摘要目的 了解2005-2013年云南省大理市HIV阳性美沙酮维持治疗(MMT)人员治疗依从性及其影响因素.方法 从“社区美沙酮信息系统”提取2005年11月19日至2013年4月30日大理市MMT门诊治疗人员一般人口学信息、既往毒品滥用行为、参加MMT情况及抗病毒治疗开始时间等信息.利用服药记录计算MMT依从性,运用多因素非条件logistic回归模型分析其影响因素.结果 480名研究对象的MMT依从性为58.11％.多因素分析结果显示,参加抗病毒治疗(OR=1.52,95％CI:1.03 ～ 2.24)、就业(OR=1.69,95％CI:1.11 ～ 2.56)、入组前有强制戒毒经历(OR=1.78,95％CI:1.04 ～ 3.04)者依从性高(P＜0.05),最近一次尿吗啡检测阳性(OR=0.38,95％CI:0.24 ～ 0.59)者依从性低(P＜0.05).结论 大理市HIV阳性MMT者治疗依从性较差,应提高无业、近期尿吗啡检测阳性、入组前未强制戒毒患者的MMT依从性.

abstractsObjective To describe the adherence and related determinants among HIV-positive methadone maintenance treatment (MMT) clients in Dali,Yunnan province from 2005 to 2013.Methods Cases were selected from the "National MMT Information Management System".The main information included demographic,drug abuse behaviors prior to enrollment,MMT treatment and highly active antiretroviral therapy (HAART).Detailed medication records were collected to calculate the adherence to MMT.Multivariate unconditional logistic regression was conducted to analyze the impact factors of adherence.Results The MMT adherence rate of 480 subjects is 58.11％.Data from the multivariate unconditional logistic regression indicated that among those HIV-positive MMT clients that on HAART program (OR=1.52,95％ CI:1.03-2.24),related factors as:having stable job (OR=1.69,95％ CI:1.11-2.56),having compulsory history prior to enrollment in MMT (OR=1.78,95％ CI:1.04-3.04) were likely to have higher rate on MMT adherence,whereas clients who showed positive result in the last urine morphine test (OR=0.38,95％ CI:0.24-0.59) were associated with lower rate on MMT adherence.Conclusion In order to improve the rate of adherence to MMT among those HIV-positive MMT clients,the coverage of HAART needed to be expanded and new approaches in combining MMT and HAART developed.Education and intervention efforts should be focused on clients who currently were jobless,those with last urine morphine testing as positive or had never received compulsory treatment.