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...
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description | 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 45 mg (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. Discussion 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. |
doi_str_mv | 10.1016/j.drugpo.2016.03.005 |
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Douglas ; Masao, Frank ; Nyandindi, Cassian ; Sabuni, Norman ; McCurdy, Sheryl ; Mbwambo, Jessie ; Lambdin, Barrot H</creator><creatorcontrib>Ubuguyu, Omary ; Tran, Olivia C ; Bruce, R. Douglas ; Masao, Frank ; Nyandindi, Cassian ; Sabuni, Norman ; McCurdy, Sheryl ; Mbwambo, Jessie ; Lambdin, Barrot H</creatorcontrib><description>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 45 mg (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. Discussion 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.</description><identifier>ISSN: 0955-3959</identifier><identifier>EISSN: 1873-4758</identifier><identifier>DOI: 10.1016/j.drugpo.2016.03.005</identifier><identifier>PMID: 27017376</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adult ; Change agents ; Clients ; Cocaine ; Cognition ; Cohort Studies ; Disease transmission ; Dosage ; Dose-Response Relationship, Drug ; Drug addiction ; Drug policy ; Drug use ; Drugs ; Epidemics ; Harm reduction ; Health behavior ; Health needs ; Health status ; Heroin ; Heroin Dependence - rehabilitation ; HIV ; HIV Infections - epidemiology ; Human immunodeficiency virus ; Humans ; Implementation science ; Infections ; Internal Medicine ; Intravenous drug addicts ; Linear Models ; Male ; Medical Education ; Mental health ; Mental health services ; Methadone ; Methadone - administration & dosage ; Middle Aged ; Opiate Substitution Treatment - methods ; Quality of care ; Quality of Life ; Regression analysis ; Retention ; Retrospective Studies ; Risk ; Risk behavior ; Risk-Taking ; Services ; Short term ; Social services delivery ; Substance abuse ; Substance abuse treatment ; Substance Abuse, Intravenous - rehabilitation ; Suicidal ideation ; Suicide ; Tanzania ; Tanzania - epidemiology ; Treatment programs ; Young Adult</subject><ispartof>The International journal of drug policy, 2016-04, Vol.30, p.74-81</ispartof><rights>2016 Elsevier B.V.</rights><rights>Copyright © 2016 Elsevier B.V. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Apr 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c546t-706fee83ba8f9472990c79440fee45ef049ddef3a0acb45be71e46bec571dd343</citedby><cites>FETCH-LOGICAL-c546t-706fee83ba8f9472990c79440fee45ef049ddef3a0acb45be71e46bec571dd343</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0955395916300652$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27843,27901,27902,30976,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27017376$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ubuguyu, Omary</creatorcontrib><creatorcontrib>Tran, Olivia C</creatorcontrib><creatorcontrib>Bruce, R. Douglas</creatorcontrib><creatorcontrib>Masao, Frank</creatorcontrib><creatorcontrib>Nyandindi, Cassian</creatorcontrib><creatorcontrib>Sabuni, Norman</creatorcontrib><creatorcontrib>McCurdy, Sheryl</creatorcontrib><creatorcontrib>Mbwambo, Jessie</creatorcontrib><creatorcontrib>Lambdin, Barrot H</creatorcontrib><title>Improvements in Health-related Quality of Life among Methadone Maintenance Clients in Dar es Salaam, Tanzania</title><title>The International journal of drug policy</title><addtitle>Int J Drug Policy</addtitle><description>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 45 mg (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. Discussion 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.