title: Factors associated with relapse into drug use among male and female attendees of a three-month drug detoxification-rehabilitation programme in Dhaka, Bangladesh: a prospective cohort study.
abstract: BACKGROUND
  To determine relapse rates and associated factors among people who use drugs (PWUDs) attending abstinence-oriented drug treatment clinics in Dhaka, Bangladesh.
  
  
  METHODS
  A cohort of male and female PWUDs admitted to the 3-month drug detoxification-rehabilitation treatment programmes of three non-governmental organisation-run drug treatment clinics in Dhaka, Bangladesh were interviewed on admission and over the following 5 months, which included the first 2 months after discharge. The study subjects comprised 150 male and 110 female PWUDs who had been taking opiates/opioids, cannabis or other drugs (including sedatives) before admission, had provided informed consent and were aged ≥16 years. Interviews were conducted using semi-structured questionnaires at four time points; on admission, at discharge and at 1 and 2 months after discharge. Relapse rates were assessed by the Kaplan-Meier method. Factors associated with relapse on enrolment and after discharge were determined using the Cox proportional hazards regression model.
  
  
  RESULTS
  A greater proportion of female than male subjects relapsed over the study period (71.9% versus 54.5%, p < 0.01). For men, baseline factors associated with relapse were living with other PWUDs (relative hazard ratio [RHR] = 2.27), living alone (RHR = 2.35) and not having sex with non-commercial partners (RHR = 2.27); whereas for women these were previous history of drug treatment (RHR = 1.94), unstable housing (RHR = 2.44), higher earnings (RHR = 1.89), preferring to smoke heroin (RHR = 3.62) and injecting buprenorphine/pethidine (RHR = 3.00). After discharge, relapse for men was associated with unstable housing (RHR = 2.78), living alone (RHR = 3.69), higher earnings (RHR = 2.48) and buying sex from sex workers (RHR = 2.29). Women' relapses were associated with not having children to support (RHR = 3.24) and selling sex (RHR = 2.56).
  
  
  CONCLUSIONS
  The relapse rate was higher for female PWUDs. For both male and female subjects the findings highlight the importance of stable living conditions. Additionally, female PWUDs need gender-sensitive services and active efforts to refer them for opioid substitution therapy, which should not be restricted only to people who inject drugs.
authors.affiliation: Department of Global Health, Medicine and Welfare Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan. maehiray@gmail.com.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Maehira
authors.forename: Ezazul Islam
authors.initials: EI
authors.lastname: Chowdhury
authors.forename: Masud
authors.initials: M
authors.lastname: Reza
authors.forename: Ronald
authors.initials: R
authors.lastname: Drahozal
authors.forename: Tarun Kanti
authors.initials: TK
authors.lastname: Gayen
authors.forename: Iqbal
authors.initials: I
authors.lastname: Masud
authors.forename: Sonia
authors.initials: S
authors.lastname: Afrin
authors.forename: Noboru
authors.initials: N
authors.lastname: Takamura
authors.forename: Tasnim
authors.initials: T
authors.lastname: Azim
mesh_terms: D000328:Adult; D001459:Bangladesh; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011446:Prospective Studies; D012008:Recurrence; D011477:Sex Work / Q000706:statistics & numerical data; D012747:Sexual Partners; D012959:Socioeconomic Factors; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D047568:Unsafe Sex / Q000706:statistics & numerical data