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Substance Abuse Treatment, Prevention, and Policy
Published in: Substance Abuse Treatment, Prevention, and Policy 1/2018

Open Access 01-12-2018 | Research

Strategies to control HIV and HCV in methadone maintenance treatment in Guangdong Province, China: a system dynamic modeling study

Authors: Xia Zou, Yong Xu, Wen Chen, Yinghua Xia, Yin Liu, Cheng Gong, Li Ling

Published in: Substance Abuse Treatment, Prevention, and Policy | Issue 1/2018

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Abstract

Background

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections among methadone maintenance treatment (MMT) participants remain high. Optimized HIV and HCV prevention strategies for MMT clinics in resource-limited regions are urgently needed. This study aims to develop an MMT system dynamic model (SDM) to compare and optimize HIV and HCV control strategies in the MMT system.

Methods

We developed an MMT-SDM structure based on literature reviews. Model parameters were estimated from a cohort study, cross-sectional surveys and literature reviews. We further calibrated model outputs to historical data of HIV and HCV prevalence among MMT participants in 13 MMT clinics of Guangdong Province. Lastly, we simulated the impact of integrated interventions on HIV and HCV incidence among MMT participants using the MMT-SDM.

Results

The MMT-SDM comprises MMT clinics, MMT participants, detoxification centers, and HIV and HCV transmission, testing and treatment systems. We determined that condom promotion was the most effective way to reduce HIV infection (2013-2020: 2.86% to 1.76%) in MMT setting, followed by needle exchange program (2013-2020: 2.86% to 2.56%), psychological counseling (2013-2020: 2.86% to 2.71%) and contingency management (2013-2020: 2.86% to 2.72%). Health education had marginal impact on reducing HIV incidence among MMT participants (2013-2020:2.86% to 2.84%) from 2013 to 2020. By contrast, psychological counseling (2013-2020: 7.54% to 2.42%) and contingency management (2013-2020: 7.54% to 2.96%) had been shown to be the most effective interventions to reduce HCV incidence among MMT participants, followed by needle exchange program (2013-2020: 7.54% to 5.76%), health education (2013-2020: 7.54% to 6.35%), and condom promotion program (2013-2020: 7.54% to 6.40%). Notably, HCV treatment reduced HCV incidence by 0.32% (2013-2020: 7.54% to 7.22%).

