Methadone maintenance treatment participant retention and behavioural effectiveness in China: a systematic review and meta-analysis.
BACKGROUND
Methadone maintenance treatment (MMT) has been scaled up by the Chinese government alongside persistent compulsory drug user detention, but the extent to which detention interferes with MMT is unknown. The study systematically reviews Chinese MMT retention rates, reasons for drop out, and behavioural changes.


METHODS
Chinese and English databases of literature are searched for studies reporting retention rates, drug use and sexual behaviours among MMT participants in China between 2004 and 2013. The estimates are summarized through a systematic review and meta-analysis.


RESULTS
A total of 74 studies representing 43,263 individuals are included in this analysis. About a third of MMT participants drop out during the first three months of treatment (retention rate 69.0% (95% CI 57.7-78.4%)). Police arrest and detention in compulsory rehabilitation was the most common cause of drop out, accounting for 22.2% of all those not retained. Among retained participants, changing unsafe drug use behaviours was more effective than changing unsafe sexual behaviours. At 12 months following MMT initiation, 24.6% (15.7-33.5%) of MMT participants had a positive urine test, 9.3% (4.7-17.8%) injected drugs and only 1.1% (0.4-3.0%) sold sex for drugs. These correspond to 0.002 (<0.001-0.011), 0.045 (0.004-0.114) and 0.209 (0.076-0.580) times lower odds than baseline. However, MMT participants did not have substantial changes in condom use rates.


CONCLUSIONS
MMT is effective in drug users in China but participant retention is poor, substantially related to compulsory detention. Reforming the compulsory drug user detention system may improve MMT retention and effectiveness.
The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia. lzhang@kirby.unsw.edu.au
Lei
L
Zhang
Eric P F
EP
Chow
Xun
X
Zhuang
Yanxian
Y
Liang
Yafei
Y
Wang
Caiyun
C
Tang
Li
L
Ling
Joseph D
JD
Tucker
David P
DP
Wilson
D001519:Behavior; D002681:China; D006801:Humans; D060046:Maintenance Chemotherapy; D008691:Methadone; D058850:Opiate Substitution Treatment; D010352:Patient Dropouts; D010358:Patient Participation; D017594:Publication Bias; D012725:Sexual Behavior
D008691:Methadone