Referring heroin users from compulsory detoxification centers to community methadone maintenance treatment: a comparison of three models.
BACKGROUND
Both compulsory detoxification treatment and community-based methadone maintenance treatment (MMT) exist for heroin addicts in China. We aim to examine the effectiveness of three intervention models for referring heroin addicts released from compulsory detoxification centers to community methadone maintenance treatment (MMT) clinics in Dehong prefecture, Yunnan province, China.


METHODS
Using a quasi-experimental study design, three different referral models were assigned to four detoxification centers. Heroin addicts were enrolled based on their fulfillment to eligibility criteria and provision of informed consent. Two months prior to their release, information on demographic characteristics, history of heroin use, and prior participation in intervention programs was collected via a survey, and blood samples were obtained for HIV testing. All subjects were followed for six months after release from detoxification centers. Multi-level logistic regression analysis was used to examine factors predicting successful referrals to MMT clinics.


RESULTS
Of the 226 participants who were released and followed, 9.7% were successfully referred to MMT(16.2% of HIV-positive participants and 7.0% of HIV-negative participants). A higher proportion of successful referrals was observed among participants who received both referral cards and MMT treatment while still in detoxification centers (25.8%) as compared to those who received both referral cards and police-assisted MMT enrollment (5.4%) and those who received referral cards only (0%). Furthermore, those who received referral cards and MMT treatment while still in detoxification had increased odds of successful referral to an MMT clinic (adjusted OR = 1.2, CI = 1.1-1.3). Having participated in an MMT program prior to detention (OR = 1.5, CI = 1.3-1.6) was the only baseline covariate associated with increased odds of successful referral.


CONCLUSIONS
Findings suggest that providing MMT within detoxification centers promotes successful referral of heroin addicts to community-based MMT upon their release.
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China. wuzy@263.net.
Liping
L
Yan
Enwu
E
Liu
Jennifer M
JM
McGoogan
Song
S
Duan
Li-Tzy
LT
Wu
Scott
S
Comulada
Zunyou
Z
Wu
D000293:Adolescent; D000328:Adult; D002681:China; D003153:Community Health Services; D005260:Female; D006679:HIV Seropositivity / Q000150:complications; D003932:Heroin / Q000008:administration & dosage; D006556:Heroin Dependence / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D037141:Mandatory Programs; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D058850:Opiate Substitution Treatment; D016495:Police; D012017:Referral and Consultation; D055815:Young Adult
D003932:Heroin; D008691:Methadone