</description><subject>Adult</subject><subject>Change agents</subject><subject>Clients</subject><subject>Cocaine</subject><subject>Cognition</subject><subject>Cohort Studies</subject><subject>Disease transmission</subject><subject>Dosage</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug addiction</subject><subject>Drug policy</subject><subject>Drug use</subject><subject>Drugs</subject><subject>Epidemics</subject><subject>Harm reduction</subject><subject>Health behavior</subject><subject>Health needs</subject><subject>Health status</subject><subject>Heroin</subject><subject>Heroin Dependence - rehabilitation</subject><subject>HIV</subject><subject>HIV Infections - epidemiology</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Implementation science</subject><subject>Infections</subject><subject>Internal Medicine</subject><subject>Intravenous drug addicts</subject><subject>Linear Models</subject><subject>Male</subject><subject>Medical Education</subject><subject>Mental health</subject><subject>Mental health services</subject><subject>Methadone</subject><subject>Methadone - administration & dosage</subject><subject>Middle Aged</subject><subject>Opiate Substitution Treatment - methods</subject><subject>Quality of care</subject><subject>Quality of Life</subject><subject>Regression analysis</subject><subject>Retention</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Risk behavior</subject><subject>Risk-Taking</subject><subject>Services</subject><subject>Short term</subject><subject>Social services delivery</subject><subject>Substance abuse</subject><subject>Substance abuse treatment</subject><subject>Substance Abuse, Intravenous - rehabilitation</subject><subject>Suicidal ideation</subject><subject>Suicide</subject><subject>Tanzania</subject><subject>Tanzania - epidemiology</subject><subject>Treatment programs</subject><subject>Young Adult</subject><issn>0955-3959</issn><issn>1873-4758</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>7TQ</sourceid><recordid>eNqFkktvEzEUhUcIREvhHyBkiQ0LJthjezyzQULh0UqpEGpZWzeeO4mDx07tmUjh1-MofUA3rCzb5x7f4-8WxWtGZ4yy-sNm1sVptQ2zKu9mlM8olU-KU9YoXgolm6fFKW2lLHkr25PiRUobSqlggj0vTipFmeKqPi2Gi2Ebww4H9GMi1pNzBDeuy4gORuzIjwmcHfck9GRheyQwBL8ilziuoQseySVYP6IHb5DMnb1z-QyRYCJX4ACG9-Qa_G_wFl4Wz3pwCV_drmfFz69frufn5eL7t4v5p0VppKjHUtG6R2z4Epq-FapqW2pUKwTNp0JiT0XbddhzoGCWQi5RMRT1Eo1UrOu44GfFx6PvdloO2JncVgSnt9EOEPc6gNX_3ni71quw06KpWsFVNnh3axDDzYRp1INNBp0Dj2FKmqmGNozXQmbp20fSTZiiz_EOqjoHklWVVeKoMjGkFLG_b4ZRfeCpN_rIUx94asp15pnL3vwd5L7oDuBDUszfubMYdTKZgsHORjSj7oL93wuPDYyz3hpwv3CP6SGLTpWm-uowU4eRYjWnNEfjfwAemcnA</recordid><startdate>20160401</startdate><enddate>20160401</enddate><creator>Ubuguyu, Omary</creator><creator>Tran, Olivia C</creator><creator>Bruce, R. Douglas</creator><creator>Masao, Frank</creator><creator>Nyandindi, Cassian</creator><creator>Sabuni, Norman</creator><creator>McCurdy, Sheryl</creator><creator>Mbwambo, Jessie</creator><creator>Lambdin, Barrot H</creator><general>Elsevier B.V</general><general>Elsevier Science Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7TQ</scope><scope>8BJ</scope><scope>DHY</scope><scope>DON</scope><scope>FQK</scope><scope>JBE</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160401</creationdate><title>Improvements in Health-related Quality of Life among Methadone Maintenance Clients in Dar es Salaam, Tanzania</title><author>Ubuguyu, Omary ; Tran, Olivia C ; Bruce, R. Douglas ; Masao, Frank ; Nyandindi, Cassian ; Sabuni, Norman ; McCurdy, Sheryl ; Mbwambo, Jessie ; Lambdin, Barrot H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c546t-706fee83ba8f9472990c79440fee45ef049ddef3a0acb45be71e46bec571dd343</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Change agents</topic><topic>Clients</topic><topic>Cocaine</topic><topic>Cognition</topic><topic>Cohort Studies</topic><topic>Disease transmission</topic><topic>Dosage</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug addiction</topic><topic>Drug policy</topic><topic>Drug use</topic><topic>Drugs</topic><topic>Epidemics</topic><topic>Harm reduction</topic><topic>Health behavior</topic><topic>Health needs</topic><topic>Health