美沙酮维持治疗门诊HIV阳性服药人员保持及其影响因素研究

发布时间：2018-10-22 07:57

【摘要】：目的了解美沙酮维持治疗(MMT)门诊HIV阳性服药人员保持状况，对其影响因素进行分析。方法采用定量研究和定性研究相结合研究方法。定量研究为随访研究，分层整群选取云南、四川、新疆、广西、贵州5省（区）选取MMT门诊HIV阳性服药人员不少于10人门诊56个（干预组和对照组各28个），2009年7月-2010年1月在各个门诊招募研究对象开展基线调查，随后干预组实施强化干预措施，对照组为常规防治工作；对研究对象进行6个月的随访，观察6个月内研究对象的队列保持情况，采用Kaplan-Meier和Cox比例风险回归模型分析队列保持率及其影响因素，同时评价干预措施对队列保持效果。定性研究采取个人深入访谈方法，对云南省玉溪、个旧、文山的4个MMT门诊，共选取42名HIV阳性服药人员和5名MMT门诊工作人员经知情同意后进行个人深入访谈，对访谈录音进行转录、编码、归纳和分析。结果定量研究基线调查共招募2529名HIV阳性服药人员，6个月随访的保持率为74.4%，648人脱失，脱失的原因及所占比例有强制戒毒26.4%、疾病/怀孕12.0%、死亡10.4%和主动退出10.4%等，控制社会人口学等因素后，Cox比例风险模型多因素分析显示地区、年龄40岁以上、采取干预措施、参加抗病毒治疗(ART)、基线调查前6个月未退出治疗、基线3次尿检全部阴性、平均剂量高及参加MMT时间长和较高的保持率相关（P0.05）。定性研究共访谈47人，其中美沙酮门诊工作人员5人，HIV阳性服药人员32人，MMT门诊脱失的HIV阳性服药人员10人。42名服药人员男性27人，女性15人，28人无工作，访谈中有6人服药人员家人同时在门诊服药。参加MMT治疗后，多数受访者身体好转，劳动能力增加，经济状况好转；改善了与家人的关系，家人信任度增加致使经济状况好转等原因，均为受访者偷吸毒品提供了机会。随着参加MMT时间增加，其脱离毒品的时间越长，获得心理治疗及其他服务越多，使得服药人员能长时间的保持在门诊。同时参加了抗病毒治疗的受访者相对于未参加抗病毒治疗者有较高的依从性和保持率。另外，夫妻双方共同服药也可以提高服药人员的保持率。结论HIV阳性服药病人在参加美沙酮维持治疗1~9个月内易退出治疗，，对此时期病人予以重点关注；门诊工作中，积极推动HIV阳性服药人员参加抗病毒治疗，应逐步提高美沙酮服药剂量，针对参加MMT时间短、曾退出MMT、年龄40岁以下、尿检阳性及治疗期间偷吸毒品服药人员进行干预；同时强化干预措施有效提高服药人员保持时间，应在美沙酮维持治疗门诊扩大推广。
[Abstract]:Objective to investigate the maintenance status of HIV positive drug users in methadone maintenance therapy (MMT) outpatient clinic and analyze its influencing factors. Methods A combination of quantitative and qualitative studies was used. The quantitative study was followed up. The stratified cluster was selected from Yunnan, Sichuan, Xinjiang, Guangxi, From July 2009 to January 2010, 56 HIV positive drug users (28 in intervention group and 28 in control group) were selected from 5 provinces (regions) of Guizhou province to carry out baseline investigation in each outpatient recruitment study object. Then the intervention group implemented intensive intervention measures, the control group was routine prevention and treatment, and the study subjects were followed up for 6 months to observe the cohort maintenance of the study subjects within 6 months. Kaplan-Meier and Cox proportional risk regression models were used to analyze the queue retention rate and its influencing factors, and the effect of intervention on queue retention was evaluated. The qualitative study adopted the method of individual in-depth interview, and conducted personal in-depth interviews with 42 HIV positive drug users and 5 MMT outpatients in four MMT clinics in Yuxi, Gejiu and Wenshan, Yunnan Province after informed consent. Transcription, coding, induction and analysis of interview recordings. Results A total of 2529 HIV positive drug users were recruited in the baseline survey of quantitative study. The retention rate of 648 patients who were followed up for 6 months was 74.4%. The causes and the proportion of loss were 26.4% of compulsory detoxification, 12.0% of disease / pregnancy, 10.4% of death and 10.4% of active withdrawal. After controlling social demography and other factors, the multivariate analysis of Cox proportional risk model showed that the area, over 40 years old, took intervention measures, did not quit the treatment 6 months before the baseline survey of antiviral therapy (ART), and all the baseline 3 urine tests were negative. The average dose was high and the duration of MMT was long and the retention rate was higher (P0.05). A total of 47 people were interviewed qualitatively, including 5 outpatients with methadone, 32 with HIV positive, 10 with HIV positive, and 42 with male 27, female 15, and 28 without work. In the interview, 6 drug users and their families were taking medicine at the same time. After MMT treatment, most of the respondents improved their health, labor ability and economic situation, improved their relationship with their families, increased family trust, and so on, all of which provided opportunities for them to steal drugs. With the increase of MMT, the longer the drug withdrawal, the more psychotherapy and other services available, so that the drug users can stay in the outpatient service for a long time. At the same time, the participants who participated in antiviral therapy had higher compliance and retention rate than those who did not participate in antiviral therapy. In addition, the husband and wife take medicine together can also improve the maintenance rate of drug users. Conclusion HIV positive drug patients are easy to withdraw from methadone maintenance therapy within 1 ~ 9 months and pay more attention to the patients in this period, and actively promote the HIV positive drug users to participate in antiviral therapy in outpatient service. The dose of methadone should be increased step by step, the duration of participation in MMT was short, the age of withdrawal from MMT, was below 40 years old, urine test was positive and drug was stolen during treatment, and the intervention measures should be strengthened to effectively increase the duration of maintenance of the drug takers. It should be expanded in methadone maintenance clinic.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.91

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