title: Improvements in health-related quality of life among methadone maintenance clients in Dar es Salaam, Tanzania.
abstract: BACKGROUND
  Injection of heroin has become widespread in Dar es Salaam, Tanzania and is spreading throughout the country. To prevent potential bridging of HIV epidemics, the Tanzanian government established a methadone maintenance treatment (MMT) clinic in February 2011. We assess the effect of MMT on health-related quality of life (HRQOL) and examine factors, particularly HIV infection and methadone dose, associated with changes in HRQOL.
  
  
  METHODS
  This study utilized routine data on clients enrolling in methadone from February 2011 to April 2012 at Muhimbili National Hospital. Change in physical (PCS) and mental health (MCS) composite scores, as measured by the SF-12 tool, were the primary outcomes. Backward stepwise linear regression, with a criterion of p<0.2 was used to identify baseline exposure variables for inclusion in multivariable models, while adjusting for baseline scores.
  
  
  RESULTS
  A total of 288 MMT clients received baseline and follow-up assessments. Mean methadone dose administered was 45mg (SD±25) and 76 (27%) were confirmed HIV-positive. Significant improvements were observed in PCS and MCS, with mean increases of 15.7 and 3.3, respectively. In multivariable models, clients who had previous poly-substance use with cocaine [p=0.040] had a significantly higher mean change in PCS. Clients who were living with HIV [p=0.002]; satisfied with current marital situation [p=0.045]; had a history of suicidal thoughts [p=0.021]; and previously experienced cognitive difficulties [p=0.012] had significantly lower mean change in PCS. Clients with shorter history of heroin use [p=0.012] and who received higher methadone doses [p=0.028] had significantly higher mean change in MCS, compared to their counterparts.
  
  
  CONCLUSIONS
  Aspects of mental and physical health, risk behaviors and quality of life among drug users are intertwined and complex. Our research revealed positive short-term effects of MMT on HRQOL and highlights the importance of sustained retention for optimal benefits. Comprehensive supportive services in addition to provision of methadone are needed to address the complex health needs of people who inject drugs.
authors.affiliation: Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania.
authors.forename: Omary
authors.initials: O
authors.lastname: Ubuguyu
authors.affiliation: Pangaea Global AIDS, 436 14th St, Suite 920, Oakland, CA 94612, USA.
authors.forename: Olivia C
authors.initials: OC
authors.lastname: Tran
authors.affiliation: Yale University, New Haven, CT 06520, USA.
authors.forename: Robert Douglas
authors.initials: RD
authors.lastname: Bruce
authors.affiliation: Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania.
authors.forename: Frank
authors.initials: F
authors.lastname: Masao
authors.affiliation: Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania.
authors.forename: Cassian
authors.initials: C
authors.lastname: Nyandindi
authors.affiliation: Tanzania Ministry of Health and Social Welfare, 6 Samora Machel Ave, Dar es Salaam, Tanzania.
authors.forename: Norman
authors.initials: N
authors.lastname: Sabuni
authors.affiliation: University of Texas School of Public Health, 7000 Fannin St, Houston, TX, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: McCurdy
authors.affiliation: Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania.
authors.forename: Jessie
authors.initials: J
authors.lastname: Mbwambo
authors.affiliation: RTI-International, 351 California St, Suite 500, San Francisco, CA 94104, USA; Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA. Electronic address: blambdin@rti.org.
authors.forename: Barrot H
authors.initials: BH
authors.lastname: Lambdin
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D015658:HIV Infections / Q000453:epidemiology; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D016014:Linear Models; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods; D011788:Quality of Life; D012189:Retrospective Studies; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000534:rehabilitation*; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
chemical_list: D008691:Methadone
keywords: Harm reduction; Implementation science; Methadone; Quality of life; Tanzania