Quality Of Health Among Methadone Maintenance Treatment (MMT) Program Clients In Myanmar
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Date
2020-06
Authors
Sun Tun
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
HIV prevalence rate among PWIDs (People who inject drugs) in Myanmar
is high at 28.5% based on 2014 IBBS results. More than 13,441 (16% of the
estimated 83,000 PWIDs) have been on methadone treatment in 2017. Evaluation of
the methadone program is vital for efficient service delivery. This study aimed to
understand the context and important treatment factors of methadone maintenance
treatment (MMT) program among clients in Myanmar. A total of 210 respondents
were recruited through stratified random sampling from five cities in Myanmar
where MMT program existed. Several study instruments such as WHO-QOL-BREF
questionnaire, Verona Service Satisfaction Scale questionnaire for Methadone
Treatment (VSSS-MT) and Addiction Severity Index (ASI) were used. The urine
drug test was also conducted to confirm respondents’ drug use status. Study results
showed that 45% (n=93) never injected heroin in the last 30 days, while 55.5%
(n=116) injected heroin. The average daily methadone dose in this study was 83mg.
Thirty-seven percent (n=74/200) had HIV, 16.27% (n=34/209) reported co-infection
(HIV/HCV). More than one-third (36.5%, n=76) received high methadone dose
(above 80mg), while 63.46% (n=132) received low dose. Higher methadone dose
was associated with decreased in heroin use (p=0.034). In reviewing the quality of
life (QOL) of the respondents, the total average score of respondents (QOL) was
60.8%; specifically, 60.1% in the physical domain, 63.1% in the psychological
domain, 59.9% in the social relation domain, and 60.4% in the environmental domain. Low QOL scores were associated with low methadone service satisfaction.
Furthermore, on analysing addiction severity index (ASI), the average ASI scores of
the respondents are; Employment (47.4%), Drug use (16.3%), Alcohol (13.5%),
Social-family (10.7%), and Legal (10.5%). Higher ASI score reflects the worse
situation. Those who did not inject in the last 30 days had lower ASI scores
compared to those who injected (p=0.026). The majority (85%, n=178) were highly
satisfied with methadone services. More than two-thirds (89.47%, n=187) were
highly satisfied with the staff category (doctor, nurse, etc), 91.87%, n=192) on basic
intervention items, and 74.64% (n=156) on specific intervention items of the
methadone program. Higher methadone dose can reduce the illicit drug injection and
subsequently prevent HIV transmissions among individuals who inject drugs. In the
estimation of treatment satisfaction of methadone program, the satisfaction of
respondent varies with different infection status after taking into consideration of
adjustment of methadone dose. Since poly-drug use was prevalent, other harm
reduction measures are seen important to prevent the risk of addiction and infectious
diseases. Continuous treatment assessments are vital for identifying challenging
areas like special service categories of MMT program (e.g individual rehabilitation,
psychotherapy and group therapy) and support for HIV/HCV co-infections are
needed to ensure effective service delivery.
Description
Keywords
Drugs