云南美沙酮维持治疗人群高危性行为及其影响因素
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摘要
目的研究美沙酮维持治疗(MMT)人群的高危性行为及其影响因素,为在MMT的吸毒人群中开展有针对性的干预提供科学依据。方法在云南省4个MMT门诊招募符合纳入标准的正在接受MMT者,建立前瞻性队列,运用音频计算机辅助自我访谈问卷系统(ACASI)对参加研究者进行基线调查和第6个月随访调查。结果共招募正在接受MMT者523人,第6个月随访时仍坚持接受治疗者204人(39.0%),发现男性(P=0.023)、无工作(P=0.008)、每月收入0～1 999元(P=0.035)和无配偶(P=0.000)对治疗者的脱失影响差异有统计学意义。204名坚持MMT者上个月发生性行为的平均次数由基线的2.87次增加至3.37次(P=0.044);其寻找商业性性服务的比率,上个月发生商业性行为由基线的8.8%增加至17.2%(P=0.039);过去与随意性性伴发生性行为每次使用安全套由基线的47.5%降至38.7%(P=0.208);与随意性性伴发生性行为时不安全行为和安全行为作为结局,进行单因素和多因素Logistic回归分析,结果均无意义。结论针对MMT吸毒人群高脱失率,男性、失业、收入低和无配偶是干预的主要人群;采取综合性性健康干预措施以降低接受MMT吸毒人群不安全性行为风险刻不容缓。
Objective To study high-risk sexual behaviors and its influence factors of the clients receiving methadone maintenance treatment(MMT), and provide scientific basis for implementation of targeted interventions among drug abusers receiving MMT. Methods A prospective cohort study was established while patients who met the inclusion criteria were recruited from four MMT clinics in Yunnan province. Baseline survey and 6-month follow-up survey were conducted by the Audio Computer Aided Interview Questionnaire System(ACASI). Results A total of 523 MMT clients were recruited, and 204(39.0%) were still receiving the treatment at the 6 th month follow-up. The study found that male(P=0.023), no job(P=0.008), a monthly income between RMB 0-1999 yuan(P=0.035) and those without spouse(P=0.000) affected the dropout of the number of MMT clients, with the differences statistically significant. The mean number of sexual intercourse in 204 MMT patients still receiving MMT increased from 2.87 at baseline to 3.37 last month(P=0.044). The rate of seeking commercial sexual services last month increased from 8.8% at baseline to 17.2% last month(P=0.039). However, the frequency of condom use per intercourse with casual sex workers decreased from 47.5% at baseline to 38.7%(P=0.208). The results of both univariate and multivariate logistic regression analysis of unsafe and safe behaviors with casual sexual partners had no statistically significant differences. Conclusion It is imperative to adopt comprehensive sexual health interventions for targeted MMT drug abusers to improve their safety of sexual behaviors.
Objective To study high-risk sexual behaviors and its influence factors of the clients receiving methadone maintenance treatment(MMT), and provide scientific basis for implementation of targeted interventions among drug abusers receiving MMT. Methods A prospective cohort study was established while patients who met the inclusion criteria were recruited from four MMT clinics in Yunnan province. Baseline survey and 6-month follow-up survey were conducted by the Audio Computer Aided Interview Questionnaire System(ACASI). Results A total of 523 MMT clients were recruited, and 204(39.0%) were still receiving the treatment at the 6 th month follow-up. The study found that male(P=0.023), no job(P=0.008), a monthly income between RMB 0-1999 yuan(P=0.035) and those without spouse(P=0.000) affected the dropout of the number of MMT clients, with the differences statistically significant. The mean number of sexual intercourse in 204 MMT patients still receiving MMT increased from 2.87 at baseline to 3.37 last month(P=0.044). The rate of seeking commercial sexual services last month increased from 8.8% at baseline to 17.2% last month(P=0.039). However, the frequency of condom use per intercourse with casual sex workers decreased from 47.5% at baseline to 38.7%(P=0.208). The results of both univariate and multivariate logistic regression analysis of unsafe and safe behaviors with casual sexual partners had no statistically significant differences. Conclusion It is imperative to adopt comprehensive sexual health interventions for targeted MMT drug abusers to improve their safety of sexual behaviors.
引文
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[7] 朱军红,钟宝亮,徐丽娟,等.美沙酮维持治疗男性海洛因依赖患者的性生活满意度相关因素研究[J].中国男科学杂志,2015,29(12):37-41.
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[11] A Pacheco Palha,M.Esteves.A Study of the Sexuality of Opiate Addicts[J].J Sex Marital Ther,2002,28(5):427-437.
[12] Hallinan R,Byrne AK,Mcmahon C,et al.Hypogonadism in men receiving methadone and buprenorphine maintenance treatment[J].International Journal of Andrology,2009,32(2):131-139.
[13] 艾孜买提·沙力,李凡,再依努尔·阿不都外力,等.180例美沙酮维持治疗的维吾尔族男性性功能状况调查[Z].疾病预防控制通报,2012.
[14] 廖艳研,蒋俊俊,韦所苏,等.广西男性吸毒人群吸毒前后性行为改变及其影响因素[J].中华疾病控制杂志,2012,16(12):1032-1035.
