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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Veröffentlicht in:The International journal of drug policy 2016-04, Vol.30, p.74-81
Hauptverfasser: Ubuguyu, Omary, Tran, Olivia C, Bruce, R. Douglas, Masao, Frank, Nyandindi, Cassian, Sabuni, Norman, McCurdy, Sheryl, Mbwambo, Jessie, Lambdin, Barrot H
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container_end_page 81
container_issue
container_start_page 74
container_title The International journal of drug policy
container_volume 30
creator Ubuguyu, Omary
Tran, Olivia C
Bruce, R. Douglas
Masao, Frank
Nyandindi, Cassian
Sabuni, Norman
McCurdy, Sheryl
Mbwambo, Jessie
Lambdin, Barrot H
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 &lt; 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 &amp; 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 &lt; 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 &amp; 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 &amp; 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 &amp; 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 &lt; 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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source Applied Social Sciences Index & Abstracts (ASSIA); MEDLINE; Elsevier ScienceDirect Journals Complete; PAIS Index
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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