status</topic><topic>Heroin</topic><topic>Heroin Dependence - rehabilitation</topic><topic>HIV</topic><topic>HIV Infections - epidemiology</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Implementation science</topic><topic>Infections</topic><topic>Internal Medicine</topic><topic>Intravenous drug addicts</topic><topic>Linear Models</topic><topic>Male</topic><topic>Medical Education</topic><topic>Mental health</topic><topic>Mental health services</topic><topic>Methadone</topic><topic>Methadone - administration & dosage</topic><topic>Middle Aged</topic><topic>Opiate Substitution Treatment - methods</topic><topic>Quality of care</topic><topic>Quality of Life</topic><topic>Regression analysis</topic><topic>Retention</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>Risk behavior</topic><topic>Risk-Taking</topic><topic>Services</topic><topic>Short term</topic><topic>Social services delivery</topic><topic>Substance abuse</topic><topic>Substance abuse treatment</topic><topic>Substance Abuse, Intravenous - rehabilitation</topic><topic>Suicidal ideation</topic><topic>Suicide</topic><topic>Tanzania</topic><topic>Tanzania - epidemiology</topic><topic>Treatment programs</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ubuguyu, Omary</creatorcontrib><creatorcontrib>Tran, Olivia C</creatorcontrib><creatorcontrib>Bruce, R. Douglas</creatorcontrib><creatorcontrib>Masao, Frank</creatorcontrib><creatorcontrib>Nyandindi, Cassian</creatorcontrib><creatorcontrib>Sabuni, Norman</creatorcontrib><creatorcontrib>McCurdy, Sheryl</creatorcontrib><creatorcontrib>Mbwambo, Jessie</creatorcontrib><creatorcontrib>Lambdin, Barrot H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>PAIS Index</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The International journal of drug policy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ubuguyu, Omary</au><au>Tran, Olivia C</au><au>Bruce, R. Douglas</au><au>Masao, Frank</au><au>Nyandindi, Cassian</au><au>Sabuni, Norman</au><au>McCurdy, Sheryl</au><au>Mbwambo, Jessie</au><au>Lambdin, Barrot H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improvements in Health-related Quality of Life among Methadone Maintenance Clients in Dar es Salaam, Tanzania</atitle><jtitle>The International journal of drug policy</jtitle><addtitle>Int J Drug Policy</addtitle><date>2016-04-01</date><risdate>2016</risdate><volume>30</volume><spage>74</spage><epage>81</epage><pages>74-81</pages><issn>0955-3959</issn><eissn>1873-4758</eissn><abstract>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 45 mg (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. Discussion 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.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>27017376</pmid><doi>10.1016/j.drugpo.2016.03.005</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adult Change agents Clients Cocaine Cognition Cohort Studies Disease transmission Dosage Dose-Response Relationship, Drug Drug addiction Drug policy Drug use Drugs Epidemics Harm reduction Health behavior Health needs Health status Heroin Heroin Dependence - rehabilitation HIV HIV Infections - epidemiology Human immunodeficiency virus Humans Implementation science Infections Internal Medicine Intravenous drug addicts Linear Models Male Medical Education Mental health Mental health services Methadone Methadone - administration & dosage Middle Aged Opiate Substitution Treatment - methods Quality of care Quality of Life Regression analysis Retention Retrospective Studies Risk Risk behavior Risk-Taking Services Short term Social services delivery Substance abuse Substance abuse treatment Substance Abuse, Intravenous - rehabilitation Suicidal ideation Suicide Tanzania Tanzania - epidemiology Treatment programs Young Adult |
title | Improvements in Health-related Quality of Life among Methadone Maintenance Clients in Dar es Salaam, Tanzania |
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