Conclusions

In conclusion, we generated a valuable system dynamic model to analyze the Chinese MMT system and to guide the decision-making process to further improve this system. This study underscores the importance of promoting condom use in MMT clinics and integrating psychosocial interventions to reduce HIV and HCV infections in MMT clinics in China.
Appendix
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Literature
1.
Degenhardt L, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health. 2017;5(12):e1192–207.CrossRefPubMedPubMedCentral
2.
United Nation Office on Drugs and Crime (UNODC). World Drug Report. New York: United Nation; 2016.
3.
Aceijas C, Rhodes T. Global estimates of prevalence of HCV infection among injecting drug users. Int J Drug Policy. 2007;18(5):352–8.CrossRefPubMed
4.
Nelson PK, et al. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet. 2011;378(9791):571–83.CrossRefPubMedPubMedCentral
5.
Office, N.N.C., 2017 National Narcotics Control Report. Beijing: National Narcotics Control Office; 2017.
6.
Hser Y-I, et al. Drug abuse, HIV, and HCV in Asian countries. J NeuroImmune Pharmacol. 2016;11(3):383–93.CrossRefPubMed
7.
China, H.a.F.P.C.o.t.P.s.R.o., Progress report on the prevention and control of HIV/AIDS. 2015.
8.
Zhang L, et al. Methadone maintenance treatment participant retention and behavioural effectiveness in China: a systematic review and meta-analysis. PLoS One. 2013;8(7):e68906.CrossRefPubMedPubMedCentral
9.
Zaller N, et al. Geographic variability in HIV and injection drug use in Ukraine: implications for integration and expansion of drug treatment and HIV care. Int J Drug Policy. 2015;26(1):37–42.CrossRefPubMed
10.
Zou X, Ling L, Zhang L. Trends and risk factors for HIV, HCV and syphilis seroconversion among drug users in a methadone maintenance treatment programme in China: a 7-year retrospective cohort study. BMJ Open. 2015;5(8):e008162.CrossRefPubMedPubMedCentral
11.
12.
Lin P, et al. Evaluation of a pilot study on needle and syringe exchange program among injecting drug users in a community in Guangdong, China. Zhonghua Yu Fang Yi Xue Za Zhi. 2004;38(5):305–8.PubMed
13.
14.
Ruan Y, et al. Evaluation of harm reduction programs on seroincidence of HIV, hepatitis B and C, and syphilis among intravenous drug users in southwest China. Sex Transm Dis. 2013;40(4):323–8.CrossRefPubMed
15.
Mathers BM, et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet. 2010;375(9719):1014–28.CrossRefPubMed
16.
Johnson LF, White PJ. A review of mathematical models of HIV/AIDS interventions and their implications for policy. Sex Transm Infect. 2011;87(7):629–34.CrossRefPubMed
17.
Chatterjee A, Guedj J, Perelson AS. Mathematical modelling of HCV infection: what can it teach us in the era of direct-acting antiviral agents? Antivir Ther. 2012;17(6 Pt B):1171–82.CrossRefPubMedPubMedCentral
18.
Merrill JA, et al. A system dynamics evaluation model: implementation of health information exchange for public health reporting. J Am Med Inform Assoc. 2013;20(e1):e131–8.CrossRefPubMedPubMedCentral
19.
20.
Dangerfield BC, Fang Y, Roberts CA. Model-based scenarios for the epidemiology of HIV/AIDS: the consequences of highly active antiretroviral therapy. Syst Dyn Rev. 2001;17(2):119–50.CrossRef
21.
Qu W, Symalla D, Barney GO. The HIV/AIDS sector in THRESHOLD 21 Malawi. In: The international conference-system dynamics society; 1998. p. 68.
22.
Weeks MR, et al. Multilevel dynamic systems affecting introduction of HIV/STI prevention innovations among Chinese women in sex work establishments. Health Educ Behav. 2013;40(1 Suppl):111s–22s.CrossRefPubMedPubMedCentral
23.
Miller RL, et al. A dynamic model of client recruitment and retention in community-based HIV prevention programs. Health Promot Pract. 2011;12(1):135–46.CrossRefPubMed
24.
Zhang L, et al. Investigation of repeat client drop-out and re-enrolment cycles in fourteen methadone maintenance treatment clinics in Guangdong, China. PLoS One. 2015;10(10):e0139942.CrossRefPubMedPubMedCentral
25.
Meng J, Burris S. The role of the Chinese police in methadone maintenance therapy: a literature review. Int J Drug Policy. 2013;24(6):e25–34.CrossRefPubMed
26.
Zhao Y, et al. Predictors of accessing antiretroviral therapy among HIV-positive drug users in China's National Methadone Maintenance Treatment Programme. Addiction. 2015;110:40–50.CrossRefPubMedPubMedCentral
27.
Deng L, et al. How clients’ during-treatment motivations relate to their perceptions and impressions of methadone maintenance treatment: a multilevel analysis of a cross-sectional survey in Guangdong Province, China. Drug Alcohol Depend. 2016;164(Supplement C):151–7.CrossRefPubMed
28.
Liu Y, et al. Trends and factors in human immunodeficiency virus and/or hepatitis C virus testing and infection among injection drug users newly entering methadone maintenance treatment in Guangdong province, China: 2006-2013: a consecutive, cross-sectional study. BMJ Open. 2017;7(7):e015524.
29.
Sindelar JL, Olmstead TA, Peirce JM. Cost-effectiveness of prize-based contingency management in methadone maintenance treatment programs. Addiction. 2007;102(9):1463–71.CrossRefPubMedPubMedCentral
30.
Hser YI, et al. Effects of a randomized contingency management intervention on opiate abstinence and retention in methadone maintenance treatment in China. Addiction. 2011;106(10):1801–9.CrossRefPubMedPubMedCentral
31.
Jiang H, et al. Efficacy of contingency management in improving retention and compliance to methadone maintenance treatment: a random controlled study. Shanghai Arch Psychiatry. 2012;24(1):11–9.PubMedPubMedCentral
32.
Kidorf M, et al. Reinforcing integrated psychiatric service attendance in an opioid-agonist program: a randomized and controlled trial. Drug Alcohol Depend. 2013;133(1):30–6.CrossRefPubMedPubMedCentral
33.
Chen W. Effectiveness and health economics evaluation on psychosocial and behavioral intervention among community-based methadone maintenance treatment. In: School of public health. Guangzhou: Sun Yat-sen University; 2013.
34.
Petry NM, et al. Prize-based contingency management does not increase gambling. Drug Alcohol Depend. 2006;83(3):269–73.CrossRefPubMed
35.
Gu J, et al. Misconceptions predict dropout and poor adherence prospectively among newly admitted first-time methadone maintenance treatment clients in Guangzhou, China. Addiction. 2012;107(9):1641–9.CrossRefPubMed
36.
Blaser N, et al. Impact of viral load and the duration of primary infection on HIV transmission: systematic review and meta-analysis. AIDS. 2014;28(7):1021–9.CrossRefPubMedPubMedCentral
37.
Valerio H, et al. Evidence of continued injecting drug use after attaining sustained treatment-induced clearance of the hepatitis C virus: implications for reinfection. Drug Alcohol Depend. 2015;154:125–31.CrossRefPubMed
38.
Alam-Mehrjerdi Z, et al. Willingness to receive treatment for hepatitis C among injecting drug users on methadone program: implications for education and treatment. Addict Health. 2016;8(2):90–7.PubMedPubMedCentral
39.
Chu CE, et al. Hepatitis C virus treatment access among human immunodeficiency virus and hepatitis C virus (HCV)-Coinfected people who inject drugs in Guangzhou, China: implications for HCV treatment expansion. Open Forum Infect Dis. 2016;3(2):ofw065.CrossRefPubMedPubMedCentral
40.
Organization, C.D.T. Registration and Information Publicity Platform of China Drug Clinical Trials. 2016 [cited 2016 December 13]; Available from: http://​www.​chinadrugtrials.​org.​cn/​eap/​clinicaltrials.​searchlist?​a=​a&​keywords=​丙肝.​ Accessed 13 Dec 2016.
41.
Jamieson, Beals, and Lalonde, Best Practices: Methadone Maintenance Treatment. Ottawa, Ontario: Office of Canada's Drug Strategy Health Canada; 2002.
Metadata
Title
Strategies to control HIV and HCV in methadone maintenance treatment in Guangdong Province, China: a system dynamic modeling study
Authors
Xia Zou
Yong Xu
Wen Chen
Yinghua Xia
Yin Liu
Cheng Gong
Li Ling
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Substance Abuse Treatment, Prevention, and Policy / Issue 1/2018
Electronic ISSN: 1747-597X
DOI
https://doi.org/10.1186/s13011-017-0140-3

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