[15] 聂沛沛,朵林,李洪,等.美沙酮门诊HIV阳性服药者的阴性配偶高危性行为的调查分析[J].中国艾滋病性病,2013,19(9):670-672.
[16] 杨放,林鹏,何群,等.美沙酮维持治疗患者脱失情况影响因素的Logistic分析[J].中国艾滋病性病,2011,17(5):543-546.
[17] 王丽,黄海东.影响门诊患者美沙酮维持治疗效果的危险因素分析[J].中国初级卫生保健,2018,32(4):59-60.
[18] Fischer B,Cruz MF,Patra J,et al.Predictors of methadone maintenance treatment utilization in a multisite cohort of illicit opioid users (OPICAN)[J].Journal of Substance Abuse Treatment,2008,34(3):340-346.
[19] 赵宇腾,徐慧芳,胡文生,等.广州市首批社区美沙酮维持治疗门诊病例脱失的影响因素[J].中国艾滋病性病,2012,18(2):89-91.
[20] 中国疾病预防控制中心性病艾滋病预防控制中心性病控制中心.2018年5月全国艾滋病性病疫情[J].中国艾滋病性病,2018,24(7):645.
[21] 陈国惠.美沙酮维持治疗门诊实施健康教育的重要性及必要性[J].中国药物依赖性杂志,2014,23(2):153-155.
[2] Fareed A,Vayalapalli S,Stout S,et al.Effect of methadone maintenance treatment on heroin craving,a literature review[J].Journal of addictive diseases,2010,30(1):27-38.
[3] 张亚海.美沙酮维持治疗门诊考核指标探讨[J].中国药物滥用防治杂志,2015,24(4):210-214.
[4] 毛文飞,周小军,廖清华,等.从患者家属视角探讨江西省美沙酮维持治疗的疗效[J].现代预防医学,2016,43(1):174-177.
[5] 曹晓斌,庞琳,柔克明,等.我国首批1 057名社区美沙酮维持治疗病人5年治疗保持率随访研究[J].中国艾滋病性病,2010,16(3):211-214.
[6] 夏莉,张泉水,黎超雄,等.美沙酮维持治疗对男性下丘脑-垂体-性腺轴功能的影响[J].中国药物依赖性杂志,2015,24(1):23-26.
[7] 朱军红,钟宝亮,徐丽娟,等.美沙酮维持治疗男性海洛因依赖患者的性生活满意度相关因素研究[J].中国男科学杂志,2015,29(12):37-41.
[8] Waruru AK,Nduati R,Tyllesk?r T.Audio computer-assisted self-interviewing (ACASI) may avert socially desirable responses about infant feeding in the context of HIV[J].BMC medical informatics and decision making,2005,5(1):24.
[9] Celani MF,Carani C,Montanini V,et al.Further studies on the effects of heroin addiction on the hypothalamic-Pituitary-Gonadal function in man[J].Pharmacological Research Communications,1984,16(12):1193.
[10] Bawor M,Dennis BB,Samaan MC,et al.Methadone induces testosterone suppression in patients with opioid addiction[J].Scientific Reports,2014,4(4):6189.
[11] A Pacheco Palha,M.Esteves.A Study of the Sexuality of Opiate Addicts[J].J Sex Marital Ther,2002,28(5):427-437.
[12] Hallinan R,Byrne AK,Mcmahon C,et al.Hypogonadism in men receiving methadone and buprenorphine maintenance treatment[J].International Journal of Andrology,2009,32(2):131-139.
[13] 艾孜买提·沙力,李凡,再依努尔·阿不都外力,等.180例美沙酮维持治疗的维吾尔族男性性功能状况调查[Z].疾病预防控制通报,2012.
[14] 廖艳研,蒋俊俊,韦所苏,等.广西男性吸毒人群吸毒前后性行为改变及其影响因素[J].中华疾病控制杂志,2012,16(12):1032-1035.
[15] 聂沛沛,朵林,李洪,等.美沙酮门诊HIV阳性服药者的阴性配偶高危性行为的调查分析[J].中国艾滋病性病,2013,19(9):670-672.
[16] 杨放,林鹏,何群,等.美沙酮维持治疗患者脱失情况影响因素的Logistic分析[J].中国艾滋病性病,2011,17(5):543-546.
[17] 王丽,黄海东.影响门诊患者美沙酮维持治疗效果的危险因素分析[J].中国初级卫生保健,2018,32(4):59-60.
[18] Fischer B,Cruz MF,Patra J,et al.Predictors of methadone maintenance treatment utilization in a multisite cohort of illicit opioid users (OPICAN)[J].Journal of Substance Abuse Treatment,2008,34(3):340-346.
[19] 赵宇腾,徐慧芳,胡文生,等.广州市首批社区美沙酮维持治疗门诊病例脱失的影响因素[J].中国艾滋病性病,2012,18(2):89-91.
[20] 中国疾病预防控制中心性病艾滋病预防控制中心性病控制中心.2018年5月全国艾滋病性病疫情[J].中国艾滋病性病,2018,24(7):645.
[21] 陈国惠.美沙酮维持治疗门诊实施健康教育的重要性及必要性[J].中国药物依赖性杂志,2014,23(2):153-155.