title: A multilevel analysis of regional and individual effects on methadone maintenance treatment in Taiwan.
abstract: OBJECTIVE
  This study evaluated the direct and interactive effects of regional-level and individual-level characteristics on methadone maintenance treatment (MMT), after considering the individual characteristics in Taiwan.
  
  
  METHODS
  This study utilized a survey research method. Opioid-dependent patients who participated in the outpatient MMT program in 2009 and met the eligibility criteria were recruited from five hospitals. The impact of MMT on self-perceived health was assessed by using questionnaires. This study assessed the participants' quality of life and treatment outcomes during 3-month follow-up visits, before evaluating the direct effects of regional and individual characteristics. Multilevel linear models were used to estimate whether regional levels influenced individual behavior and treatment outcomes.
  
  
  RESULTS
  Three hundred thirty-four opioid-dependent patients agreed to participate in this study. After the follow-up period, 127 participants completed the study (completion rate = 38%). Participants receiving MMT demonstrated significant improvements in psychological state, HIV risk-taking behavior, social functioning, and health. Regional characteristics, such as the lower than junior high school rate, low-income family rate, and related crime rates, of the study regions were negatively associated with improvements in drug abuse behavior.
  
  
  CONCLUSIONS
  This study shows that MMT can significantly improve the HIV risk-taking behavior and health of the study participants. Disadvantaged regions, however, exhibit poor treatment outcomes. This study suggests actions to minimize the treatment variations between regions.
authors.affiliation: Institute of Health Policy and Management, Chang-Hua Hospital, Executive Yuan, Puxin Township, Changhua County, Taiwan.
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Shuo-Yen
authors.initials: SY
authors.lastname: Ting
authors.forename: Happy Kuy-Lok
authors.initials: HK
authors.lastname: Tan
authors.forename: Ming-Chin
authors.initials: MC
authors.lastname: Yang
mesh_terms: D000328:Adult; D005260:Female; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008603:Mental Health; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D012309:Risk-Taking; D012725:Sexual Behavior; D012959:Socioeconomic Factors; D013624:Taiwan
chemical_list: D009294:Narcotics; D008691:Methadone