection. Methods The accumulative 24 389 patients with methadone treatment in the moni-toring data in the methadone maintenance treatment clinic of Chongqing City from 2007 to 2012 were collected, among them 10 572 cases of treatment dropping out were emphatically analyzed. Then the dropping out situation of methadone treatment in Chongqing City was statistically analyzed. Results A total of 24 389 cases of methadone maintenance treatment were accumulat-ed during 2007-2012 in Chonqing City,including accumulative 10 572 cases of dropping out,the dropping out rate was 43.3%. The top five of dropping out reasons were respectively no treatment for 7 d without causes,unable to contact,disease/pregnancy, out-migration for work/on business/doing business/migration/go abroad ,illegal criminal activity and being caught without relation with drug;the patients of male,low cultural degree,short drug use time,treatment dose<60 mg/d were more likely to quit the methadone maintenance treatment;the HIV and HCV infection rates in the dropping out crowds were 4.0%(428/10 572) and 65.9%(6 962/10 572) respectively,in which the HIV/HCV merge infection rate was 3.1%(328/10 572),accounting for 76.6%(328/428) of HIV infection people. Conclusion The dropping out rate of methadone maintenance treatment in Chongqing City from 2007 to 2012 is higher,the HCV infection situation in the dropping out crowds is serious. The intervention on the drug users of male,low cultural level,short drug use time and low treatment dose should be strengthened in order to increase the retention rate of methadone maintenance treatment and decrease the infection risk.%目的：分析美沙酮维持治疗脱失的原因及人群特征，以便采取相应干预措施提高保持率，降低人类免疫缺陷病毒（HIV）与丙型肝炎病毒（HCV）的感染风险。方法选取2007~2012年重庆市美沙酮维持治疗门诊监测数据中应用美沙酮门诊累计治疗的24389例患者，重点分析10572例治疗脱失患者，对其脱失情况进行统计分析。结果2007~2012年重庆市美沙酮维持治疗累计患者24389例，累计退出10572例，脱失率为43.3%。脱失原因前5位分别为无故7 d未治疗、无法联系、疾病/妊娠、外出打工/出差/做生意/移居/出国、与毒品无关的违法犯罪被抓；男性、文化程度低、吸毒时间短、治疗剂量小于60 mg/d的患者更容易退出美沙酮维持治疗；脱失人群的HIV和HCV感染率分别为4.0%（428/10572）、65.9%（6962/10572），其中HIV/HCV合并感染率为3.1%（328/10572），占HIV感染人数的76.6%（328/428）。结论重庆市2007~2012年美沙酮维持治疗脱失率较高，脱失人群HCV感染形势严峻，门诊应加强对男性、文化程度较低、吸毒时间较短、治疗剂量偏低的吸毒者进行干预，以提高美沙酮维持治疗保持率，降低感染风险。